The eyelids are often the first area of the face that patients wish to address when considering cosmetic surgery. Eyelid surgery can have dramatic rejuvenating effects simply by removing loose skin and prominent “bags” around the eyes. In addition, in evaluating each patient, I consider the face as a whole to determine whether the adjacent structures, like the brows and the cheeks, may require simultaneous attention in order to achieve that patient’s cosmetic goals.
The upper eyelids are usually treated by trimming the excess skin and sculpting the fat around the eye using a CO2 laser. Very conservative fat removal or repositioning is crucial to preserve the youthful fullness around the eyes, while any bulging is eliminated. The incision is carefully hidden within the natural eyelid crease. The use of the laser reduces the swelling and some of the bruising seen with traditional methods. The procedure is performed under local anesthesia with sedation available to those who desire the added comfort. Minimal discomfort is characteristic, and icing and rest are recommended in the first 48 hours. Patients resume most of their activities in 3-4 days and return to work soon thereafter, though some may choose to wait one to two weeks after surgery until all the bruising has resolved.
The lower eyelids involve careful anatomical considerations. Often, patients will notice “bags” under their eyes.  The specific considerations that are crucial to understand include: the relative position of the eye and the upper edge of the cheek bone, fat pad protrusion that presents over the cheek bone, and descent of the cheek soft tissues producing a groove between the eyelid and the cheek (aka: the tear trough).
These factors determine the appropriate surgical approach. Although fat is sometimes trimmed conservatively, it is often repositioned over the upper edge of the cheek bone to correct the tear trough groove. Other implants may also be placed at the edge of the lower bony rim to address the tear trough.
Skin is always conservatively removed or resurfaced with the CO2 laser to avoid changing the shape of the lower eyelid. Lower eyelid blepharoplasty (eyelid surgery) is performed under local anesthesia with sedation, and use of the CO2 laser allows greater precision and limits bleeding, bruising and swelling.
Patients of all ages can benefit from blepharoplasty, especially since many have inherited tendencies that become bothersome early in adult life. Blepharoplasty can be combined with laser resurfacing, forehead lifts, facelifts and liposuction.  General anesthesia may be necessary during more extensive operations.