Signs of aging may occur first around the eyes. Eyelid surgery performed by James M. Shaw, MD, a board certified plastic surgeon, can provide long-lasting improvement. Many individuals start to show changes in their 40s, and in some patients it can start even sooner. Often, family history and genetics play a role in the onset of these changes. Frequently there are complaints of “looking tired” all the time.
Upper eyelid changes are mostly due to skin laxity. Sometimes there can be a bulging fat pad on the inner aspect of the upper eyelid, next to the nose. In addition, there can be drooping and descent of the outer half of the eyebrow area which contributes to the skin crowding down on the upper eyelid.
With the lower eyelid there is a combination of three things that give the appearance of aging. One is bulging of the fat pads that are always present behind the eyelid. At a young age, the support for this is stronger and keeps the fat pad back in position. Over time, the support weakens and the fat bulges forward. The second is loss of fat in the “tear trough” area. In youth there is enough fat at the lower eyelid/cheek junction that everything is smooth. You can’t tell where the eyelid stops and the cheek starts. With normal aging, this fat goes away and a crease develops. The last factor is thinning and wrinkling of the skin.
Eyelid surgery to remove excess skin on the upper eyelid gives an instant result. Dr. Shaw will take care to avoid removing too much skin. This would make normal blinking difficult. It is better to leave a tiny bit extra than to take away too much.
Wrinkles may be best treated with laser resurfacing. If there are prominent lines at the crow’s feet area, this is best treated with Botox.
Sagging eyebrows can hang down and worsen the appearance of the upper eyelids. This hooding of the outer portion of the eyebrow cannot be corrected with eyelid surgery. This will require a forehead lift (or brow lift).
You can see treatment of aging eyelids may take variety of approaches, both surgical and non-surgical.
The Eyelid Surgery
When removing excess skin and fat, Dr. Shaw will typically be conservative. Over aggressive eyelid surgery can lead to an unnatural appearance.
For volume loss at the tear trough area, fat grafting can be done. This involves removing a small amount of fat from the abdomen or hip and injecting the fat into the area that needs more volume and fullness.
Unless the patient is elderly, it is uncommon to remove skin from the lower eyelids. This skin can be smoothed and tightened with laser resurfacing using a CO2 laser.
The eyelid surgery can be done either with the patient sedated or asleep. Either method would be under the supervision of a board certified anesthesiologist. You will need a responsible adult to drive you home following surgery.
Eyelid skin is very thin and tends to have more bruising and swelling than in other facial areas. It is best to keep the head of the bed elevated for the first few days and to keep cold packs on the eyes as much as possible. Sleep in a recliner or use several pillows to raise your back, shoulders and head. Try not to sleep on your side, or one side may swell more than the other. Some patients prefer to use a horseshoe shaped airplane type pillow to avoid turning to the side.
Eyelid surgery is usually not very painful. Time off from work depends how comfortable you are with having visible bruising and swelling. It typically takes about 10 days for these to subside. Many patients use glasses or sunglasses and are able to be out running errands after a few days. Strenuous activity and exercise should be avoided for the first two weeks.
Wearing contact lenses may be uncomfortable for the first week or two after eyelid surgery.