Blepharoplasty involves cutting out excess skin (and sometimes fat and muscle as well) from either the upper or lower eyelids to reduce the appearance of heavy and droopy eyelids. This operation can significantly rejuvenate the eye and periorbital (around the eyes) area, and "open up" the eye, so more of the iris shows. It usually results in eyes that appear younger and more rested. As we age, the muscles and skin of the lid and other eye-related structures droop, causing heavy, redundant lids, bags under the eyes and a "hound-dog" look. Not only the eyes, but the forehead and brow can also descend and add to the overall undesirable effect. In these cases, lid surgery alone may not be enough, but can be combined with forehead and brow lifts. Upper blepharoplasty is very effective in eliminating the extra skin and giving the eyes a fresher and more pleasing appearance. For patients who have puffy bags under their eyes, a lower blepharoplasty may be appropriate. Since this surgery has more potential complications than the upper, the surgical planning and approach are slightly different, see below. Often, the two procedures are done together. Surgery-Upper blepharoplasty 
A simple incision is made in the lid, and excess skin (and fat and muscle, if necessary) are removed. The incision is then closed. The resultant scar is usually only minimal, well hidden in the natural creases of the eyelid. Surgery-Lower blepharoplasty The approach to lower blepharoplasty is somewhat different than upper. It is generally more prone to problems, especially if too much skin is removed. Excessive resection here can lead to ectropion (eversion, or outward turning, of the lower lid) which gives a tired and sometimes "clownish" look, and can result in dry eyes. Also, lagophthalmos (inability to completely close the lids) can occur. For these reasons, skin and muscle resection, if done at all, is very conservative. Our usual approach is to do a simple transconjunctival removal of herniated fat (removing the excess fat from under the lid that causes bags through an incision on the inside surface of the lower lid) and a "pinch resection", meaning that only as much extra tissue as can be pinched with forceps (without distorting the anatomy of the eye) is removed. Both these operations are simple, and is usually done under local anesthesia (numbing of the eyelids) along with sedation. Although bruising and swelling are quite common after this surgery, recovery is usually rapid and pain is minimal. We use fast-dissolving sutures, so there is no need to return for suture removal. | 
