Excess hooded skin of the upper eyelids and puffy bags of the lower eyelids are usually the first and most dramatic signs of aging of the face. As we age our skin becomes loose and begins to sag. This becomes quite noticeable around the eyes since the eyelids have the thinnest skin on your body. Fatty tissue under this thin skin begins to protrude under the skin, causing "bags" under the eyes. This creates a tired, aged look despite the fact that many patients are not tired and are actually young in age. Exposure to the sun also leads to a loss of elasticity in the skin around the eyes and can cause more sagging or wrinkling.

Best Candidates:

The Procedure:

Upper Eyelids:
The upper eyelid blepharoplasty corrects both the looseness of the skin of the eyelids and the puffiness of the lids produced by projections of fatty tissues beneath the eyelid muscle. Upper eyelid surgery removes the extra, hanging thin eyelid skin, giving the upper lid a more youthful and energetic look. The incision is carefully placed in the natural eyelid fold, is well camouflaged and almost imperceptible once healed.

Lower Eyelids:
Lower eyelid blepharoplasty removes "bags" and puffiness that are present in the lower eyelid area. Most often, Dr. Guida often treats the lower lid bags with a procedure called transconjunctival blepharoplasty. With this procedure, the excess fat is removed through the inner eyelid (which is not seen) avoiding the need for an incision in the external skin. The results are very positive and quite significant. With no visible scarring, there is little risk of changing the shape of the lower eyelid, and a very quick recovery period, often only a few days.

Recovery Time:
Most patients after blepharoplasty surgery ease back to their normal routine within less than a week after surgery. Most bruising is gone in less than one week, though camouflage makeup can be used to hide any lingering discoloration. Upper eyelid sutures are removed by Dr. Guida within 3 - 5 days after surgery. Most often, there are no sutures to be removed for the lower eyelids. At this time you will be able to resume most of your normal activities. You may begin to lightly exercise three to four weeks after surgery.

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If I have the fat removed from my lower eyelids using a transconjunctival approach, what happens to the extra skin?
Once these pouches are removed, they do not recur. However with age, the skin does become looser and fine lines appear. The lower eyelid has the thinnest skin in the body and sun damage here can be quite noticeable. Dynamic wrinkle around the eyes, "crow's feet" (wrinkles that occur when you smile) are best treated with selective Botox injections.

Static wrinkles (lines present at rest), require resurfacing. This can be done at different levels. The deeper the resurfacing, the longer lasting and more dramatic the results, but this can be associated with a longer recovery. From little recovery to a few weeks recovery, one can opt for home Skincare regimen and anti-aging eye creams (no real down time), light to medium depth chemical peels (1-5 day recovery, depending on peel), and CO2 laser resurfacing (most dramatic, but over a week recover) are the techniques most utilized.

Though Dr. Guida most commonly uses the transconjunctival approach for the lower eyelids, there are certain circumstances in which he will suggest using an external skin incision for the lower eyelids and actually remove extra skin. This still does not address resurfacing of any sun damaged skin, however.

I want a natural look. If I have my eyes done, will i have an unnatural, "startled" or "deer in the headlights" look to my eyes?
A natural, refreshed, rested, and more youthful look is what you can expect from a properly performed upper blepharoplasty. The over-done, "startled" look occurs when too much is done, often combining a browlift with a blepharoplasty during the same operation. Many people with extra skin of the upper eyelids also have a component of a droopy brow. However, correcting both at the same time can give an exaggerated, funny, and startled look, and, in most cases, should be avoided.

What can be done about the dark circles under my eyes?
There are many different causes for dark circles under the eyes, and that is why there is not one simple way to make them disappear. Some of causes could be heredity, allergies, excess sun exposure, allergic eczema, or simply shadowing form large, puffy, protruding bags of fat under the lower eyelids. For mild cases, over the counter creams may offer some help, especially if they contain vitamin C of K, alpha hydroxyl acid, or kinetin.

For more specific and stronger treatment, advice from a doctor is needed to try and understand the underlying causes. More specific treatment, which should be under the direction of a physician, include prescription bleaching agents, anti-aging eye creams with a combination of bleaching agents and skin tightening agents, or perhaps certain types of chemical peels and laser resurfacing. Dr. Guida has had positive results with treatment of dark circle in many cases with CO2 laser resurfacing, which dramatically tightens the lower eyelid skin and can significantly help fade the dark circle.