Your eyes are often the first thing people notice about you and are an essential aspect of your overall appearance. Scientific studies have proven that the first signs of aging and tiredness are perceived from the changes that occur in the periocular region.
This study supports the hypothesis that age and fatigue judgments are related to preferential attention toward the eye region. Consequently, these results suggest that aesthetic or functional surgery to the eye region may be one of the most effective interventions in enhancing the appearance of an individual’s face.
It is indeed the first area of the face to show your actual age. As we age, the tone and shape of the skin of the eyelids become loose and saggy. In the lower eyelids, the orbital fat that is usually invisible prolapses anteriorly and becomes visible through the skin, forming the so-called eyelid bags. The skin loses its elasticity, and wrinkles form all around the eyes, becoming even more visible as we smile. This aging process results in our face looking more tired and aged even when we are well-rested and happy.
Sometimes ‘baggy lids’ may occur at a young age due to familiar or constitutional factors and are not related to aging. Eyelid surgery can restore a fresh and more youthful look by removing excess skin, bulging fat, and lax muscle from the upper or lower eyelids.
Who Should Perform a Blepharoplasty?
When choosing a surgeon to perform blepharoplasty, look for a cosmetic and reconstructive oculoplastic surgeon who specializes in the eyelids with extensive training in ophthalmic plastic reconstructive and cosmetic surgery.
The aging of the periocular aesthetic unit is caused by a combination of tissue descent and fat atrophy. To achieve the best results, we need to recognize the upper eyelids are united to the brows and the forehead forming the superior complex of the aesthetic unit, and we should discuss with the patients the best indications case-by-case.
A proper clinical evaluation is required to perform the correct procedure in each patient. The procedure may look like a simple procedure to perform; achieving consistent results with a high satisfaction rate and pleasing aesthetic outcomes in each patient requires a deep understanding of the individual aesthetic features and the local eyelid anatomy regarding eye function.
Complex eyelid shape and anatomy; the oculoplastic surgeon understands how to achieve the best results and protect the eye.
Excess skin and fat are removed through an incision hidden in the natural eyelid crease for the upper eyelids. The incision is then closed with fine sutures, and it will rapidly heal to imperception. The procedure lasts less than an hour, is performed under local anesthesia with monitored intravenous sedation, and the patient can go home 2 hours after completing the surgical procedure.
The scar is placed in the upper eyelid crease, therefore invisible when the eyes are open.
For the lower eyelids, the most requested procedure is aimed at the removal of the so-called ‘bags’. The fat in the lower eyelids can be removed or repositioned through an incision hidden on the internal surface of the eyelid, without any visible scar.
The lower lid bags are accompanied by underlying troughs (tear trough, infraorbital hollowing) and shadowing (dark circles), giving the eyes a tired and aged appearance.
As surgeons, we need to recognize that many factors intervene to cause the so-called eyelid bags, and we need to discern what is what and how to best approach each individual patient accordingly.
We also need to look at the lower lids jointly with the cheek and the mid-face and address the two altogether to achieve a real rejuvenation.
The best technique of modern lower blepharoplasty consists of trans-conjunctival lower lid fat transposition. The excess fat of the bags is not removed as in the past but repositioned inferiorly to fill the emptiness of the infra-orbital hollow, so to correct the bulging without causing excessive hollowness, but rather a smooth transition between the eyelid and the cheek.
When present, eventual excess of skin in the lower eyelid can be successfully treated and corrected at the same time with tiny incisions hidden below the lash line.
At the same time, the lateral corner of the eyelid fissure can be slightly tightened and elevated, improving the fresh and young appearance without altering the natural aspect of the shape of the eyes.
The incision is then closed with fine sutures. Also, in this case, the procedure lasts less than an hour and is performed under local anesthesia with monitored intravenous sedation. The patient is discharged 2 hours after completing the surgical procedure.
Lower lid fat repositioning and skin excision offer a complete rejuvenation of the eyes and the mid-face without leaving any visible scar. When combined with facial fat grafting, the area around the mouth, lips, chin, and naso-labial folds can be improved simultaneously.
Upper and Lower Blepharoplasty
Upper and lower blepharoplasty are usually performed at the same time. Also, they can be combined with other procedures such as eyebrow or forehead lift, midface lift, face lift, neck lift, or laser skin resurfacing.
In the combined upper and lower eyelid blepharoplasty, the procedure will last less than two hours, is performed under local anesthesia with monitored intravenous sedation, and the patient is discharged 2 hours after completing the surgical procedure. The results generally last 10 years or longer.
Blepharoplasty: Pre and Post Operative Examples
Case 1: preoperatively, on the left, shows the common signs of periocular aging in an otherwise beautiful face giving a tired and aged appearance; in the picture on the right, a complete blepharoplasty brings back beauty and youth without any external marks of the surgery.
Case 2: preoperatively in the left shows the common signs of periocular aging, giving a tired and aged appearance to the entire face; in the picture in the right, an upper and lower blepharoplasty combined with fat grafting to the area around the mouth (naso-labial folds, lips, marionette lines) is effective in giving the patient face a younger look without altering her natural appearance.