The eyelids are often the first facial feature to show signs of aging resulting in a sad, tired appearance even in the most energetic individual. Blepharoplasty, a surgical procedure designed to rejuvenate the eyelids, can return that youthful elegance to your face, making the eyes appear brighter and more refreshed. Browlift is another procedure used to lift the brows and eyelid skin that is combined to establish a more youthful appearance. The combination of procedures will generally give the longest lasting result and the happiest patients. This is especially true in individuals who notice the skin of the upper eyelids to be so lax and impart a hooded appearance to the upper eyelids; and in severe instances, even obscure your vision.
Any one or combination of the following conditions may indicate that you are a good candidate for eyelid surgery:
- Excess skin obscuring the natural fold of the upper eyelids
- Loose skin hanging down from the upper eyelids, perhaps impairing vision
- A puffy appearance to the upper eyelids, making the eyes look tired
- Excess skin and fine, paper Mache wrinkles of the lower eyelids
- Bags and dark circles under the eyes, often with a depression along the bony border of the lower eyelids
- Droopiness of the lower eyelids, showing white below the iris (colored portion of the eye
The Upper Eyelid Blepharoplasty
The upper lids can be approached through the skin and from under the eyelid. In general, patients that require significant skin removal to rejuvenate the eyelids will be approached by incisions in the skin. Younger patients, which may not manifest signs of aging, but have “bags” of fat in the upper eyelids are better treated with an incision under the eyelid, where it is not visible.
The Lower Eyelid Blepharoplasty
For the lower eyelids, the approaches are similar. Some individuals experience an accumulation of fat in the lower eyelids creating persistent “bags” under the eyes. These “bags” are not always related to aging. Removing the fat pads that create these “bags” will rejuvenate your eyelids quite nicely. The incision is performed inside the lower eyelid and will not be visible. A small amount of skin tightening can be accomplished with either CO2 laser or chemical peel, if needed. Similarly, if you experience excess skin and fatty deposits in the lower eyelids, then the best treatment for you may be a skin incision approach that allows simultaneous removal of skin and fat pads. We individualize all of our surgical procedures around the eyelid region to fit the needs and desires of the individual.
When Should I Consider Eyelid Surgery?
The most common reason someone chooses to have eyelid surgery is vision impairment. As we age the skin and often the muscles develop laxity which creates a heaviness of the lids causing a reduction in vision. Eyelid surgery is not covered by most insurance carriers and should be considered cosmetic surgery.
However, more and more people are deciding to address heavy eyelids earlier in life. Most patients say “people tell me I look tired” or “I cannot see my eye shadow when applied any longer”. It becomes an issue of looking refreshed. A blepharoplasty is a surgical procedure that can restore a youthful appearance to the eye area. The upper and/or lower eyelids are lifted and loose, or excess, skin and fatty tissue are removed from the eye lids. The procedure can be limited to the eyelids, but it may be recommended that it is combined with other procedures to improve your overall appearance. There is minimal bruising and swelling after eyelid surgery and down time is only a few days.
Functional blepharoplasty restores normalcy to an eyelid that has been altered by age, infection, degeneration or neoplasm (tumor). It can also be performed to improve vision. Functionally, the patient may complain of visual problems and eyestrain related to heavy upper eyelid tissue. The skin of the upper eyelids may rest across their eyelashes and block their vision, making them feel like they are looking through their lashes. Patients may report that they can improve their vision by elevating the flaps of skin with their fingertips.
Restoring vision is the primary goal of functional blepharoplasty. Patients undergoing functional blepharoplasty report improved vision, less eyestrain and also improved appearance. A consultation for functional blepharoplasty begins with an eye exam. Skin of the upper eyelids resting across the eyelashes is a clue that the vision may be compromised by the eyelid configuration. A visual field test will often confirm significant visual field loss. Formal visual field testing is performed both with the eyelids in a natural position and with the excess skin held off the eyelids. Most major insurance companies will pay for surgery when excess eyelid skin produces a greater than 50% loss of the superior field of vision.
Improving vision is only one of the reasons for blepharoplasty to be performed. In some cases, excess upper eyelid skin can push eyelashes into contact with the cornea and cause eye pain. Removing excess upper eyelid skin, since bacteria and debris can be trapped underneath the folds of tissue can help many people with intractable eyelid inflammation.
Functional blepharoplasty can significantly improve vision and enhance periocular (situated around the eye, as opposed to the term intraocular, which refers to within the eye) health in a wide variety of patients.
Cosmetic Blepharoplasty goals are to improve the appearance of the eyelids and the patient’s overall sense of well being. The frequency of this procedure is increasing rapidly. Patients who desire cosmetic eyelid surgery often express the wish to restore a more rested and youthful appearance to their eyelids.
Cosmetically, patients may want to accentuate their eyes, improve their overall appearance, and instead of looking tired, they may want to restore a rested and youthful appearance. Female patients may report trouble putting on eye shadow, or their eyeliner becomes smeared across their upper lid.
The lower eyelid blepharoplasty is always considered cosmetic surgery. The removal of lower eyelid fat is performed through the inside of the lid and via a transconjunctival approach. This approach minimizes many of the complications seen with older blepharoplasty techniques. The transconjunctival lower eyelid blepharoplasty is probably the most common cosmetic procedure performed on men today.
After cosmetic eyelid surgery, the eyes appear more rested and vibrant. The results can be so natural that friends and co-workers will often comment on how great you look, but may not realize that surgery was performed.