As we age, eyelid skin frequently becomes a concern, prompting people to consider treatment to relieve heaviness and alleviate a tired appearance. To understand why these changes develop, we need to have an understanding of the anatomy of the eyelid area and how the ageing process affects this.
The prime role of the eyelids is to protect the eye to ensure that the cornea remains hydrated and provides a physical barrier to injury. As we age, the brow falls a little, allowing more skin to sit in the upper eyelid. This increases the overhanging skin fold and may give a sensation of heaviness. The quality of the skin changes, also leading to crepey texture within the eyelid and this increased fold often looks messy and can lose its sharpness. Fat may be apparent in the corners of the upper eyelid.
Fat that is naturally present around the eye is kept in place by a structure called the orbital septum. As we age, the orbital septum becomes lax, allowing the fat to prolapse forwards. This prolapse forwards gives the characteristic puffiness that commonly occurs with advancing age.
With the above changes, the junction between the eyelid and the cheek falls, leading to hollow lines appearing and giving the illusion of the eye becoming smaller.
In assessing the eyelids for an upper blepharoplasty procedure, we need therefore to assess the following –
Skin excess and quality
Natural lid tone
As every patient has unique needs and concerns, a detailed consultation with a consultant plastic surgeon is essential prior to undergoing a procedure of this nature. During the consultation, your Surgeon will discuss your area/s of concern, desired improvements, options available (including no treatment at all) and expected outcomes. Your surgeon will examine your face and eye area and may take some photographs for your medical records.
Should upper eyelid surgery be agreed upon as the most suitable treatment, the procedure will be carried out by your surgeon in our operating theatre. Following cleaning of the eyelids, the skin is carefully marked and local anaesthetic gently given. The procedure commonly takes around 120 minutes to perform and after the anaesthetic is given, it is entirely pain free. Skin is removed along with a small strip of redundant muscle and if necessary, the fat can be re-contoured. The wound edges are carefully closed and fine strip dressings applied.
As the upper eyelid has to have spare skin in it to enable it to close effectively, there is only so much skin that can be removed. You will therefore always have a fold of skin in the eyelid unless of course you are of eastern origin.
You will always be able to see a scar. Usually the scars settle to fine lines but often these are only noticeable when the eye is closed. Occasionally the inner and outer aspects of the scar may be visible as fine lines.
The brow doesn’t lift after upper blepharoplasty unless a specific procedure is used at the time of surgery. The brow may be lifted surgically or botulinum toxin is often an effective non surgical alternative.
It is imperative that after surgery you rest to allow the area to settle, we advise you not to bend
over or strain and avoid exercise for a few days after your surgery. This ensures that your blood
pressure remains stable, reducing the chances of bleeding and subsequent swelling and bruising.
Patients generally experience minimum discomfort after this procedure and healing usually
progresses quickly. After surgery the area will bruise a little reaching a maximum after 48 hours,
gradually settling over the weeks after surgery, any bruising that occurs on the lower eyelid may
be covered up with concealer.
The very fine stitch is easily removed after a week. We advise you start gently massaging the incision line with a light eye cream to help soften the scar and speed up the healing process two weeks after surgery.
Application of local anaesthetic at the treatment site ensures total comfort for the duration of the procedure
Skin is removed, along with a small strip of redundant muscle and if necessary, the fat can be re-contoured
Results can be seen once sutures have been removed and post operative swelling has subsided
It is imperative that after upper blepharoplasty you rest to allow the area to settle. We advise you not to bend over or strain and avoid exercise for a few days after your surgery
Whilst excess skin is permanently removed, eyelid surgery doesn’t stop the clock, it merely resets it. As time passes, the ageing process will once again progress.