It is almost impossible to look at a television screen—or even a computer monitor—without seeing the evidence of cosmetic and Eyelid Surgery.  Yes, we are youth obsessed.  Our celebrities are always under pressure to look as young as possible.  The only story we seem to like more than one about a celebrity having cosmetic surgery are articles about celebrity surgery gone wrong.  It is not accurate to call cosmetic surgery a craze.  No it is a fact of life.  Even feminist social critics have come to terms with women having cosmetic surgery.   What once was a phenomena for the rich and powerful, is now an accepted necessity for many of us.  Along with this demand comes a growing list of cosmetic specialists and others looking to provide these services.  For this reason, it is essential that consumers considering eyelid surgery understand how to evaluate a potential surgeon.

Why do we get cosmetic eyelid surgery?

Eyelid Surgery is also referred to as a lidlift, lid tuck, lid job, or more technically, blepharoplasty.  Youthful appearing eyes are defined by a bright, open, and almond shaped eye.  The upper eyelid rests just above the pupil but within the colored iris.  There is commonly a well-defined upper eyelid fold that rest above the eyelid platform and does not rest or touch on the eyelashes.  The upper eyelid fold has smooth contours.  The lower eyelid also rests just into the colored iris in the lower half of the eye.  There is always a flat to slightly full portion of the lower eyelid below the eyelashes extending to the lower eyelid crease when the fullness of the cheek begins.  There is no under eye circle to speak of and little lower eyelid darkness.  The cheek is full close to where the lower eyelid starts.

As we age the eyebrow flattens and falls below the orbital rim.  The upper eyelid fold begins to encroach onto the upper eyelid platform the fold of the upper eyelid.  Irregular fullness can be seen in some in the upper eyelid from herniation of orbital fat and descent of the lacrimal gland laterally.  Some individuals develop upper eyelid ptosis.  The predominant feature here is a long thin upper eyelid and a gradual hollowing of the upper eyelid, which is consistent with levator dehiscence ptosis.  The heavy upper eyelid makes the eyes look tired.  Encroachment of the upper eyelid fold onto the eyelid platform makes it difficult for women to apply makeup.  In the lower eyelid, the earliest change is a gradual loss of volume at the top of the cheek with an increasingly visible tear trough.  This is associated with increasing visibility of the lower eyelid fat, which can herniate into the lower eyelid.  With sun damage and time, the eyelid skin is associated with wrinkles and discoloration.

Blepharoplasty allows the surgeon to remove the excess skin and fatty tissue that develops around the eyes as we age.  In the upper eyelids surgery is performed to adjust the upper eyelid fold, control the firmness of the upper eyelid platform skin, elevate the upper eyelid margin, sculpt the fullness of the upper eyelid, and when necessary improve the quality of the skin using chemical peels or laser treatment.  In the lower eyelid, fullness of the lower eyelid can be reduced, lower eyelid wrinkles can be improved, and the midface can be elevated.  Lateral canthal surgery is now being offered as cosmetic eyelid surgery.  However, it is important to understand the lateral canthal surgery is reconstructive not cosmetic.  Done well, the upper and lower eyelid surgery restores to a much younger look with a brighter looking eyes.  When things go wrong, usually too much skin, fat or muscle are removed.  In the upper eyelids, the crease may be made too high or asymmetric with the other side.  Overaggressive surgery can associated with difficulty closing the eyes and dry eye symptoms.  Complications of lower eyelid surgery can include loss of the almond shape of the eyes, shortening of the lower eyelid, and lower eyelid contour issues.

What to look for in an eyelid surgeon?

There seems to a growing number of physicians and surgeons looking to offer cosmetic eyelid surgery.  Traditionally, this was limited to general plastic surgeons, facial plastic surgeon, and oculoplastic surgeon.  Now one finds dentists, dermatologists, and even interventional neuroradiologists offering cosmetic eyelid surgery.  It is important to understand that some surgeons do a better job performing eyelid surgery than other surgeons.  To get the best results, it is helpful to have a surgeon who is extensively trained in eyelid surgery and the health of the eyes.  Unfortunately non-oculoplastic surgeons lack depth in their training to perform eyelid plastic surgery.  It is appropriate to use caution in deciding what surgeon will be right for you.

Dr. Steinsapir recommends sticking with board certified surgeons who are fellowship trained in oculoplastic surgery and board certified in ophthalmology.  Additionally, some facial and general plastic surgeons do a very good job with primary eyelid cosmetic surgery.  However, this is the exception rather than the rule.  He advises looking very closely at the surgeons work by studying their website.  Confirm that the work posted on the surgeon’s website is actually that of the surgeon.  Shockingly some websites use “pooled” pictures.  Obviously that is a concern.  Check with the surgeon’s office and confirm that they have hospital privileges for the surgeries they do, and that they have medical malpractice insurance for their practice.  Surgeons who are “self-insured” may have been sued many times in the past and this may be a cause for concern.  Check with the state medical board that licenses the surgeon to determine if they are in good standing.  Finally meet with the surgeon.  Does the surgeon or his or her office rub you the wrong way or does the office make you totally comfortable? Does the surgeon spend time with you, actually examine you, or do you get passed off to surgical closers.  If the examination is less than 5 minutes, this should make you concerned.  If you are not sure, get other opinions to find a surgeon who makes sense to you.