Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat - usually along with excess skin and muscle from the upper and lower eyelids.

Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel. It may even interfere with your vision. However, it won't remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage.

Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift, neck lift or browlift.

If you're considering eyelid surgery, this information will give you a basic understanding of the procedure - when it can help, how it is performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and Dr. Freedland. Please ask Dr. Freedland if there is anything about the procedure you do not understand.

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Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Freedland.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery.

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Thousands of these procedures are performed successfully each year. When done by a qualified plastic surgeon, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. Often there is temporary loss of sensation, which may last up to a year after surgery.

You can reduce your risk of complications by closely following Dr. Freedland's instructions before and after the surgery, especially with regard to when and how you should resume physical activity.

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The initial consultation with Dr. Freedland is very important. He will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform Dr. Freedland if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

You should also provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them along.

You and Dr. Freedland should carefully discuss your goals and expectations for this surgery. You'll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate.

Dr. Freedland will explain the techniques and anesthesia he will use, the type of facility where the surgery will be performed, and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery, unless you can prove that drooping upper lids interfere with your vision. Check with your insurer.)

Don't hesitate to ask Dr. Freedland any questions you may have, especially those regarding your expectations and concerns about the results. If you are interested in a Lower Eyelid Lift view Dr. Freedland's before and after photos of his patients.

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Individuals considering blepharoplasty often feel a bit overwhelmed by the number of options and techniques being promoted today. However, Dr. Freedland can help. In deciding which the right treatment approach is for you, Dr. Freedland will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Dr. Freedland also uses this judgment to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

Dr. Freedland's education and training, which he received at the University of Michigan, has helped to form his surgical judgment. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.

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Dr. Freedland will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, Dr. Freedland may have to postpone your surgery.

If you smoke, plan to quit at least two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before surgery and do not go on a stringent diet, as both can inhibit your ability to heal. Though it is rarely necessary, Dr. Freedland may recommend that you have blood drawn ahead of time in case it is needed during surgery.

Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

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Eyelid surgery may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. Dr. Freedland feels a hospital provides the safest environment for your surgery and therefore performs almost all of his procedures at a JCAHO accredited hospital. The surgery is usually done on an outpatient basis; rarely does it require an inpatient stay.

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Eyelid surgery can be performed under local anesthesia - which numbs the area around your eyes - along with oral or intravenous sedatives. Because you are awake during the surgery you may feel some tugging or occasional discomfort. For this reason, Dr. Freedland prefers to use general anesthesia. This assures that you will sleep through the operation and be assured the maximal amount of comfort.

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Blepharoplasty usually takes one to two hours, depending on the extent of the surgery. If you're having all four eyelids done, Dr. Freedland will probably work on the upper lids first, then the lower ones.

In a typical procedure, Dr. Freedland makes incisions following the natural lines of your eyelids - in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, Dr. Freedland separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle.

The incisions are then closed with very fine sutures.

If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, Dr. Freedland may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.

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After surgery, Dr. Freedland will probably lubricate your eyes with ointment, but will most likely not apply a bandage. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by him. If you feel any severe pain, you can call Dr. Freedland immediately.

Dr. Freedland will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two to four weeks.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Occasionally, Dr. Freedland recommends eye drops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

Dr. Freedland will follow your progress very closely for the first week or two. The stitches will be removed two to seven days after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.

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You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in seven to ten days. By then, depending on your rate of healing and Dr. Freedland's instructions, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sun block made for eyelids when you go out.

Dr. Freedland will probably tell you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about two weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention. Dr. Freedland can instruct you on skin care products that can help make your scars less visible.

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Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line.

On the other hand, the positive results of your eyelid surgery - the more alert and youthful look - will last for years. For many people, these results are permanent.

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