One would think that surgery in an area as small as the eyelid region is an uncommon procedure, but the truth is that about 100,000 eyelid surgeries, or blepharoplasties, are conducted every year in the United States alone. Just as the eyes are the windows to the soul and one of the most prominent features of a person’s face, the eyelids immediately draw attention to themselves from their mere placement, and as such, are often the target of aesthetic enhancement. What makeup cannot fix, it is hoped that surgery can correct. Most people undergo a blepharoplasty to restore a youthful and vibrant look to their eyes, as sagging or droopy eyelids give the impression of fatigue or sleepiness.

The process is not entirely for cosmetic reasons, however. Sometimes, particularly in older individuals, sagging of the eyelids may actually affect one’s vision, as the excess skin blocks peripheral acuity and prevents a person from performing activities such as driving and engaging in various sports. As such, a blepharoplasty may be recommended for functional adjustment.

As a procedure, a blepharoplasty involves the reduction of excess skin and fat deposits in the eyelids, and the tightening of the eyelid muscles. First, a local anesthetic is injected in the area, and a sedative may also be administered intravenously. External incisions are made along the natural lines of the eyelid, such as below one’s eyelashes or above the regular creases of the eyelid, to conceal scarring that may result from the surgery. A tiny, crescent-shaped portion of skin from the eyelid will be removed, and then the surgeon will slowly extract pockets of fat from the incised region. If muscle looseness is a significant concern, the surgeon may also trim muscle tissue or stitch it together. Once these processes are completed, the area is closed with small, fine stitches. The entire operation takes between one to three hours to complete.

In the case of east Asians, about half of whom are born without an upper eyelid crease, a special technique, rather unimaginatively called an Asian blepharoplasty, may be used to create an artificial crease above the eye, most often through the use of partial or full incisions to simulate an eyelid flap.

For patients whose only problem is an excessive accumulation of fat in their eyelids, a transconjunctival blepharoplasty is recommended. Instead of an external incision, a cut is made in the inner eyelid, and the fat deposits removed from there. An advantage of this method is the lack of visible scarring, due to the incision being on the inside of the eyelid. Also, skin resurfacing or chemical peeling may be performed simultaneously on the affected area.

After the surgery, an antibiotic ointment will be applied to the stitched region for a period of several days, and the patient will be asked to take antibiotics several times a day to ward off infection to such a sensitive area. Ice-cold compresses are applied to the treated area to reduce discomfort and to bring down swelling. During the recovery period, patients are expected to abstain from alcohol and aspirin consumption and any physical activity that would place strain on the body. Inflammation and discoloration are normal, and should subside in about a week. The stitches will be removed after two to three days, and the patient may resume normal activity in seven to ten days.

Although a blepharoplasty is a generally safe and simple procedure, there are several complications that patients undergoing eyelid surgery should consider. In some cases where too much skin is removed, a person may have difficulty closing his eyes properly. Some patients develop dry eye syndrome due to the disruption of the eyelid tissue, and will require artificial lubrication through the use of eye drops from that point forward. In rare instances, this may lead to damage of the cornea and loss of vision.