Cosmetic eyelid surgery is a surgical procedure that is not medically necessary and is performed solely to improve your appearance. Unfortunately, your upper and sometimes lower eyelids may become droopy or baggy as part of the aging process. Your eyebrows also may sag or droop as a part of the same process. The eyelid skin stretches, muscles weaken and fat pockets become more prominent as they bulge. This may be a hereditary condition that runs in your family. Cosmetically, such conditions may detract from the overall attractiveness of your eyes and face and cause a tired or older appearance. A number of different types of surgeons can perform cosmetic blepharoplasty.
Ophthalmologists and oculoplastic surgeons (a surgical sub-specialty of ophthalmology) most commonly perform these types of procedures.
However, general plastic surgeons, oral and maxillofacial surgeons, and ear, nose and throat surgeons also perform cosmetic eyelid surgery.
The Eyelid Aging Process
As skin ages, it gradually loses its elasticity. A lack of elasticity plus the constant pull from gravity causes excessive skin to collect on the upper and lower eyelids. Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin can hang over the eyelashes and get in the way of seeing. The fat that cushions the eyeball from the skull can also cause bulges in the upper and lower eyelids. The thin membrane that holds the fat in place weakens with age, letting the fat come forward into the lids.
A eyelid surgery procedure performed?
Eyelid surgery (blepharoplasty) can be performed on your upper eyelids, lower eyelids, or both. Based on a preoperative evaluation of factors such as your underlying facial muscle structure, bone structure, and the symmetry of your eyebrows, your surgeon will decide how much skin, muscle, and/or fat to remove.
- Your surgeon will make precise markings to indicate where excess tissues will be removed in your upper eyelids and in your lower eyelids.
- In your upper eyelid, your surgeon will make an incision hidden within the natural fold of the upper eyelid.
- In the lower eyelid, the incision will be hidden just below the lower lashes. Alternatively, when excess fat is being removed, the incision can be placed inside the lower eyelid (transconjunctival incision). A laser may sometimes be used in conjunction with this method to tighten lower eyelid skin.
- Your surgeon will remove tissue through these incisions using surgical instruments, including scalpels, surgical scissors, radiofrequency cutting devices, and, sometimes, cutting lasers.
- Sometimes fat may be redistributed in the lower lids to eliminate puffiness or bulges. Your surgeon may make other adjustments to correct special problems such as muscle laxity.
- He or she will then apply sutures or tissue adhesives (glue) to smooth and reconfigure areas around the eyebrows and eyelids. Sutures are invisible to the eye and are commonly self-dissolving. In most cases, there is virtually no detectable scar.
- Less tissue is removed in patients with dry eyes to avoid exposing more of the eye to the air, which can cause symptoms to worsen.
- Your surgeon also may use a laser to enhance the procedure by resurfacing skin and smoothing wrinkles in the eyelid and eyebrow area.
A surgeon who is board-certified in an appropriate specialty will choose the right procedure for you based on your physical characteristics and aesthetic concerns.
Your surgeon will place the incision line at the natural eyelid crease through which he or she will remove excess skin, muscle, and fat. Lasers may be used to remove this excess tissue to reduce swelling and bruising.
There are a number of options for performing lower eyelid surgery:
- The traditional approach places the incision just below the eyelashes, trimming and/or repositioning excess skin and fat, and tightening the lower eyelid muscle.
- In the transconjunctival approach, effective in improving lower eyelid bags and puffiness, your surgeon places the incision inside the eyelid. Your surgeon can remove excess fat through a transconjunctival incision, but not excess skin.
- The ‘skin pinch’ blepharoplasty removes only a bit of skin. This is effective if you have strong lower eyelid support and only a little extra skin. In some patients laser resurfacing can both tighten excess skin and remove wrinkles.
- The use of hyaluronic acid (HA) fillers is a nonsurgical alternative for the lower eyelids. Restylane, Juvéderm, and other soft tissue fillers can be injected into the tear trough (crescent-shaped under-eye area) to rejuvenate the appearance of the under-eye area. Results are varied and last approximately six months.
Eyelid surgery incisions and scars be like:
Upper eyelid surgery: Your surgeon will mark the natural lines and creases of your lids and keep your scars as hidden as possible along these natural folds. Fine sutures will be used to close the incisions, thereby minimizing scar visibility.
Lower eyelid surgery: In traditional blepharoplasty, your surgeon will make the incision in an inconspicuous site along the lash line and smile creases of the lower lid. In a transconjunctival approach, your surgeon corrects eyelid puffiness caused by excess fat by making an incision inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin.