Whether a face looks fresh and young is partly determined by eyelids. If they become saggy wrinkled and puffy, the overall impression is that of a tired and aged person. Ageing also makes eyes look smaller. Blepharoplasty is the name for an operation that reshapes eyelids, by removing redundant skin, some wrinkles and puffiness. It also returns to the upper eyelid, its natural fold that may have been obscured by redundant skin.

The surgery is usually carried out under general anaesthesia, although it may be done under local anaesthesia and sedation. There is usually no requirement to stay in hospital overnight, and the majority of patients leave hospital the same day. It is a relatively painless operation but rest is required for several days and bruising will persist for 10 to 14 days.

For upper eyelids the surgeon makes an incision in the natural crease, and excises any excess skin and fat that may have accumulated. The scar is barely perceptible when mature.

In the lower eyelids there are two options. In standard lower blepharoplasty the skin is incised a few millimetres below the eyelashes, and either the skin lifted alone or together with the underlying muscle, and the excess fat is then removed through the same incision. Finally, the skin is redraped and any excess removed. It is not often understood that standard blepharoplasty cannot remove fine lines, especially crow's feet. This can lead to dissatisfaction in the presence of an otherwise good result.

To deal with the problem of eyelid wrinkles, the laser has assumed a significant role in eyelid surgery. Fat can be removed through an incision inside the eyelid without causing visible scarring, and loose skin and wrinkles are treated with laser resurfacing. In selected patients, this combination appears to yield better results than previously possible with conventional surgery. The only problem with this technique is that the lasered skin takes 5-7 days to heal, and the redness may take 6-8 weeks to settle. The final result however, is superior because the laser removes lines that are outside the scope of conventional surgery, such as crow's feet, and there is no scarring at all.

Eyelid surgery is very safe, but complications may occur as in other surgical procedures. However, all are very rare.

1) Infection: This is very unusual even in the form of conjunctivitis, because the eye is protected with an antibiotic cream

2) Bleeding: This becomes apparent shortly after surgery, or when patients exert themselves, or drink large quantities of alcohol, particularly red wine. If severe, it may necessitate taking the patient back to the operating theatre to stop the bleeding.

3) Scar: Although eyelid scars are the best one can have, some may not be satisfactory, and may need to be revised at a later stage. Laser eyelid surgery leads to no visible scars, and for those who worry about scar visibility, this may be a better option.

4) Ectropion : (Drooping Eyelid) This is usually caused by the removal of too much skin. In some cases, particularly if the eyelids are slack, it may be a temporary complication that usually corrects itself.

5) Dry eye: Some patients develop this problem, either temporarily or permanently, which is due to reduced lubrication of the eyeball. It presents itself with a gritty feeling, crusting of the eyes in the morning, and sensitivity to light. Treatment with artificial tears usually corrects the problem. Long-term contact lens users may be more prone to it.

6) Blindness: This frightful complication has been reported, and is caused by bleeding behind the eyeball, where it compresses the artery to the retina. Proper and expert management of this complication should lead to complete recovery.

As in all surgery it is essential to see a surgeon who will be able to tell you whether your problem can be remedied by surgery, and what the risks are. Thereafter you will be in a position to decide whether you should go ahead or not.

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