All about blepharoplasty

As the effects of ageing take their toll, a blepharoplasty procedure (eyelid surgery), which addresses the upper and/or lower eyelids, can help recapture a sense of youth and also express an overall sense of health and happiness to others.

As the ‘window to the soul’, the eyes offer an indication of someone’s age, level of fatigue and even overall state of health. Studies have shown that factors such as the degree of wrinkling, skin texture and upper eyelid ‘hooding’ can indicate poor health and lifestyle to others.

From skin laxity to thinning and fat depletion and descent, ageing can take its toll on the eye region, resulting in delicate changes. With age, the muscle layer beneath the skin starts to lose its tone; the fat of the eyelid can protrude forward to cause a dark shadow; the cheeks begin to shrink, leaving a groove-like valley known as a tear trough; and the brows descend. The result is a tired-looking, aged appearance.

The effects of ageing can also be exacerbated by sun exposure and cigarette smoking, both of which lead to the emergence of crow’s feet and fine lines and wrinkles under the eyes.

Despite the largely uniform ageing process, however, the variety of ways in which these effects present themselves on each individual means that blepharoplasty is not suitable for everyone. Even when someone is convinced an upper or lower blepharoplasty procedure is right for them, this may not be the case, and it is the surgeon’s job to identify where the real opportunity for improvement lies. A thorough consultation, including a review of past photos, can help determine whether someone will benefit from blepharoplasty.

The approach to eyelid surgery will be individualised to each patient. Skin quality, ethnic features, as well as anatomical differences will dictate the ideal approach for each patient.
Surgeons will typically consider the aesthetics and function of both the upper and lower eyelid, and consider whether altering one or both is the appropriate surgical approach. An extensive understanding of the anatomy of the upper and lower lids is vital in undertaking the correct rejuvenation procedure. Often, an upper eyelid blepharoplasty is sufficient in rejuvenating the appearance of younger patients, whereas a lower lid blepharoplasty may be needed to remove redundant skin and bags in older patients. In others, a brow lift or fat sculpturing may be the best option to address specific concerns.

Upper blepharoplasty

Considered a more straightforward procedure than lower eyelid surgery, upper blepharoplasty is well suited for those with excess skin that creates a ‘hooded’ effect over the eyes. Typically, the procedure involves removing excess skin to create a more ‘open’ appearance in the eye area, revealing the contour of the brow and inner eyelid crease.

Upper eyelid surgery is usually approached from the skin crease in the outer surface of the eyelid. The incision is typically made in the lid crease and is made with either a scalpel or CO2 laser that seals the blood vessels as it incises. Skin and muscle are removed to reduce hooding in the upper eyelid. In some cases, fat pockets may need to be repositioned during surgery, but this is dependent on the patient.
For suitable patients, upper blepharoplasty can produce dramatic results and is a minimally invasive surgical procedure when no fat transfer is required.

Lower blepharoplasty

Approaches to the lower lid are more likely to require a combination approach, which may involve surgery, filler and laser to give the best result.

Incisions for the lower lid blepharoplasty can be made either inside the eyelid or just below the lower lash line. Excess skin in the lower eyelids is removed through these incisions to correct under-eye bags or sagging.

Eyelid heaviness caused primarily by excess fat may be corrected by a transconjunctival blepharoplasty. The incision in this case is made inside the lower eyelid, and excess fatty material is removed.

The supporting muscles and structures surrounding the lower lids play an important role in the appearance of the eyes, and therefore lower blepharoplasty requires an intimate understanding of the periocular anatomy. Damage to any of the surrounding structures can lead to complications such as scarring and droopy lids. The preservation of the blinking mechanism is also of critical importance in order to avoid problems with eye irritation post-surgery.

The results of eyelid surgery become apparent gradually, with swelling and bruising usually subsiding after around two weeks to reveal a smoother, better defined eye region and a more alert and rejuvenated appearance. Results typically last around seven to 10 years. Some patients may also elect to have their eyelid surgery combined with a facelift or brow lift to maximise the rejuvenating effect and further enhance results.