One of the most common requests from patients is for improvement of the area around the eyes. In younger patients, the request is usually for creation of a double eyelid or correction of an asymmetry. Older patients ask for improvement of droopy upper eyelids or improvement of their lower lid eyebags.
The problem of a droopy upper eyelid can stem from many different issues. This is something that I spend a long time explaining to patients. In the simplest case, it is a matter of excess skin and fat in the upper eyelid. More often, it’s a combination of lax skin and fat in the upper eyelid and a lowered eyebrow area. A youthful eyebrow in a lady is usually 1-2 cm above the bony ridge in the frontal bone. In a man, the eyebrow is right on this bony ridge. With age, the eyebrow moves down and affects the upper eyelid making it droopy. You can try this on yourself by artificially lowering your eyebrows with your fingers. Finally, a condition could exist where the upper lid opening muscle is weak or detached. This is called eyelid ptosis.
These three issues require an upper blepharoplasty, a suture browlift or endoscopic browlift or a correction of ptosis respectively. Sometimes a combination of procedures is needed. All of these surgeries can be done under local anesthesia with a light to moderate sedation. They are associated with 2-3 weeks of downtime due to swelling.
In the case of the lower eyelids, age, lack of rest and repeated fluid retention in the lower lids cause swelling, skin laxity and lid laxity. The fat within the eye socket protrudes forming eyebags and also cause a distinct line between the cheek and the eyelid. This is the “tear trough” deformity so named because this is where tears collect when one cries.
In mild cases in younger patients, I usually try a course of eye gels. These will usually contain an astringent to remove excess fluid, a compound to tighten the lower lid skin like a peptide, a lightening agent and micronized silica to camouflage the dark eye circles. In moderate cases, it is possible to add in a radiofrequency based tightening procedure like Thermage to tighten the lower lid skin.
Finally, if surgery is considered, a lower blepharoplasty can be done. Depending on the patient, this may involve redistribution of fat to improve the tear trough, tightening of the lower eyelid and a judicious removal of skin and muscle. The surgery can be done as a day surgery under local anesthesia and light sedation. They are associated with 2-3 weeks of downtime due to swelling.
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