It has been said that the eyes are the mirror of the soul, and many studies have confirmed that the eyes and central face are the places that our eyes are first drawn to when we look at someone's face. Sagging skin of the upper eyelids, and bags and wrinkles beneath the lower eyelids contribute more to the "tired" appearance than any other area of facial aging.

The bags under the eyes are actually fat bulges that are made to appear worse by sagging of the cheek tissue. This is often an inherited condition, and can occur relatively early in life. Some people experience periodic swelling of the lids due to allergies or other medical conditions, and surgery will generally not help problems with periodic swelling, but can help bags and wrinkles.

Several factors account for the excess skin of the upper lids. The eyebrows are typically the first part of the face to sag, and their downward drift contributes to the excess skin of the upper lids. Actual excess skin can accumulate due to the effects of gravity and reduced skin elasticity. This may become significant enough to droop over the eyelashes and cause obstruction of the visual field. In many instances, upper and lower eyelid problems are corrected at the same time, but either can be performed alone.

When thinking about surgery to rejuvenate the eyes, one may want to consider the area surrounding the eyes. As mentioned above, both the brow and cheek play a significant role in the appearance of the eyelids so these areas may need to be addressed in order to achieve the best results possible. Patients undergoing the facelift procedure will usually be good candidates for eyelid surgery, browlift or midface rejuvenation as well.

Cosmetic surgery of the eyelids is called blepharoplasty. Upper lid blepharoplasty alone may be carried out in the office at the Face and Skin Center under local anesthesia, resulting in considerable cost savings. Browlifting, facelifting and lower eyelid surgery are performed in the outpatient operating room at the Day Surgery Center at University Hospital. Affordable prearranged package prices are available. Consultation with Dr. Jordan will help you decide what you can do to help with your concerns over facial aging.

How is the procedure performed?

Intravenous sedation, otherwise known as "twilight anesthesia" is usually sufficient for the procedure, and the patient is discharged home after recovering. The surgery is performed by making an incision along the skin creases of the upper eyelid, and then excising excess skin. Any prominent fat bulges will also be removed at this time, but this is a lesser problem than in the lower eyelid. The skin is then closed with a single suture underneath the skin that barely leaves a visible scar once healed.

The lower lids can be handled in several ways. In most individuals, the incision is made in a skin crease just below the lower eyelashes. The fat bulges are removed or relocated, and any excess skin is excised. Suturing is done with dissolving sutures. In some people, mainly younger individuals, the main problem is fat bulges and not excess skin. These patients may be candidates for "invisible incision" eyelid surgery. This is where the fat is approached from the inside surface of the eyelid, and no incision has to be made on the outside skin.

It is important to understand that the purpose of the procedures is to remove excess and bagging skin and fat, and not to remove all the wrinkles and "crow's feet" around the eyelids. Both of these will be improved by the surgery, but neither will be completely removed. In addition, it is impossible and unnatural to eradicate all the wrinkles that appear with smiling and laughter. The best treatment for crow's feet is a neurotoxin such as Botox™, Dysport™or Xeomin™, and a chemical peel or laser resurfacing will help the fine wrinkling. These procedures can be discussed at the consultation.

How long will the recovery period be?

The first evening should be spent in bed or a recliner with the head elevated. Ice cold compresses should be used to reduce swelling for the first three days. You can be up and about the next day, but with only a light activity level. Discomfort is usually very minimal with this procedure. The vision will be slightly blurred for several days, and therefore, driving a car or other activity requiring good vision is prohibited for seven days. The incisions should be cleaned with hydrogen peroxide and Q-tips on a regular basis. The eyelids will be swollen and bruised for seven to ten days, but will usually be easily covered with make-up at eight days, and oversized sunglasses will disguise the area quite well. In general, the incisions heal very rapidly, and are difficult to see in four weeks. Most patients can go back to work at seven days with some makeup to cover any remaining bruises. Contact lenses should not be worn for ten days, and the eyebrows and lashes must not be tweezed for the same period.

What are the possible complications?

These procedures are usually very well tolerated and safe. Patients with any pre-existing eye problems should inform the physician at the time of the initial consultation. An examination by an eye specialist is recommended for all patients prior to surgery. If you do not have one already, we can make recommendations. Those patients with existing dry eyes will often find that this condition is temporarily worsened after eyelid surgery. This is usually readily treated with moisturizing eye drops. Bleeding behind the eyeball is very rare with these operations, but is potentially damaging to the vision, and for this reason, medicines containing aspirin and other blood thinners must not be taken for two weeks prior to surgery. Any medications that you are taking should be reported to your physician at the time of the consultation. If instructions are followed, the healing period is usually very short and problem free.