For upper eyelid surgery, ideal patients generally have normal position of their brows and eyelid margins, healthy eyelid skin without much discoloration, no medical problems with their eyes and who have excess skin on their upper lids either with or without some bulging fat pads near the nasal area. Those who have some excess descent of their brows may consider having a brow lift at the same time as their eyelid procedure.
Contacts and Drops
Patients who wear contacts will have to switch to glasses for a week or so and those that use eye drops, especially for dry eyes, will generally need to use more moisturizing drops during the day and often add lubricating drops or ointment at night. This tends to occur more so with patients who have has some sort of refractive laser surgery such as the Lasik procedure.
Lower Eyelid Surgery
Good candidates for lower eyelid surgery are those with good position of their lower lids with respect to their irises, have good tone of their lower lid margin and not much excess skin as well as no other eye problems. The lower eyelid procedure is generally more of a fat surgery where the pockets are reduced or repositioned to remove or reduce lower lid bags and dark circles.
Not much skin can be removed from the lower eyelids in general because the lower lid does not have the support that the upper lid does; for this reason, too much skin removal can result in malposition of the lid margin causing too much of the white of the eye (sclera) to show or actual turning out of the eyelid (ectropion). This happens less often in patients with good tone of their lower eyelids, which is why, during the evaluation, the surgeon pulls down and out on the lid to see how fast it returns to normal position. Those with loose lower eyelids will commonly have a suspension of the outer corner of the eyelid at the time of surgery to provide additional eyelid margin support; this is known as a canthopexy.
Sometimes, in addition to sagging upper eyelid skin, there is actual drooping of the eyelid itself that has nothing to do with the excess skin. In these cases, the tendon-like structure (aponeurosis) that attaches the eyelid margin to the muscle that elevates the eyelid has weakened or lost its attachment causing the eyelid to sit lower than it should; covering some of the pupil, which should be completely exposed with the eyes open. This can be corrected at the same time as an upper eyelid surgery by reconnecting the aponeurosis to the lid margin. This procedure may be covered by insurance in cases where the drooping of the eyelid margin is severe enough.