Eyelid Surgery (Blepharoplasty)
The skin around the eyelids is usually the first area of the face to show the signs of aging. Sagging of the upper eyelids and bagginess in the lower eyelids can result in a tired, sad, angry or aged appearance.
Loose excess skin, weak muscles or a combination of both can cause sagging of the upper lids. Every time you blink, the skin and muscles of your upper eyelids stretch a bit and, in time, the repeated stretching causes the skin and muscles of the upper eyelid to get longer. A fold may even develop as the skin bulges outward and hangs over the lid.
Our eyes are surrounded by a protective layer of fatty tissue encased by a membrane that holds the fatty tissue tightly in place. As we age this membrane weakens allowing the fatty tissue to slip downward. Skin and muscle are stretched by the protruding tissue, increasing the appearance of “bags” under the eyes.
Eyelid surgery, called blepharoplasty, is a minimally invasive surgical procedure used to remove excess skin and fat around the eyes, giving you a brighter, more youthful appearance. This surgery is usually performed for cosmetic reasons, but can be considered medically necessary when the excess skin is interfering with vision. It is very common for both women and men, and new advances in technology allow the procedure to be tailored to each person’s anatomy and gender.
Eyelid surgery is done on an outpatient basis under local anesthesia with mild sedation. For the upper lids, a small incision is made in the natural fold and the excess skin is removed along with appropriate amounts of fatty tissue to rejuvenate the upper eyelid appearance. The most common incision site for the lower lids is just inside the inner surface of the eyelid. The excess fat is removed through this tiny incision, resulting in a more restful and youthful under-eye appearance. If there is also excess skin in the lower lid that needs to be removed, the incision can be made in the natural crease immediately below the eyelashes.
Incisions in the eyelid usually heal quickly, and there is very little risk of complications. Mild swelling and discoloration is common immediately after the surgery. Most people are able to resume their normal activities within one week after the surgery.
Over time, eyebrow sagging can develop as the result of gravity and the repetition of opposing muscle contraction that occur with different facial expressions. Sagging of the heavier eyebrow skin can push the eyelid down, causing an older, tired appearance. In more advanced stages, low eyebrows and upper eyelid fullness can contribute to peripheral and upper visual field loss.
To counteract the eyebrow droop, many people unknowingly raise their eyebrows to remove the brow and eyelid skin from their visual space. This only creates a new problem and these people eventually develop furrows or wrinkles in the forehead due to the constant contraction of the muscles that raise the eyebrow. In addition, some people – usually those with light-colored eyes — are sensitive to light and frequently ‘squint and squeeze’ their eyes. This pulls the eyebrows down and leads to wrinkles between the eyebrows and at the corners of the eyes commonly called crow’s feet.”
Cosmetic injections of Botox or Dysport can often temporarily correct lines and furrows in the forehead by freezing the muscle movement for several months, but some people may require a more permanent solution – a brow lift procedure.
Today, most brow lifts are performed with an endoscopic technique to raise the brow line and smooth wrinkles without removing any skin. This approach is much less invasive and requires only a few small incisions hidden in the hairline, through which the endoscope and specialized surgical instruments are inserted. A small camera on the endoscope allows the surgeon to see the tissues beneath the skin on a monitor. This results in less nerve damage, swelling, and bruising than traditional open, coronal browlift surgery. And because of the minimal trauma with endoscopic surgery, the patient has an overall faster recovery time.
In some cases, particularly with older patients or men who have a great deal of excess skin of the forehead, a traditional browlift technique may be needed to achieve the best results. This involves a longer incision, usually slightly behind the natural hairline. Healing time with this technique is a little longer, but the incision is barely perceptible once it heals.