In my view, eyelid surgery, also known as blepharoplasty, is one of the most popular surgical procedures for facial rejuvenation. It is a procedure to remove excess fatty tissue and/or loose skin surrounding the eyes to give the area a more rejuvenated appearance.
The orbital region is of primary importance of facial aesthetics and expression. The eyes and the area around them are particularly important in establishing a first impression when meeting people. This is also the area that shows the first signs of ageing. As a consequence, small improvements in the look of the eyelids have a magnified impact because of the large difference eyelids make to the overall look of a face.
In the upper eyelids, ageing causes a downward movement of the outer corner of the eye, stretching of the eyelid skin producing a ‘hooded’ appearance and, in some patients, heaviness and downward movement of the outer half of the eyebrows.
In the lower eyelid, the most frequent complaint is of puffiness or eye bags, which is noticeable more in the morning and may improve as the day passes. This is mainly due to increased prominence of the fatty cushion around the eyeball because of weakening of the structures holding it in place, and movement of the cheek fat pad downwards with gravity, which makes the outline of the bony eye socket more visible through the skin. There is usually a little skin excess, though in some patients there may be none and in others it may be marked. Lower eyelid surgery may also improve a pronounced tear trough — a depression running from the inner corner of the eyes to the cheek.
In some patients, the primary problem may be due to sagging of the eyebrows with age rather than the eyelid in which case a brow lift may be indicated.
It is important to remember that the procedure can never halt the ageing process. The clock can be turned back but no surgeon can stop it ticking.
What is blepharoplasty?
Blepharoplasty is a surgical procedure to improve the appearance of the eyelids. Surgery can be performed on the upper eyelids, lower eyelids or both. Different types of procedures are undertaken for the upper and the lower eyelids.
Upper eyelid blepharoplasty frequently involves removal of excess skin and/or muscle on the upper eyelid, although some people complain also of puffy upper eyelids due to excess fatty pockets which can also be removed. It is a relatively straightforward surgery with few complications and a rapid recovery. Upper blepharoplasty, restores a natural, more youthful contour to the upper eyelid by removing excess skin that causes hooding or upper lid bags, causing a tired appearance.
In contrast, lower blepharoplasty can be very complex and involves the management of the fat pads and the skin if required. It carries a higher complication rate and a much more prolonged recovery time. Lower blepharoplasty restores a smooth, natural contour to the area beneath the eyes, by correcting puffiness and bags resulting in a more youthful appearance.
Blepharoplasty can be performed as a standalone procedure or more often in combination with other facial aesthetic surgery operations such as a brow lift or a facelift.
Who is a good candidate for blepharoplasty?
It is most common for people in their forties and fifties to have this procedure, but it may be performed on much younger people who may have inherited heavy, droopy eyebrows and fullness in the upper eyelids. Most people have the operation to get rid of the overhanging folds at the outer half of the upper eyelids. In my opinion, the most common reasons for considering eyelid surgery are:
- Excess skin obscuring the natural fold of the upper eyelids
- Loose upper eyelid skin that impairs the vision
- Puffy appearance to the upper eyelids, making the eyes look tired and sad
- Excess skin and fine, ‘crepe paper’ type lower eyelid wrinkles
- Bags and deep grooves under the eyes
- Upper eye surface is too small or not smooth enough to apply makeup
What are the limitations of blepharoplasty?
- Following blepharoplasty, it is possible that pre-existing asymmetry of the eye area may persist
- In some people, if the brow is not corrected or stabilised, the position of the brow can descend following upper blepharoplasty
- If the brow, for example, lies in a low position, this may well contribute to the appearance that you are unhappy with. In this case, a form of brow lifting procedure may be advised in addition, or even as an alternative
- In case of deep set or sunken upper eyelids, upper blepharoplasty on its own may not be the right procedure
- If you have deep set or sunken lower eyelids, lower blepharoplasty on its own may not be the right procedure. Adjunctive procedures may be necessary to achieve the best result. This may be especially true if you have festoons (large swollen bags under the eyelids that in extreme cases can look like flaps of skin). In this case, a mid-face lift may be more appropriate, or even direct excision of the festoons
- Blepharoplasty will not eradicate dark circles or the wrinkles around the eyes nor will it elevate droopy eyebrows. There are other procedures designed for these purposes.
Where will the incisions be?
The incision lines for eyelid surgery are designed so the resultant scars will be well concealed within the natural structures of the eyelid region. The incision for the upper eye surgery is made in the natural crease line approximately 8-10mm above your eyelashes and extends a little into the “crow’s foot” area at the side of the eye.
The incision for the lower lid is made just below the eyelashes and runs out to the natural crease area. If excess skin is minimal, it is sometimes possible to perform this lower lid surgery without external scars by making an incision inside the lower eyelid, a procedure known as transconjunctival blepharoplasty.
How long does the effect of the eyelid surgery last?
The rate at which ageing occurs, and continues, varies from one person to another. In general, blepharoplasty surgery should provide an improvement that lasts for about 10 years.
You can help keep your results looking their best by living a healthy lifestyle. My advice as a plastic surgeon is to wear sunscreen daily, eat a diet rich in whole foods and vitamins, don’t smoke and use good skincare. This will help keep your body healthy and skin looking its best.
What are the complications of blepharoplasty?
Fortunately, significant complications from eyelid surgery are infrequent. Blepharoplasty, which remains the gold standard for eyelid rejuvenation, is usually performed without any major problems. However, all surgeries carry some uncertainty and risk, but complications are infrequent and minor.
It is important to remember, that complications can happen with any type of surgery; however, confirming your surgeon is certified by the Royal Australasian College of Surgeons (RACS) in Plastic Surgery serves as a warranty for the type of training your surgeon has received and the type of exams needed to successfully pass, in order to become a certified and accredited plastic surgeon (FRACS). All RACS members have undergone extensive specialist training and follow a strict code of conduct.
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Words — Dr Katarzyna Mackenzie, Plastic Surgeon
