By Dr. Lawrence Gray

Your eyes are one of your most expressive features. But, sagging skin around the eyes can make you look tired, even angry. My patients want to repair that thin, loose skin around their eyes and to look their best for as long as possible. Blepharoplasty, also known simply as eyelid surgery, reduces under-eye puffiness, removes loose skin, and softens wrinkles, giving you back confidence and extending your youthful look for about 10 years or more.

Sagging eyelids develop as we age. Eyelid surgery removes and tightens this excess eyelid skin for a more alert, youthful appearance. Cosmetic blepharoplasty is a relatively quick and uncomplicated surgery that can be performed under either local or sedation anesthesia.

Bags under the lower eyelids are also a common problem. They are corrected in same way as upper eyelids by removing excess skin and tightening and smoothing the under eye area. Excess fat on the lower eyelids can be removed without using stitches to close the incision so no scars will be visible.

The most common cause of droopy eyelids is normalaging, but there are other causes.
Sun exposure can weaken the elasticity of the skin. One study suggests that sagging eyelids may have a genetic component. Another study suggest that drooping eyelids are most likely to appear in men, people with fair skin, people who smoke and those who are overweight. Light or fair skin color is an additional risk factor. There is thought to be a higher susceptibility to UV-induced damage in lighter skin.

The connective tissue in the skin, including around the eyes, changes due to some or all of these factors. Collagen and elastin fibers are reduced in number and the skin loses its strength and resilience. This process begins at about age 40 or earlier and worsens as you get older. The eyelid skin stretches, muscles weaken and fat pockets become more prominent as they bulge.

Blepharoplasty can be performed on upper eyelids and lower eyelids in separate surgeries or both at the same time. During upper eyelid surgery, an incision is made in the natural fold, in the crease. In lower eyelid surgery an incision is made just beneath the lower lash or just behind the lower eyelid. Incisions are virtually unnoticeable after they have healed. I carefully examine the patients eyelids and make precise markings to designate where excess skin and/ or fat pads need to be removed.

If the patient chooses to have local anesthesia, he or she remains awake during the procedure. The area around the eyes is be numbed. Patients often choose to have eyelid surgery under local anesthesia because it costs less due to the elimination of the need for an anesthesiologist.

If the patient chooses to have Intra-venous (IV) sedation instead, he or she is “asleep” during the procedure and is “woken up” after the procedure is complete. Patients often choose to have IV sedation if they are having a second procedure as well, such as a facelift or breast augmentation.

Smokers are at increased risk of surgical complications because their skin heals more slowly. I advise my patients who smoke to quit smoking for at least several weeks prior to a procedure.

Recovery from eyelid surgery is surprisingly brief. Most patients are up and about sooner than they expect to be. However, I insist that they take 2 or 3 days off to give themselves time to rest and help insure an optimal result. I strongly recommend that they lay down and keep the ice packs on their eyelids as much as possible for 24 to 48 hours. This will help keep the swelling and any possible bruising to a minimum which creates less strain on the stitches and will help them to have a result they will be very happy with. Sutures will be removed about a week after the procedure.

What can you do to prevent sagging eyelids? Maintain a healthy weight. Don’t smoke. Protect your skin from the sun by wearing sunscreen, sunglasses and hat with a brim.

The aging process will continue after eyelid surgery, as with any cosmetic procedure. Your improved appearance after your eyelid lift surgery will not last indefinitely. The good news is that depending upon your health and the care you take in protecting yourself from excess sun exposure, a blepharoplasty can last as ten years or longer. My patients tell me they are very happy with their results and enjoy the frequent compliments on how young they look.

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