Eye Lid Surgery

Definition

Our eyes are often the first area to show the signs of aging in our face. The aging is shows up as crow's feet, "bags" under the eyes, loose skin and a hollowing around the eye. There are several reasons why the lines, excess skin and "bags" occur. As our skin ages, the collagen in the skin becomes damaged and this leads to the wrinkles and the excess skin. We also lose fat underneath the skin around our eyes and this leads to the hollowed appearance and also to the excess skin. In the lower lid, the "bags" or bulge that forms is due to the weakening of the lower eyelid and the bulging of the fat behind the eyelid.

The brow also can affect the skin excess and fullness of the upper eyelid. As the brow descends with aging, it folds the skin of the upper lid making the upper lid more heavy and full, sometimes to the point where the upper lid skin touches the eyelashes.

The good news is most of these changes with aging can be improved with eyelid surgery - also called blepharoplasty. Over 240,000 people had a blepharoplasty last year in the United States according to statistics by the American Society of Plastic Surgery.

Problems with Upper Eyelid

A common complaint is the excess skin of the upper eyelid. This is due to loss of elasticity of the skin of the eyelid and also to a loss of fat under the skin in the brow region above the eyelid. The combination of events creates a loose fold of upper eyelid skin. Often, this excess skin can make it difficult to place eye makeup.

Removal of the excess skin and sculpting the upper lid region is often necessary to rejuvenate the upper eyelid. The small incision is placed in the eyelid fold so it is not seen. I also will sometimes recommend a very small amount of fat grafting to plump up the skin area above the eyelid and give you back your fullness you had in youth. The removal of upper eyelid skin is sometimes combined with a lifting of the brow using a forehead lift. Together a browlift and upper blepharoplasty can make for a great rejuvenation effect for your eyes.

Problems with Lower Eyelid

The lower eyelid will show some bulging with aging which produces the "bags" under the eyes. We also get a loss of the elasticity of the skin of the lower eyelid which produces the fine lines on the eyelid. A loss of fat just under the skin where the eyelid joins the cheek as we age gives the effect of a hollowness of the area around the eye.

I can improve the look of the lower eyelid "bags" by removing the fat which is bulging out from behind the eyelid. I generally do this using an incision on the inside of the lower eyelid so the scar does not show. Again, a small amount of fat grafting can plump up the hollowness around the eye. A small amount of skin removal may also be beneficial if you have some skin folds. The incision used to remove and tighten the lower eyelid skin is just under the lashes so it hardly noticeable once it heals.

Dark Circles Under the Eyes

There are two reasons why "dark circles" appear under the eyes. If your skin is light colored, the muscle that is right under the eyelid skin may show through creating a brownish or purple hue. How this happens is the eyelid skin is very thin and delicate. Under the skin is a thin layer of fat and then the muscle that we use to squint our eye. As we age, the skin itself thins as does the fat, so the muscle color shows through the skin to a greater degree. The muscle is dark red to brown and this produces the dark skin discoloration. I can help with dark circles by adding some fat beneath the skin again which keeps the color of the muscle from showing through. If your skin is dark, excess pigment can become deposited in the lower eyelid skin with aging. We have special eye creams that can be quite effective in reducing the amount of pigment in the skin thus helping the discoloration.

Fat Grafting Around the Eyes

We lose fat under the skin of the eyelids as we are and this produces the appearance of "tiredness" or dark circles. This is not something that gets talked about much but this affects most everyone as they age. I perform a simple procedure where small amounts of fat are placed under the skin through pinpoint incisions to restore the fullness under the skin and blend the eyelid with the cheek. Fat can also be placed just under the eyebrow to give back the round fullness of youth in that area. This fat that is placed is permanent because it is your own fat cells that are now just living in a different area.

Procedure

I usually like for you to have a general anesthetic to do eyelid surgery so you will not remember anything about the procedure and so you remain comfortable. Generally, the procedure lasts 1 – 1.5 hours. You will go home after your blepharoplasty. The recovery is about 10 – 14 days until the bruising and swelling subsides. You will feel fine in 2-3 days but you might have swelling you do not want others to see. I use dissolving sutures (stitches) so you will not need to have them removed. Sunglasses are always in fashion after blepharoplasty.

Accompanying Procedures

It is very common to have other facial rejuvenation procedures completed at the same time as a blepharoplasty. Facelifts, browlifts, Botox and chemical peels all are common to have at the same time as a blepharoplasty. Botox helps by decreasing the activity of the muscle that produces the crow's feet and helps reduce them. A chemical peel of the eyelids also is helpful in treating the fine wrinkles of the upper and lower eyelids.