Published on 7 October 2021

    If you have concerns about puffy eyes, sleepy-looking lids or feel that your eyes are a little too small and short, there are many surgical ways to enhance the way you look.

    According to Dr Jane Lim, Senior Consultant, Division of Plastic, Reconstructive & Aesthetics Surgery, Department of Surgery, National University Hospital, some of the most common types of cosmetic eyelid surgery include:

    • Laser surgery to reduce fine wrinkles and pigmentation

    • Upper eyelid surgery or ‘double eyelid surgery’ that removes excess skin and stitch the skin to create or enhance a crease and create the appearance of larger eyes

    • Lower eyelid surgery or ‘eye bag surgery’ to remove or reposition excess under eye fat, tightening the skin and smoothing out bagginess, sagging skin and wrinkles

    • Lateral canthoplasty or ‘outer eyelid surgery’, which increases the side-to-side length of the eye to make the eyes look bigger. Medial canthoplasty can be done on the ‘inner corner of the eyelid to reduce the epicanthal fold.

    • Eyebrowplasty or ‘eyebrow lift’, a procedure that reduces heaviness and furrows in the forehead, raises drooping eyebrows and rejuvenates the eyes

    Laser surgery uses ablative skin lasers to remove skin to tighten it. A second advantage of lasers is that it can target abnormal pigmentation. “The laser surgery is carried out in various modes and depths according to the patient's needs,” Dr Lim explained. This procedure can be done under local anaesthetic and nerve blocks can be given for more extensive treatment. 

    Procedures can be done as a day case, after which the patient can go home on the same day or as an inpatient if indicated, where the patient is warded for a variable period for observation. The treated areas will heal on their own – with good wound care – in about a week, or up to two weeks for procedures that are more extensive.

    Dr Lim pointed out that brown discoloration known as inflammatory hyperpigmentation may occur and can last several weeks to months after the procedure, so sun protection is highly recommended to minimise hyperpigmentation.

    As for surgical procedures for the eyelid, they can be done under sedation, local or general anaesthesia. Depending on the complexity, these take two to three hours.

    In all these surgeries, the plastic surgeon will – based on prior discussion with the patient – remove excess skin and excise, redistribute or resuspend soft tissues artfully to restore a more youthful appearance. “More bruising and swelling are expected in these procedures,” said Dr Lim, “Wounds typically dry by in five to seven days and bruising may take three to four weeks to resolve.”

    Due to the surgery, there may also be some residual fluid retention that can take about three months to dissipate. Surgical scars take about six months or more to become pale and less prominent. 

    As with all surgeries, it is important to undergo a comprehensive pre-surgical consultation with your surgeon. This session helps you to communicate and clarify your wishes and expectations and your best options to achieve your goals. Sometimes more than one procedure is needed for better outcome.

    These can be done together or separately. Your doctor will also help you to understand the limitations of surgery, including the risks. 

    Advancements in surgical techniques have enabled surgeons to achieve better results, with more options such as minimal access or scarless surgery and laser-based surgery, which are not incur less downtime, but lower risks.

    Dr Lim noted that in the past, surgeries have focused on removing tissues and fat, “modern techniques preserve and redistribute or add volume to the aging periorbital regions.” This results in more natural results.  Cosmetic eyelid surgery is also gaining popularity as aesthetic procedures gain wider acceptance, even among younger people.

    In consultation with Dr Jane Lim, Senior Consultant, Division of Plastic, Reconstructive & Aesthetics Surgery, Department of Surgery, National University Hospital.