What really happens in upper eyelid surgery?

It's lovely to see the sun setting on the horizon or observe autumn leaves drifting downward. But watching your upper eyelids gradually fall lower each year? That's a bit unsettling. The sagging, drooping skin might affect the way you feel about your appearance. Worse, it might interfere with your vision, with eyelids hanging so low and feeling so heavy that it's hard to open your eyes. Fortunately, a routine surgery can help.

Upper eyelid surgery

The fix for falling upper eyelids is a type of surgery called upper blepharoplasty ("BLEFF-ar-oh-plass-tee"). It takes place in an outpatient surgery center, with anesthesia — local anesthesia (an injection to numb the area), "twilight" sedation (so you're very relaxed), or general anesthesia (so you're unconscious and unable to feel pain), depending on your needs.

During the procedure, a surgeon — an ophthalmologist, an oculoplastic surgeon, or a plastic surgeon — will use a scalpel or laser to make incisions along the upper eyelid's natural folds. The surgeon will remove excess skin from both the left and right upper eyelids, possibly remove underlying fat, and close the incisions with stitches.

The procedure takes about half an hour. If you received twilight sedation or general anesthesia, you'll have to go to a recovery room for about half an hour before you can go home.

Recovery

Recovery from upper blepharoplasty takes two to four weeks. You may have moderate (temporary) bruising and swelling around your eyes, but pain will be minimal.

Icing your eyelids and keeping your head elevated will help reduce swelling. "It's not unlike icing a twisted ankle. Put ice in a small towel and apply it to your eyelids for 10 or 20 minutes per hour while you're awake, for the first two days. At night, use extra pillows when you sleep, so gravity will help drain fluid causing inflammation," says Dr. Michael Yoon, an oculoplastic surgeon at Harvard-affiliated Massachusetts Eye and Ear.

You'll also have to rub a topical antibiotic ointment on your stitches three times a day for a week to prevent infection.

See the difference

After just one week, you should notice improvement — some reduced swelling and eyes that are more open than they were before surgery. "After two weeks, most people are healed and the puffiness is gone," Dr. Yoon says. "It takes longer for some people, however, so don't schedule major social events until three or four weeks after your procedure," Dr. Yoon suggests.

Don't expect a major change in your appearance. "We can't give an older person their 30-year-old eyelids. But if your eyelids interfere with your vision, we can correct that. And we can provide a rejuvenating effect that helps accentuate what you like about your eyes — their color, appearance, and alertness when engaging in face-to-face interactions," Dr. Yoon says.

Candidates for surgery

Almost anyone who's bothered by the function or appearance of falling upper eyelids is a candidate for upper blepharoplasty.

However, it might not be right for people with certain serious eye diseases or prominent or bulging eyes because of an overactive thyroid. And it might be risky for people with severe dry eye syndrome, which can become more pronounced after surgery. "Removing the excess skin allows the eyelid to open at a higher level. But when eyes are more open, they're more exposed to air, so existing dryness will become worse," Dr. Yoon explains.

Another risk is noticeable asymmetry. "The risk might be 5% or 10%, because the unique way people heal can occasionally lead to mildly uneven results," Dr. Yoon says. It's best to look for a surgeon who performs upper blepharoplasties frequently (every week).

Is it worth it?

If falling upper eyelids are interfering with your vision, insurance will likely cover all or part of the costs for upper blepharoplasty. The surgery won't be covered, however, if it's for cosmetic reasons only. Costs start at several thousand dollars, depending on your surgeon and where you live.

Is it worth the investment? "It's a good 'bang-for-your-buck' procedure," Dr. Yoon says. "There's not a lot of pain and recovery, the results last 10 to 15 years, and you will literally be able to look in the mirror and see improvement."

Image: © Valentina Khruslova/Getty Images