If you are considering eyelid surgery, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and Dr. Gutstein. Please ask Dr. Gutstein about anything you don't understand.

THE BEST CANDIDATES FOR EYELID SURGERY
Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Gutstein.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism, hyperthyroidism and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; if you have any of these conditions a check with your ophthalmologist before you have surgery would be warranted.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK
When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following Dr. Gutstein's instructions both before and after surgery.

The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; Dr. Gutstein can remove them easily with a very fine needle.

Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.

PLANNING YOUR SURGERY
The initial consultation is very important. Dr. Gutstein will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform Dr. Gutstein if you have any allergies; if you are taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

You and Dr. Gutstein should carefully discuss your goals and expectations for this surgery. You'll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate.

We will explain the techniques and anesthesia he will use, the type of facility where the surgery will be performed, and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery, unless you can prove that drooping upper lids interfere with your vision. Check with your insurer.)

Don't hesitate to ask Dr. Gutstein any questions you may have, especially those regarding your expectations and concerns about the results.

PREPARING FOR YOUR SURGERY
Dr. Gutstein will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.

While you are making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.

WHERE YOUR SURGERY WILL BE PERFORMED
Eyelid surgery may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis; rarely does it require an inpatient stay.

TYPES OF ANESTHESIA|
Eyelid surgery is usually performed under local anesthesia--which numbs the area around your eyes--along with oral or intravenous sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.) If the patient wishes we can use general anesthesia; in that case, you'll sleep deeply through the operation.

THE SURGERY
Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you are having all four eyelids done, Dr. Gutstein will probably work on the upper lids first, then the lower ones.

In a typical procedure, incisions are made in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, Dr. Gutstein separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, Dr. Gutstein may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.

AFTER YOUR SURGERY
After surgery, we will lubricate your eyes with ointment. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication and cold compresses. If you feel any severe pain, call the office immediately.

You will be instructed you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from one to three weeks.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Eye drops may be recommended, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

Dr. Gutstein will follow your progress very closely for the first week or two. The stitches will be removed three days to a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.

GETTING BACK TO NORMAL
You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in 5 to 10 days. By then, depending on your rate of healing and the doctor's instructions, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and sunblock.

You will be asked to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes flushing and fluid retention.

YOUR NEW LOOK
Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line. The positive results of your eyelid surgery-the more alert and youthful look-will last for many years.