Eyelid Lift (Blepharoplasty)
“I’m tired of looking tired” is a very common concern. The eyes are incredibly expressive and your ability to interpret human fatigue, emotion, and age depend on sub-millimeter movements within the eyelids and the skin and muscles around them. This makes blepharoplasty an incredibly powerful way to rejuvenate the face.
We all age in 3 ways. Our skin begins to have surface changes (sun spots), we lose volume (mostly fat), and we lose elasticity in our skin. The rate at which these occur depends on your heritage and your degree of exposure to the environment (sun, smoke, etc).
The bags that you see are the product of volume loss in the cheeks. The fat around the eyes does not change along with the fat pads of the face. As the volume in your cheeks decreases, the normal amount of fat around the eyes is exposed to a greater extent and is further highlighted by laxity in the septum that separates the fat around the eyes (periorbital fat) from the more superficial eyelid and cheek. While many procedures used to be aimed at removing this fat from around the eyes, it can leave the area around the eyes looking hollow, which is not rejuvenating, just different.
The current method with which we correct lower lid bags is a blending of the lid cheek junction to re-establish the youthful contours of the lower eyelid and cheek. This typically entails fat grafting of the cheeks and rearrangement of the fat around the eyes in order to smooth the transition from lower lid onto the cheek. Once this youthful relationship is established, the amount of skin to be removed is quite minimal and the incision is hidden just under the lash line.
While the lower eyelid can cast a shadow and give us bags or dark circles, the upper lid is critically important to our ability to see. It moves much more than the lower lid in its effort to protect our eye and works together with the eyebrow to optimize our vision.
The Aging Eyelid
Lets start from the top, down. As we age, our eyebrows begins to descend as we lose elasticity in our skin, but our upper eyelids are constantly sensing the amount of weight placed upon them and send signals back to the forehead to lift the brow in order to optimize our vision. As the brow drops further, the signals become stronger to lift the brow and we begin to see lines across our forehead. Our body is so good at coordinating this relationship that we need not think about it and while our eyes are open, we never see the eyebrows drop to their true, relaxed position.
The eyebrow and eyelid work together
The reason it’s so important to discuss the eyebrow at the same time as the upper eyelid is that if you have “excess” skin on your upper eyelids, we can’t simply remove the skin without first ensuring a normal position of the eyebrow. Removing upper lid skin could take away the signal to lift the eyebrow and then after surgery you may find that your eyebrow droops more than it did before surgery. Additionally, once the eyebrow has been lifted to its normal, youthful position, the “excess” skin of the upper lid, may now be just the right amount of skin for normal function and contour.
A word on the function of the upper eyelid. There is a muscle called the levator that lifts the upper eyelid when your eyes are open. If you have noticed that one eyelid sits lower than the other when your eyes are open, this may be due to weakness or even disruption of levator attachments to your eyelid. Restoring the normal relationship of the levator to the eyelid margin can restore normal function, symmetry and make you look more alert and rested.
If have find that your eyes no longer represent your state of rest, alertness, or self-perception, please reach out to one of our patient coordinators. Blepharoplasty can significantly improve your wellbeing, self-esteem, and quality of life.