Background: Aging affects all areas of the face but the eyes develop the first and often some of the most profound age-related structural changes. The repetitive movement of the upper eyelids eventually creates redundant skin, that when significant enough, may hang down near or on the lashes. While the lower eyelids also develop loose skin, the appearance of the three lower fat pads also herniates outward creating bags or lower eyelid pooches.
Blepharoplasty surgery is a generic term for eyelid surgery and does not convey what exact technique is done. But in the concepts of excessive skin removal, minimal orbiculares muscle removal, and either fat pad removal or transposition. In some cases on the lower eyelid chemical peels or laser resurfacing may be done. Depending upon the degree of eyelid changes and the patient’s age, these technique are mixed and matched to treat the appropriate anatomic problem.
Blepharoplasty surgery is most commonly done in pairs but not always done in sets. Both eyelids are done together, both lower eyelids are done together or all eyelids are done during a single surgery known as 4-lid blepharoplasties. Some patients only address the eyelid pair that bothers them the most, waiting to do the other pair later when it bothers them more. Other patients will be more proactive and take the opportunity under anesthesia to do all eyelids even if it means a more minimal technique is done on the less concerning eyelid pair.
Case Study: This early 60ish female had developed a large amount of redundant skin on the upper eyelids with hooding. The lower eyelids were less severe by comparison but still had redundant skin and herniated fat pads.
Under general anesthesia after the completion of her facelift, an upper blepharoplasty was perfumed removing a large segment of skin and a small strip of orbiculares muscle. A skin-muscle flap was raised on the lower eyelids partially removing some of the fat pads and a small strip of skin and muscle right below the lash lines.
Her six week after surgery results show well healed eyelids that look better but also natural. They are neither overdone (too much tissue removed) or pulled too tight.
1) The earliest and often most profound areas of the face that ages is the eyes.
2) The upper and lower eyes exhibit some slightly different signs of aging but redundant skin is the hallmark of both.
3) Upper and lower blepharoplasty surgery is often done together since the eyelids are a ‘matched set’.
Dr. Barry Eppley