“You don’t get a second chance to make a first impression!” This is one of the opening lines that personal development experts love to use when starting their talks. While your clothing and body language are all important in creating a first impression, eye contact is crucial before engaging in social interaction and conversation. We try to understand the emotions of the person in front of us by looking into their eyes. Therefore, the eye area is a body part so important that it can influence our thoughts about them.

The face is not just eyes, lips, eyebrows, or cheeks; it should be considered as a whole. However, facial aging first begins to show itself around the eyes. Sagging skin, puffiness, wrinkles, and bags in the upper and lower eyelids cause an aged, sleepy, and tired appearance. Although the upper and lower eyelids are almost similar in structure, they may not deform at the same rate, so they can be evaluated separately.

Downward displacement of the forehead and eyebrows due to gravity begins around the age of thirty-five. Loosening of the upper eyelid skin becomes even more pronounced with sagging on the outer side of the eyebrows. Around the age of fifty, the muscles and skin of the upper eyelid, like those throughout the face, thin, and sagging increases. Due to the loosening of connective tissue and fibers around the eyes, the fat pads in the eye socket herniate outwards, creating what are known as under-eye bags. Depending on genetic factors, sagging and/or bags in the eyelids can sometimes be seen at an earlier age. Aesthetic eyelid surgery, or blepharoplasty, can give a person a younger and more vibrant appearance. Since the area around the eyes has a very complex and delicate anatomical structure, a very careful pre-operative examination and a treatment plan tailored to the problem are necessary.

The upper eyelid typically presents with two problems: excess skin and herniated fat pads. If there is excess skin, only the skin may need to be removed; if excess fat is also present, some of the fat may need to be removed as well. Sometimes, the sagging of the skin in the upper eyelid is so severe that it can even narrow your field of vision and obstruct your vision. Swelling on the outer side of the upper eyelid may not be due to excess fat but rather to the downward displacement of the tear gland. Fixing the tear gland towards the bone can resolve this problem. In the lower eyelid, there is usually a bulging of fat tissue under the eyeball due to loosening of the connective tissue. If this fat is excessive, it can be removed, or a procedure can be performed to compensate for the tissue deficiency in areas such as the tear trough at the lower eyelid-cheek junction by shifting the fat tissue in the direction of the reduced fat tissue. The tear trough at the lower eyelid-cheek junction can also be temporarily corrected with fillers without surgery.

Upper eyelid surgeries can usually be performed under local anesthesia, but lower eyelid surgeries require sedation in addition to local anesthesia because the tissues are worked on more deeply. Upper eyelid surgery alone takes about half an hour, but lower eyelid surgery takes about an hour. General anesthesia can also be administered to patients who prefer it. Patients can be discharged the same day if the surgery is performed under local anesthesia or sedation. Depending on individual characteristics, bruising and swelling around the eyes may last 7-10 days. Full results are seen in 1-2 months. Eyelid skin is one of the easiest and best-healing skin types on the body, therefore noticeable scarring is minimal.

Eyelids age along with other facial features. In a person with sagging eyebrows and crow’s feet, performing only eyelid surgery will only partially alleviate the tired or aged expression, and the patient will not be sufficiently satisfied. Therefore, a detailed examination by a plastic surgeon is necessary to analyze whether the patient needs additional procedures such as brow lift, facelift, fillers, or Botox.

As with any surgery, eyelid surgery can lead to complications. In the early stages, risks associated with general anesthesia, bleeding, infection, or wound healing problems, as seen in any surgery, may occur. Because the surgery is performed around the eyes, irritation or dry eyes may be observed in the early stages, and treatment may be required. Swelling and bruising around the eyes after this surgery may persist for a longer period if exposed to sunlight for an extended time. The amount of skin removed from the upper and lower eyelids is crucial. If too much skin is removed, the eyes may remain open, leading to dryness and keratitis. Since removing excess tissue is much more difficult to reverse, thorough planning before surgery is essential. Although the skin on the eyelids is the thinnest and most easily healed skin on the body, it should not be overlooked that each individual’s wound healing process is different.