The eyes and the area immediately around them are particularly important in establishing a first impression when meeting other people. This is often the area that betrays the first signs of ageing, which is particularly evident in the upper eyelid. Also, some people have a family history of excess swelling of the lower eyelids and thus present with lower eyelid bags in early age. This swelling which first presents only in the morning tends to last longer, making people always look tired. Correction of lower eyelid bags where there is no excess of skin can be performed through incisions on the inside of the lower eyelid. Where there is excess skin as well as fat then surgery is performed using an excision that runs just underneath the eyelashes and out into the crow's foot. Initially the scar appears as a small red mark at the side of the eye, but as time passes this fades into one of the creases in the crow's foot. This is easily concealed in the first few weeks with a little standard makeup. Excess skin in the upper eyelid can be removed through a transverse incision lying in the skin fold leaving a virtually invisible scar. Upper eyelid surgery is sometimes combined with a browlift procedure undertaken endoscopically (keyhole surgery), which allows the outer part of the eyebrow to be elevated to a more youthful position and at the same time weakens the muscles at the root of the nose which cause frowning. Surgery can either be undertaken under local anaesthetic, particularly to the upper eyelids, or under a general anesthetic. Frequently encountered complications are swelling and bruising and depending upon the extent of surgery two weeks should be allowed for complete healing and resolution of swelling.
