Very often, patients report that they look much more tired than they actually feel. Frequently, this involves the typical aging processes occurring around the eyes and is treated with an upper and/or lower eyelid lift, also referred to as a “blepharoplasty.”
In the upper eyelids, excess and redundant skin is typically a primary contributor to the look of heaviness to the upper eyelid. This appearance can be further exaggerated by a brow position that is too low causing further redundancy in the upper lid skin. Oftentimes, the medial fat pad located in the upper eyelid towards the nose is slightly bulging and full as well.
In the lower eyelids, redundancy of the skin and wrinkling of the skin plays a role. However, it is not the primary problem in the lower eyelid itself. For the lower eyelid, we typically notice a bulging and fullness of the lower eyelid, often referred to as “bags under the eyes.” In the lower eyelid, there are three fat compartments as opposed to the two in the upper eyelid. With age, the thin septum that holds the fat compartments in tightly becomes weak, allowing the fat pads themselves to bulge outward. Furthermore, the typical facial aging process discussed in the facelift portion of this website is occurring causing the cheeks to descend from a more prominent bone in the face to a more concave portion of the facial skeleton. This process of the upper lid bulging and the cheek descending creates a noticeable depression and transition zone between these two structures. This also gives the appearance of shadowing and darkening under the eye further contributing to that aged and tired appearance.
What is involved with eyelid surgery or “blepharoplasty?”
Because the primary concern of the upper eyelid is skin redundancy, the upper blepharoplasty involves an incision that ultimately falls within the natural crease of the upper eyelid allowing the appropriate amount of skin overhanging the eye to be removed. This will recreate a clean fold in the upper eyelid rather than a redundancy of overhanging skin. Oftentimes a portion of the medial fat compartment that can give a heavy appearance is also removed.
In the lower eyelid, an incision is made along the eyelid margin where eyeliner is typically worn. The skin in this area can then be elevated and later on conservatively excised to allow for a more clean and smooth re-draping of the lower eyelid. This helps to treat some of the fine lines and wrinkles in the region. Most importantly in the lower eyelid, we treat the fat pads themselves. The septum is incised and each of the three fat compartments is entered and a patient-specific amount of fat is removed to improve the bulging that is seen. In certain patients who do not have wrinkles or redundant skin of the lower eyelid, this portion of the procedure can be performed without any visible scars by making the incision on the inner surface of the eyelid and accessing the fat compartments. This is referred to as a transconjunctival blepharoplasty.
What other procedures can be combined with eyelid surgery?
As discussed in the browlift section of this website, in some patients the brows can be positioned too low. This worsens the degree of skin redundancy of the upper eyelid. Therefore, in these specific patients there is the possibility of a browlift to help to open up and refresh the upper lids in conjunction with the upper lid blepharoplasty. For the lower lid, this may also be combined with a mid-face lift which helps to lift the cheek structures back to their normal anatomic position over the prominent cheekbone, thereby smoothing the contour and transition from the lower eyelid to the cheek. This helps to alleviate the depression and shadowing that can be present in that region. Oftentimes, fat injections into the cheek region and the tear trough deformity that develops in this area is also performed for the same purpose of smoothing the transition from the lower lid to the cheek and restoring fullness to this area. Obviously, any of the other procedures that are associated with facial rejuvenation, such as a facelift or laser resurfacing of the face can be combined with eyelid surgery.
Lastly, there are some patients that in addition to having excess skin of the upper lids, they actually have what is referred to as eyelid ptosis. This refers to the actual position of the upper lid margin itself being too inferiorly positioned on the eyeball itself. The normal resting position of the upper lid should lie approximately 1 mm below the upper margin of your colored iris. If this is too low, this can also give a tired appearance, as well as create some visual field obstruction. In these patients, eyelid ptosis repair that is performed by one of several different techniques with the goal of repairing or reconstructing the levator muscle in the upper eyelid that functions to raise the eyelid may be advised.
What type of anesthesia is used for this procedure?
As with other facial rejuvenation procedures, IV sedation with the injection of local anesthetic is typically used. Patients seem to tolerate this well and sleep comfortably throughout the entirety of the procedure.
*What should I expect after surgery?
Most patients tend to experience only minimal discomfort after eyelid surgery. There is obviously a degree of swelling and bruising that is patient-specific and lasts approximately a week. At that point, it typically can be covered with makeup. However, it still takes several weeks for full resolution of the swelling. Most patients can actually return to activity and work even within a few days of the procedure.
I am interested. What do I do next?
The information on eyelid procedures contained within this website is for overview purposes. If you have further questions or are considering this procedure for yourself, schedule a consultation with Dr. Coscia. At that appointment, he will listen to your specific concerns and then provide specific treatment options to address your concerns.
*Individual results may vary