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Sooner or later, all of us complain that our eyes make us look tired. Sometimes this is just a temporary condition - a sleepless night, the flu or an extended period of stress may cause dark circles under our eyes that will eventually go away when we are feeling better. But often, particularly as people begin to show early signs of aging, the position of the eyelids will change, modifying our facial expression in subtle but significant ways.

A study presented at a meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) analyzed how brow shape and eyelid position influence the way other people perceive our mood. The study used digital imaging software to modify a photograph of a youthful upper face in a variety of ways. Twenty study participants were asked to look at 35 versions of the photographic image and quantify on a scale of 1 to 5 the presence of each of seven expressions or emotions: surprise, anger, sadness, disgust, fear, happiness and tiredness.

One of the findings was that raising the lower eyelid dramatically increased the scores for "happiness." Lowering the upper eyelid, to create the appearance of excess or loose skin hanging down, greatly increased the scores for "tiredness."

Cosmetic eyelid surgery, also called blepharoplasty, removes the excess fat and wrinkled, drooping skin of the upper eyelids that can make you look constantly tired or sad. It also eliminates bags under the eyes and elevates the lower eyelid skin, creating a brighter, more alert and rested appearance.

Cosmetic eyelid surgery is a very popular procedure among both women and men. Because the eyes are one of the first areas to show visible signs of aging, eyelid surgery is commonly performed as early as the mid-30s. Some patients have hereditary conditions that cause them to seek cosmetic improvements to their eyelids at an even younger age. There is really no upper age limit to having cosmetic eyelid surgery, and many people 65 or older undergo cosmetic eyelid surgery.

One of several techniques may be suggested to improve the appearance of your eyelids. The particular technique that Dr. Yarish recommends will depend on many factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of the muscles around your eyelids.

The incision for upper eyelid surgery generally is hidden within the natural fold of the eyelid and may extend out slightly into laugh lines or other existing creases. It will be well camouflaged when healed. For lower eyelid surgery, the incision may be hidden just below the lower lashes or placed inside the lower eyelid. Excess fat in both the upper and lower eyelids may be removed or redistributed.

There are certain things that cosmetic eyelid surgery cannot achieve. Sometimes a patient will have sagging brows, perhaps in addition to excess skin in the upper eyelids. If this is the case, a procedure to lift the brows may be necessary to achieve the kind of results that the patient wants. Smoothing of crow's feet may require chemical peeling or laser resurfacing. Although lower eyelid surgery can eliminate dark shadows under the eyes that are caused by bulging fat, circles that are the result of dark pigmentation may need to be treated with a bleaching solution or a chemical peel.

The results of cosmetic eyelid surgery are long-lasting. Even though the aging process continues, patients are usually happy with their appearance for many years. Of course, the eyelids are seen in the context of the entire face. If the rest of your face and neck are showing aging changes, you may want to talk with Dr. Yarish about other facial rejuvenation procedures to achieve a more harmonious look.