Introduction

Aging is a complex, dynamic process that can produce numerous structural changes in the face. In the region of the eye, or what is termed the orbit, structural changes occur in the bone, fat, muscles, ligaments and skin. In the youthful eye, the lid opening is long with graceful arcs. As we age, this opening becomes foreshortened and rounder, the eyeball sits further back in the orbit, the lids may droop, fat may bulge, and the skin becomes redundant. Each patient is different, and each eye must be evaluated for what needs to be done during the eyelid surgery (blepharoplasty) to restore a youthful appearance.

Blepharoplasty is a global term meaning eyelid surgery. A blepharoplasty can be performed on the upper lid alone, the lower lid alone, or on both eyelids together. In the past, eyelid surgery may have meant removing excess skin and fat, leaving an operated appearance. However, the modern blepharoplasty is designed to restore the youthful beauty of the eye. 

Upper Eyelid Surgery

The upper lid may show signs of aging by a variety of means. There may be shortening and rounding of the lid margin, excess skin may have developed, there may be bulging of the upper lid fat pads, there may be redundancy of superficial lid muscle, or there may be sagging of the lid position.

Aging changes may also be associated with lowering of the eyebrows in many patients. Eyebrow lowering may be the of the changes they see in the lids.

It is important to identify the problems if a youthful, natural and pleasing eyelid surgery result is to be achieved. The aging of the upper lid may even interfere with the peripheral vision.

The Blepharoplasty Procedure

An upper blepharoplasty is performed either under intravenous sedation, or local anesthetic, depending upon the individual procedure necessary. A curvilinear incision in the normal upper lid crease gives the surgeon access to the anatomical structures relevant to the procedure. Some may be tightened, some may be repositioned, and others may be reduced in size or volume. The excess skin is then tailored, and the skin is closed with tiny sutures. The youthfulness of the lid is restored, and a natural, graceful sweep to the lid is created. 

Patients usually return to normal activities in 2-3 days. Sutures are removed 3-4 days after the eyelid surgery. This surgery may be performed alone, or it may be combined with other facial rejuvenation procedures to improve the youthfulness of the entire face.

Lower Eyelid Surgery

The lower lid may show similar characteristic aging changes to the upper lid. There may be shortening and rounding of the eyelid margin, excess skin may have developed, there may be bulging of the lower lid fat pads, there may be redundancy of superficial lid muscle, or there may be sagging of the lid position. Many patients complain that these changes make them look sad or tired.

The Blepharoplasty Procedure

A lower lid blepharoplasty is usually performed under intravenous sedation. Some patients may only need a hidden incision inside the lid, while in others an incision just below the eyelashes is made. The eyelid surgery will improve the look of the lower lid by removing excess skin, tightening the muscle surrounding the lid, repositioning the outer part of the lid, and / or removing or repositioning excess fat. 

Patients usually return to normal activities in 2-3 days. Sutures are removed 3-4 days after surgery. The lower lid usually shows bruising a little more than the upper eyelid, and that usually lasts 7-10 days.