Has anyone ever said “you look tired” or “you must have been up all night” when in fact you feel great? The fact is changes around the eyelids can lead to an aged, tired appearance. Youthful eyes have no excess fat, smooth skin, no lid laxity, and an almond shape. Undesirable changes in the upper lids include excess skin and fat as well as ptosis (droopy eyelid) which can obscure your vision. Undesirable changes in the lower lids include excess fat and skin and ectropion (laxity) leading to a dry eye.
Surgical procedures to rejuvenate the eyelids involve removing excess skin and fat and tightening of lax eyelids. Blepharoplasty will not correct crow’s feet nor correct excess skin in the eyebrow area. Botox will be needed to correct crow’s feet and a brow lift will be needed to correct brow ptosis. Most eyelid surgeries are performed in office under local anesthesia with minimal discomfort and recovery. Below is a discussion of the common methods of rejuvenation of the eyelids.
Excess skin in the upper lid is carefully measured and marked after being cleaned with an antiseptic solution. Local anesthesia is injected to numb the area and to limit bleeding. A strip of skin is removed along with a strip of eyelid muscle. In some patients the eyelid muscle is preserved for a more natural look. Fat pockets are then dissected and excess fat removed. If the eyelid is droopy (ptosis), a repair can be completed at this time. Following a short healing period of 3 days the sutures are removed. After a few weeks of healing the scars become imperceptible. Complications are rare and can include over tightening of the lid skin, bleeding, and incomplete removal of fat.
Preoperative evaluation includes amount of skin and fat as well as evaluating the elasticity of the lower lid by performing a “snap back” test. For laxity of the lower lid a canthopexy or canthoplasty may be needed. Following cleansing with an antiseptic, local anesthesia is injected. An incision is made 2-3 mm from the lash line and a flap is developed. Excess skin is removed followed by removal of fat from all 3 pockets. Sometimes fat is preserved and rolled under the nasojugal groove. Following the surgery one should keep their head elevated and ice the lower lids for the first day. Sutures are removed after 2-3 days and recovery is very quick.
Transpalpebral lower blepharoplasty
For patients with fatty lower eyelids and minimal skin, a lower eyelid lift with an incision inside the eyelid may be used. This has the advantage of no external scar but may require a peel of the lower lid skin.
Ptosis of the upper eyelid occurs when the eyelid drops down toward the pupil. The cause of ptosis is multifactorial but advanced age is one of the most common causes. Repair involves suturing the levator aponeurosis (a ligament) which elevates the lid to a more normal position. This procedure may be covered by insurance.
Excess wrinkling of eyelid skin can be improved by chemical peeling. Chemical peeling requires 2-5 days of recovery and has minimal complications.
For patients with lax lower lids or festoons an orbicularis lift may be indicated. This involves pulling the muscle of the lower lid upward and suturing it into place. Suspension of this muscle supports the lower lid leading to a more youthful look.
These procedures tighten the lax lower lid by repositioning the lateral canthus (corner of the eye) or by shortening the lower lid. Laxity of the lower lid can lead to ectropion (outward bowing of the lower lid) which can cause dry eye syndrome. Ectropion can also lead to an aged appearance. The elasticity of the lower lid is evaluated by performing a snap back test. The eyelid is pulled down by the surgeon and the degree of “snapback” is measured. Inability of the eyelid to return to a normal position or an excessive distance of pull down may indicate the need for a canthopexy. Your surgeon will decide which type of canthopexy or canthoplasty is indicated to achieve a normal appearance.
Before & After Patient Photos
Surgical Pricing Estimate – $2,500-$5,500
These prices are NOT offers and merely estimates.