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The surgeon will begin by deciding whether excess skin, fat deposits or muscle looseness are at fault. Most commonly, the surgeon will make incisions along the natural creases of the upper eyelids, and just below the eyelashes for the lower eyelids. These incisions may be made with a traditional scalpel or a laser. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon will work to tease out small pockets of fat that have collected in the lids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull it tighter. The incisions are then closed with tiny sutures, which are often removed in about a week.

If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a variation on the above procedure. Known as a transconjunctival blepharoplasty, an incision is made inside the lower eyelid, leaving no visible scar, while still producing the desired result. The pocket of fat is removed with tiny forceps and the incision closed with dissolving suture. It is usually performed on younger patients with thicker, more elastic skin.

Blepharoplasty 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.) Some surgeons prefer to use general anesthesia; in that case, you'll sleep through the operation. After surgery, a lubricating ointment will be placed in the eyes that may cause temporary blurred vision.

Your procedure 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.

All four eyelids may be operated on or just the upper or lower ones. The entire procedure may take from one to three hours, depending largely on whether all four lids are being operated on, or just the upper or lower ones. If you're having all four eyelids done, the surgeon will probably work on the upper lids first, then the lower ones.