When one speaks of baggy “eyelids” he or she may be referring either to the upper or the lower eyelids, or both. Baggy upper lids can result from either genetic predisposition, or may be age related; or both. This problem can be expressed as too much skin or even wrinkled skin (especially in the lower lids), bulging fat, or both. Upper eyelid bags can also occur if the brow above droops to a point where it pushes the upper eyelid skin down onto the eyelashes. Baggy upper eyelids can in extreme cases fall over the lashes and block the pupil of the eye thereby causing visual loss. In this circumstance insurance may pay for the surgery. Lower eyelid bags and wrinkles are almost never covered by insurance.
Prior to surgery a complete medical history and physical exam is taken related to the eye and eyelid region. Your surgeon may request a complete eye exam by your eye doctor looking for eye related issues that could be adversely affected by eyelid surgery; e.g. dry eyes, poor closure, or blinking, etc. Photographs are taken and the procedure itself is described in detail including the recovery, risks, anesthesia, and complications. In many instances blood work and a recent general physical examination is required as well as discontinuation of certain drugs that may interfere with blood clotting. Full pre-operative written instructions will be given to you.
In the vast majority of cases, eyelid surgery is done under a local anesthetic with either no sedation or minimal oral sedation. In rare cases, or upon request, general anesthesia may be used. All surgery is performed in a state licensed, nationally accredited surgery center. An incision is made in the crease of the upper eyelid and all excess skin is removed along with any bulging fat. Enough skin must remain so you can close your eye. This approach allows for the scar to be hidden in the crease. In the lower eyelid an incision is made either on the inside (called transconjunctival), or on the skin outside just below the eyelashes. In the transconjunctival approach only fat (NO skin) is removed, whereas the external skin excision allows for both skin and fat removal. Some situations require CO2 laser treatment on the skin to smooth and tighten the wrinkles. This is done only in association with the transconjunctival approach.
Following the Procedure
Ice compresses are used aggressively for the first three days, then reduced, and stopped after one week. There is rarely any pain associated with this type of eyelid surgery. Pain medicines are prescribed as needed. An anti-biotic ointment is placed on the incision twice a day for the same time. Sutures are removed at one week or allowed to dissolve naturally if dissolving sutures are used. Bruising will resolve after 2-3 weeks, but small amounts of swelling can last for months. Results will slowly emerge as swelling and bruising subsides.
Complications are rare, however, there are certain inherent risks connected to every surgical procedure and these should all be discussed with your surgeon prior to the procedure. All complications can be minimized by carefully following all of your doctor’s pre and post operative instructions.