Over the years eyelids can start to sag. By your late 30s or early 40s, the thin skin of your eyelids starts to lose its elasticity as the muscles beneath the skin grow weaker and begin to stretch. This allows fat to protrude through, resulting in excess folds of skin that may actually hang over the edge of the upper eyelids.
Not only can this make a person look older but you may also feel an extra heaviness in the upper lid or feel the skin sitting on your lashes. Fine wrinkle lines and creases appear in the delicate skin around the lids. The result is a tired, sleepy or sad look that detracts from the natural beauty of the eye area. The extent of visible ageing around the eyes is largely determined by heredity and the chances are that, if your parents had droopy eyelids, so will you.
In 2014, elective blepharoplasty, also known as eyelid surgery, was the fourth most commonly performed cosmetic surgical procedure but its popularity has been decreasing. The procedure corrects drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin and muscle. Surgery can also be performed on the lower eyelid but this area needs more medical attention to correctly diagnose the problem as sometimes there is too much fat, too much skin or not enough of either.
The main conditions that can be treated by blepharoplasty include:
Good candidates for the procedure are adult men and women who have healthy facial tissue and muscles, do not smoke, and do not have a life-threatening illness or medical condition that could affect healing. A physical examination must be conducted to determine the cause of the droopy lid. If it is a functional problem of the lid, the medical term is called a ptosis repair of the eyelid. If it is downward displacement of the brow, then the correction is to elevate the position of the brow with or without surgery of the upper lid.
During surgery, incisions are made in the natural folds of the eyelid, in the crease of the upper eyelid and just beneath the lashes or behind the lower eyelid. This way, incisions are virtually unnoticeable after they have healed. Your surgeon will make precise markings to designate where excess skin and fat pads need to be removed. Some underlying muscle may also be removed. These tissues are removed with surgical instruments such as scalpels, surgical scissors, radio-frequency cutting devices and sometimes cutting lasers. Sutures or tissue adhesives (glue) are then carefully applied to smooth and reconfigure areas around the eyebrows and eyelids.
During the procedure, your surgeon will make judgments about how much skin, muscle and/or fat to remove, based on a pre-operative evaluation of factors such as your underlying facial muscle structure, bone structure and the symmetry of your eyebrows. Less tissue is usually removed for ‘dry eye’ patients to avoid exposing more of the eye to the air, which can cause symptoms to worsen. Your surgeon also may use a carbon dioxide (CO2) laser to enhance the procedure by resurfacing skin and smoothing out any remaining wrinkles in the eyelid and eyebrow area.
In cases where the eyebrows also are droopy, a procedure to elevate the eyebrows also may be appropriate. This procedure, called a brow lift, involves making incisions into the scalp and tightening the skin to lift the eyebrows.
It will take time to see results after surgery. You are likely to be bruised and swollen and your eyes may be itchy and dry following the procedure. Your eyelid surgery results should be long-lasting. For the most part, removal of hooding and upper eyelid skin is a procedure that is performed only once. As ageing continues, your brow can drop or descend, causing excess skin to reappear on the upper eyelid but, in this case, the solution is a brow lift, not a second upper blepharoplasty. Lower blepharoplasty should also only need to be performed once.
Elise Bevan, a clinical negligence solicitor at Penningtons Manches said: “Eyelid surgery can enhance your appearance and help build your confidence. However, it may not result in your ideal look or cause people to treat you any differently. Blepharoplasty will not alter your facial structure. It is important to know your face well before you decide to have surgery. Think carefully about your expectations and discuss them with your surgeon. Fortunately, significant complications from eyelid surgery are infrequent but, as with any cosmetic surgery, it is important that the patient has realistic goals for improvement of the upper and/or lower eyelids and surrounding area.”