Otherwise known as blepharoplasty, this is one of the best known and “first for the individual” aesthetic surgery operations.

As one ages, everything begins to droop, the skin of the forehead over the orbital margins descends imperceptibly until the previously recognizable upper lid is covered and hidden. Since in normal conversation, persons tend to look into each other’s eyes, this may be the first change a person is told about by their well-meaning friends.

The technique employed varies according to the situation, the patient’s needs and the surgeon’s preferences but in general it is performed under local anesthetic on an out-patient basis.

There are two eyelids, upper and lower; reconstructive surgery on the eyelid is called blepharoplasty; it was first performed for the extremely rare condition of cancer of the eyelid, but is now one of the commonest of plastic surgery procedures.

The upper lid has a skeleton of dense fascial plate which is not usually at fault. The problem arises in aging with the skin over the eyelid losing its elasticity and turgor, and drooping down to obscure the lid. This does not interfere with vision but is among the first signs of age-related changes that others notice.

At the lower lid, the skin sags down from the lower orbital margin, there is often some excess fat deposition in the “bags under the eyes.” Vision is not impaired but the “dissolute” look engendered by these bags might be disconcerting and totally misleading.

The technique employed varies according to the situation, the patient’s needs and the surgeon’s preferences but in general it is performed under local anesthetic on an out-patient basis.

At the upper eyelid an incision is made along a skin crease, the skin is freed up sub-dermally from the deep structures, and usually an ellipse of skin is excised, the margins curving down medially and laterally. Such excess fat as indicated is also removed. Tautening of the underlying fascia might possibly be indicated, but as a rule it is not.

For the lower lid, the incision may be made in a skin crease immediately beneath the eye’s lower lashes if a portion of skin is to be removed to tighten up the “bag” under the eye. If it is planned to remove fat, and there is no need to remove skin, the incision might be made actually within the lower lid.