The eyes have been called “the gateway to the soul”. The eyes are a very prominent feature on the face and, as such, can show the effects of aging most evidently. The natural process of aging and the daily stresses we encounter produce many visible facial signs: wrinkles around the eye, “crow’s feet”, fat deposits under the eye which bulge, redundant skin above the eye that can, in some cases, hang well below the lashes, and puffy eyes, creating a tired appearance.

Eyelid surgery, also known as Blepharoplasty, is a very effective way to reduce some of these signs of eyelid aging. The surgery is successful at removing fat from around the eye, as well as removing excess skin and muscle from the upper and lower eyelids. The procedure can help to reduce hanging, droopy skin from above the eye and puffy bags from below your eye – features that make you look older and more tired that you actually feel.

The Best Candidate

The best candidate for eyelid surgery is one who has one or any combination of the above listed eyelid conditions. Eyelid surgery is generally performed on men and women who are unhappy with the appearance of their eyes. The average age of eyelid surgery patients is 35 years or older, however, if you exhibit the signs of eyelid aging or if puffy, droopy eyes run in your family, the surgery can be performed on people younger than the average age.
The patient should be in good health and physical condition, stable psychological state, and have realistic expectations of the surgery. As with any cosmetic procedure, the surgery will help to improve the overall appearance of the problem area, but it may not live up to your preconceived ideal. The surgery cannot stop the natural aging process, but it can help to make you more self-confident and happy with the appearance of your eyes. Be sure to discuss your expectations with Dr. Heddle, as well as your support network.
Some medical conditions make having an eyelid surgery considerably more risky. If you have any of the following conditions, be sure to inform Dr. Heddle during your consultation: 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, so be sure to discuss your interest in the surgery with your ophthalmologist before you begin the process.

The Office Visit

During your initial consultation, Dr. Heddle will ask for your detailed medical history, including information that could cause complications during the surgery, such as, high blood pressure, blood clotting problems, diabetes, and liver/heart diseases. Be sure to tell your surgeon if you smoke or are taking any drugs, medications, vitamins, herbal supplements or have any allergies (especially if the allergies affect your eyes). Also during this initial visit, Dr. Heddle will ask questions about your emotional and psychological outlook on the surgery. While the surgery is ultimately a deeply personal decision, help and advice is available for you, so feel free to ask questions and express your concerns.
In this consultation, Dr. Heddle may ask you to look in a mirror and point out exactly where your concerns are and what you would like to see improved. This will help Dr. Heddle understand your expectations, putting both of you on the same page. Dr. Heddle, or his nurse, will test your vision and examine your tear production. If you wear glasses or contact lenses, bring them with you to the appointment, as well as any pertinent information from your ophthalmologist, including a copy of the record of your most recent eye exam.
Dr. Heddle will also discuss with you whether to do all four eyelids or just the upper or the lower ones during the surgery. The decision will depend on your own personal concerns. You will also decide whether the skin and fat will be removed and if additional procedures (such as a facelift or brow lift) may be appropriate for achieving your goals.

Preparing for the Surgery

Dr. Heddle will give you specific instructions on how to prepare for the surgery, including what you should/should not eat and drink, smoking and avoiding certain vitamins and medications prior to the procedure. It is very important to follow these guidelines in order to make the surgery go smoothly.
Plan to have someone with you on the day of the procedure who can drive you home afterwards and stay with you for the first 48 hours if needed.
An additional precaution is to set up a mini-recovery area in your home before the surgery. This recovery area may include: plenty of ice, clean towels, gauze, ointments or creams recommended by Dr. Heddle, magazines and books.

How the Surgery is Performed

As a result of individual factors, not every patient will achieve the same results from eyelid surgery. Dr. Heddle will select the surgical technique that he feels will obtain the best outcome for you. The procedure takes from one to three hours to complete. If you are having all four eyelids done, Dr. Heddle will first work on the upper lids and then move on to the lower lids.

	Dr. Heddle will make the incisions following the natural crease and fold of the upper eyelid and slightly below the eyelashes of the lower eyelid. The incisions will extend slightly beyond the outside corner of the eye into the laugh lines or crow’s feet. Because the incisions follow the natural contour of the eye, they will be well-hidden during the healing process.
	Through these incisions, Dr. Heddle will separate the skin and remove the underlying fat and trim away the excess skin. Fat may also be redistributed to eliminate puffiness or bulges under the eyes.
	The incisions are then closed with fine sutures, which again will be camouflaged in the natural lines of your eyes.
	The finished surgery will hopefully have attended to each area of concern. Drooping upper eyelids, bulges and puffiness will all have subsided, leaving you with younger looking eyes.

After the Surgery

It is important to understand that the amount of recovery time after surgery varies from patient to patient. Recovery is just as unique as the surgery.
Immediately following the surgery, Dr. Heddle will lubricate your eyes with ointment and may apply a bandage. Dr. Heddle will also show you how to properly clean your eyes in the days following, as they may be “gummy” from the ointment. Pain medication and eye drops will be prescribed to control any pain or dryness experienced.
The first evening after the surgery, make sure you rest quietly with your head elevated above your heart. Placing ice on your eyes during the first 48 hours is most important for reducing pain, discomfort and puffiness as a result of the surgery. Putting the gauze squares given to you by Dr. Heddle in the freezer with water and allowing them to melt on your eyes, will allow your eyes to benefit from the anti-inflammatory effects of ice.
In the first week or two, you may experience temporary discomfort, such as, tightness of the eyelids, swelling and bruising, which differs from patient to patient. You may also undergo temporary dryness, burning or itching of the eyes and in some cases, blurred or double vision. Excessive tearing and sensitivity to light is normal for the first few weeks. The stitches will be removed in two days to a week after the procedure is performed. Dr. Heddle will remain in close contact with you in the weeks following the surgery, so be sure to approach him with any questions or concerns.

Getting Back to Normal

Most patients are able to watch television and read normally within two to three days after the surgery. It may take seven to ten days in order to feel well enough to return to work and about three weeks to resume more strenuous activities and continue wearing your contact lenses. Be sure to follow any additional guidelines reviewed by Dr. Heddle.
The results of the surgery will last several years and in some cases, may be permanent. Although the aging process does continue normally, the majority of patients feel more confident and happy with their new look: rested, refreshed and alert.