The eyes are the most revealing feature of the face. When engaged in conversation, our eyes are the center of attention. Puffiness, dark circles around the eyes or droopy upper eyelids give the appearance of fatigue and old age. In some individuals, the excess skin of the upper eyelids can actually obstruct the field of vision, which can be dangerous when driving. Surgery can remove the excess fat and drooping skin on the upper eyelids, minimize bags under the eyes and tighten the lower eyelid skin. The result is a fresh, youthful and more rested appearance. Men and women of all ages who want to improve their self-image receive eyelid surgery. For upper eyelid surgery, doctors remove excess skin that hides the natural folds of and hangs down from the upper eyelids. This procedure helps reduce puffiness in the upper eyelids that creates a tired look. The surgery of the lower eyelid involves removing extra skin and fine wrinkles and reduces puffy bags under the eyes as well as unsightly dark circles. In many instances, excess droopy skin on the upper eyelids causes a lowered eyebrow ridge. As we age, gravitational pull and decreased elasticity of the skin leads to a downward fall or ptosis of the eyebrows. Naturally occurring low set eyebrows are sometimes genetic, in which case an endoscopic forehead lift or brow lift is necessary. It is imperative, however, to address low eyebrows in addition to eyelid surgery (blepharoplasty) to avoid excision of excess skin of the upper eyelid. Returning the eyebrow to its aesthetic position decreases the amount of skin necessary for excision in the blepharoplasty. The surgeon conducts the procedure under light sedation or general anesthesia. Long acting local anesthetics assure pain free after the procedure concludes. The incision at the upper eyelids typically begins within the natural crease of the inside corner of the eye and extends to the crow's feet or laugh lines. The surgeon removes excess skin and fatty tissue through this incision. The incision line follows the natural contour of the upper eyelid and is not very visible when healed. If the upper eyelids are droopy and have excess skin, the physician tightens the muscles underneath the eyelid to correct the placement of the upper eyelid. There are two components to lower eyelid surgery, depending on individual needs. The first component is to remove excess skin that wrinkles or unevenness of the lower eyelid. To address this problem, a surgeon makes an incision just below the eyelashes and excises the excess skin. The physician re-drapes the remaining skin is over the eyelid and the closes the wound to create a well- concealed scar. The second component addressed by lower eyelid surgery is excess puffiness or bulging due to excess or protruding fat. A doctor makes an incision at the lower eyelid crease just at the base of the eyelashes, where eyeliner is normally applied, and the doctor removes excessive skin, adjusts muscle folds, reduces puffiness and removes fatty pockets. When neither skin nor muscle fold removal is required, doctors address puffiness and "bags" with a hidden incision made inside the lower eyelid without any visible external incision. Physicians close incisions with very fine specialized plastic surgery stitches, some of which are absorbable by the body, while others require removal five to seven days after an operation.

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