Sometimes referred to as an "eyelid tuck", a blepharoplasty procedure can remove eyelid "bags", wrinkles around the eyelids, hooding of the upper eyelids, or reduce bulging or puffiness of the eyelids.

Generally upper and lower lid blepharoplasties are aimed at reversing the signs of aging. There are some conditions of the eyelids which are not necessarily age related, and are usually inherited. This includes puffy lower lids, which often appear in younger patients without saggy skin and with relatively few wrinkles. There are various techniques of blepharoplasty available, including the use of the laser, which allows for specific problems such as this to be addressed. Once again, it is during the course of your consultation that the type of blepharoplasty that will best meet your goals, will be determined. The effects of the surgery last several years and are sometimes permanent.

If drooping or the hooding of eyelids interferes with visual fields, the costs of surgical correction may be covered by certain health care insurance plans (including the Ontario Health Insurance Plan).

Before Surgery

Some issues considered at the time of your consultation include:

• Your general health, and specifically any eye related medical problems
• Smoking
• The specific area of concern (upper lids, lower lids, hooding, droopiness, bagginess or puffiness of the lids, etc.)
• Associated wrinkles of the eyelid skin or crow's feet area
• Eyelid function (ability to close and open the lids, elasticity of the lids, dry eyes, tearing, etc.)
• The position of your brow line and its contribution to the droopiness of your upper lids

Some conditions may preclude you from having eyelid surgery, or may require certain procedural modifications to ensure that the function of your eyelids is not impaired.

Some of the more common reasons patients seek consultation for eyelid surgery include:

• Looking "tired" all the time
• Eyelid hooding
• Baggy lower or upper lids
• Wrinkling of eyelid skin
• Crows feet
• Puffy lower or upper lids
• Dark circles under the lower lids
• Absent upper eyelid crease (the so-called "Asian" eyelid)
• Drooping upper eyelids (this may be a condition called ptosis and surgical correction may be covered by certain health care plans)

The Surgery

Eyelid surgery is often performed under local anaesthetic with sedation as an outpatient procedure. In certain circumstances it may be performed under a general anaesthetic.

Most commonly, the surgery for both upper an lower eyelids involves the removal of excess bulging fat and excess baggy skin and muscle. For the lower lids, the fat may be removed through an incision on the inside of the eyelid, and the skin may be tightened with a resurfacing laser. The appropriateness of this "transconjunctival" blepharoplasty for the lower lids can only be determined at the time of consultation, including a thorough physical examination. If other modifications to the traditional blepharoplasty are indicated, this will also be determined at the time of consultation.

The surgery may take anywhere from 1 to 3 hours depending on which lids are involved and the complexity of the procedure required.

There are risks and complications with all surgical procedures such as bleeding and infection. Some specific complications related to blepharoplasty include temporary blurring of vision, dry eye, tearing, problems with scar contractions, etc. Permanent complications are extremely rare with cosmetic eyelid surgery. These as well as the other complications specific to eyelid surgery will be discussed at the time of consultation.

After Surgery

1st post-operative visit within 48 hours after surgery:
• to remove dressings, check for bleeding, level of discomfort, to answer any immediate concerns and reiterate washing instructions
• Showering and face washing can begin
1st week after surgery:
* Sutures are removed, itching, pain and swelling reach maximum within three days then begin to subside
* Light sensitivity, tearing and dry or irritated eye sensation persist in the first week
* Resume normal, daily activities including reading, no heavy lifting or working out
10 - 14 days after surgery:
* Return to work, can resume wearing contact lenses, bruising gone, swelling itching and pain significantly reduced
* Patient is "presentable"
* Vigorous activity (exercise, heavy lifting) still restricted
* Dry eye may persist and eye lubricating drops may still be required
3 - 6 weeks after surgery:
* Side effects gone (dry eye, light sensitivity), most swelling gone, resume normal exercising activity, lifting, etc.

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