Like many cosmetic procedures, removal of upper eyelid skin began as a result of necessity. Many people have excessive skin of the upper lids, which as they age became more pronounced to the point that they have visual impairment, and until a physician came up with the idea of actually excising the skin, people with this problem resorted to actually using scotch tape to hold the lids up so that they could see. In extreme cases, the excess skin totally occluded their vision.
At first, surgery was indicated only as a medical necessity, and insurance companies would often consider the problem debilitating enough to be insurable. Usually, the skin has to cover at least half of the pupil in order for an insurance company to pay.
However, these days it is not uncommon for a patient who is younger with excess upper eyelid skin to request the procedure for cosmetic reasons. The procedure, called an upper eyelid “Blepharoplasty,” is actually a very simple procedure. Under local anesthesia, the excess skin has to be carefully measured and removed. Sutures are then used, and the patient is requested to use ice soaks for a few days. There will be some bruising, and sutures are removed usually in 5 days.
Why would a person have excess skin in their upper eyelids? Actually, genetics has a lot to do with it. Those with Asian backgrounds are usually the ones with excess skin in the upper eyelids. One may say yes, I have excessive upper eye lid skin, but I have no Asian heritage. However, your heredity goes back thousands of years, and even though one may not realize it they do have Asian ancestors. About fifty thousand years ago humans originally came out of Africa and into Asia, so everyone has Asian heritage if you go back long enough. It’s according to how long their ancestors remained in Asia that may determine how they look and the appearance of eyelids. National Geographic has a genome study that anyone can get that will give them the information about their heritage. As a matter of interest, Eurasians are considered by many to be among the most beautiful women in the world.
Other causes of older looking eyelids are excess sun exposure, aging, smoking, and weight loss. But even these tendencies go back to heredity.
The most common complaint that these younger people have requiring removal of the excess upper eyelid skin is they look tired all the time, and that it makes them feel as though they look older than their actual age. Another issue, often not recognized by the patient is a young person coming in with very noticeable forehead furrows. They wish to soften these lines using Botox or Dysport; however, it is actually the heaviness of the upper eyelid skin which is causing them to lift their brow in order to see better. This in turn causes premature forehead wrinkles. Usually removing the excess eyelid skin will solve forehead wrinkles and is actually a less costly alternative to Botox or Dysport in the long run, which have to be injected basically forever for maintenance.
As far as the lower eyelids go, there are several reasons why patients have issues with lower lids also with several treatment options. The most common complaint is “bags and circles” under the eyes, once again, making the patient look tired and older than their age.
These are pockets of excess fat that have accumulated (also a genetic factor), and this can be resolved under local anesthesia with a small incision inside the eyelid to remove the excess fat. The procedure takes less than 30 minutes to perform.
When a patient has excess skin in addition to the excess fat, both skin and fat can be removed (under local anesthesia or general if a patient prefers). With this procedure, there usually is a fair amount of bruising and swelling for approximately 7-10 days.
An alternative and very common procedure to diminish the dark circles under the bags is to inject a “filler” into the hollow under the eyes. This can make a dramatic difference in temporarily correcting or reducing the problem.
What about complications? Usually, if the fat is removed through an incision inside of the eyelid to remove the bags. The complication rate is rare.
If skin is also to be removed, the surgeon performing the procedure must carefully measure the amount of skin to be removed. If too much skin is removed in the upper lids, this could cause the patient to not be able to close their eyes completely and have chronic dry eyes. If too much skin is removed in the lower lids and in older patients where there is less skin elasticity, “ectropion” could result. This is where the skin of the lower eyelid droops causing the eyelid to pull downward. Any of these complications can occur, but with proper surgical technique and adequate post care (imperative) and treatment normally avoids the problem or resolves the problem if it occurs. The older the patient and the more sun damage present, the more likely ectropion can occur. Using ice soaks, keeping the eyes moist with ointment and drops will usually do the trick. Patients must realize that they need to carefully follow the postoperative regimen to help avoid these postoperative uncommon issues.
In conclusion, eyelid surgery has evolved from a medical necessity to being performed for cosmetic reasons patients as young as their 20’s and can be performed as an outpatient procedure. When needed, blepharoplasty results can improve the appearance of premature aging dramatically, and patients are elated regardless of age.