Why do people have cosmetic eyelid surgery?
Cosmetic eyelid surgery, or Blepharoplasty, removes excess skin, fat and muscle from around the eyes to create a more alert and youthful appearance. This procedure can be performed on the upper and lower lids, at the same time or separately. As we age, the skin around our eyes loses its elasticity. You may develop loose folds of skin on the upper eyelids and deep creases on the lower lids. At the same time, your muscles in this area may also slacken so that any fat bulges forward and looks baggy. Cosmetic eyelid surgery can remove the excess skin, fat, or both, from around your eyes.

Realistic expectations
Cosmetic eyelid surgery (Blepharoplasty) can also remove wrinkles, but only those in the skin that is cut away in the operation. It will not remove "crow's feet" and cannot change the colour of dark shadows under the eyes. It is important to discuss with your surgeon what you are hoping to gain from the operation, and the result you can realistically expect.

What happens before cosmetic eyelid surgery?
Initially you will have a telephone consultation with your surgeon followed by a face to face consultation before your operation. The surgeon will ask about your general health and discuss how to prepare for your surgery.

Your surgeon will examine:

• your eyelids
• your vision
• your tear film (a layer of tears covering the surface of your eye)
• the front of the eye
• your retina - an area on the rear wall of your eyeball
• your whole face to see the condition of your skin
• the position of your eyebrows and eyelids, which will be measured

Getting the most out of your consultancy
Often in cases where clients are unhappy with the results of surgery it is because they did not discuss their expectations thoroughly or were afraid to talk about the outcome or risks. You have to make an informed decision before signing the consent form so ask plenty of questions. You want to feel relaxed and confident and completely understand what will happen during surgery.

What happens during Eyelid Surgery (Blepharoplasty)
The operation lasts one to three hours, less if just the upper or lower lids are being done. You may need to stay one night in hospital for observation.

The surgery can be carried out under a local anaesthetic, in which case the area around your eyes will be numb but you will be awake. It can also be done under a general anaesthetic, which means that you will be asleep throughout the procedure.

For surgery on the upper eyelids, cuts are made:

• into the natural lines and creases in your eyelid
• into the laughter lines at the corner of your eye

For surgery on the lower eyelids, cuts are made:

• just below your eyelashes, which means the scars will run along your eye's natural folds

Excess fat, muscle and loose skin are then removed, and the cut is closed using fine stitches. These are generally removed two days to a week after surgery.

If only fat is being removed, the cut can be made on the inside of the lower eyelid, leaving no visible scar. This is called a transconjunctival blepharoplasty

After surgery
After the operation, your eyes may be covered with gauze pads. The surgeon will apply some sterile paper tape to support the eyelids after surgery, which is normally removed after three to five days. Sometimes you will be advised to use the support for the lower eyelids for a week or so. An ointment will be applied to your eye area to prevent it from drying out.

You will be given painkillers to help with any discomfort.

If the operation has been planned as a day case, most people go home once they have made a full recovery from the anaesthetic. If you have had a general anaesthetic you will be transported back to your hotel accommodation.

Before you leave hospital, a nurse will give you some advice about how to care for the eye area and you will usually be given an eye ointment to use at home.

Road to Recovery
Once you are home, you may take further painkillers if you need to. Follow the hospital's advice.

Applying a cold compress, such as an ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an "ice burn".

There are some important things to remember while recovering from cosmetic eyelid surgery.
Keep your head higher than your body by lying propped up on pillows, and avoid bending over for a few days. This will help to reduce swelling and bruising.

Clean around your eyes and use any ointment that the hospital staff gave you as they instructed.

Avoid wearing eye make-up until a couple of days after the stitches have been removed, or for as long as your surgeon tells you to.

Avoid wearing contact lenses for two weeks (they may still feel uncomfortable for a while after that).

Avoid driving until your vision has returned to normal and your eyes have stopped watering.

Most people are able to read or watch television within a few days. People usually feel like returning to work after a week to 10 days.

All surgery carries an element of risk
Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection, or an unexpected reaction to the anaesthetic.

Specific complications of cosmetic eye surgery are uncommon but can include:

A haematoma - a pool of blood collects under the skin around the eye, which may need to be drained or if it is large swelling that pulls the lower lid away from the eye, which usually settles on its own after a couple of days, but occasionally another operation will be needed.

• Damage to the surface of the eyeball or the surrounding muscles.
• Acute glaucoma, an eye condition requiring treatment by an eye specialist
• Unusually red or raised scars (called keloid scars) which some people have a tendency to form
• Sunken appearance if too much fatty tissue is removed
• A difference in appearance of the two eyes - they may not be identical
• Partial or complete blindness, but this is very rare

The chance of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your doctor will be able to explain how these risks apply to you.

Deciding on Cosmetic Eyelid Surgery (Blepharoplasty)
It's important not to rush into the decision to have cosmetic surgery and, it's sensible to discuss the issue with your doctor.

Cosmetic eyelid surgery is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having cosmetic eye surgery can also expect:

• Soreness around the eyes, which can be helped by taking painkillers
• Bruising and swelling for up to a month after the operation, which might make your eyes feel tight and difficult to close when going to sleep
• Sticky, dry and itchy eyes for the first week
• Watery eyes for a few weeks
• Double or blurred vision for a few days - you should contact your hospital or a GP if this lasts longer than three to four days
• Sensitivity to light for a few weeks
• Tiny white heads along the line where the stitches were - your surgeon can remove these with a very fine needle
• Pink scars for a few months, but eventually become almost invisible