What is eyelid surgery?
Eyelid surgery, also called blepharoplasty, is an operation to diminish the signs of aging around the eyes.
How do my eyelids age?
All skin loses its elasticity as we age. That loss combined with the stretching effects of gravity causes excess skin to collect in the upper and lower eyelids. In the lower eyelids, the excess skin causes wrinkles and bulges. In the upper eyelids the excess skin forms an extra fold that can even hang over the eyelashes and obstruct vision. Here is an example of excess skin in the upper eyelids that was corrected with upper eyelid surgery:
You may notice that your eyes appear to be getting smaller. You may have trouble putting on eye shadow or find that your eyeliner winds up on the upper part of your eyelid instead of staying next to your eyelashes. You might also find that you are looking through your eyelashes, which are being pushed down by the heavy upper eyelid skin.
Also, the eyeball is cushioned within the skull by a surrounding layer of fat. With advancing years the thin membrane that holds back this fat weakens, and the fat can protrude, producing bulges or bags in both the lower and upper eyelids. Bulges caused by protruding fat, especially in the lower eyelids, can be a hereditary problem even in younger persons. Lower eyelid surgery can improve these fatty bulges on someone who does not yet require tightening of the lower eyelid skin. Here is an example of lower eyelids that had their fat bulges removed:
Thus, during eyelid surgery, excess skin and protruding fat of the upper and lower eyelids are removed. These changes that you see around your eyelids are hereditary. Different people acquire the changes at different ages, depending on how their parents’ eyes aged.
Can men as well as women have eyelid surgery?
Yes. Men can benefit in the same way from the same surgical techniques.
At what age can I have my eyelids done?
This operation is usually performed on people in their forties and fifties, when the signs of aging are evident enough that the benefit obtained is a fair trade for the cost and risks of surgery.
There is no upper age limit for having eyelid surgery. On the other hand, hereditary fat protrusions, especially in the lower eyelids, can occasionally make someone as young as twenty a good candidate for eyelid surgery.
What else makes my eyes look older?
The position of your eyebrows and your "crow’s feet."
As gravity pulls on the facial skin over the years, loose excess skin becomes present in the forehead region, and the eyebrows drop in position. Lowering of the eyebrows exacerbates the problem of excess skin on the upper eyelid. The combination of these normal changes can make the eyelids look and feel heavy and make one look tired or even grumpy. Here is an example of drooping eyebrows:
How do you help drooping eyebrows?
If low eyebrows are a problem, a forehead lift can raise them. In this procedure, which can be performed endoscopically, the small incisions are hidden in the hair on the top of your head, and the eyebrows can be raised. This procedure can be performed by itself, or at the same time as a face lift, or eyelid surgery, or both.
In a man, if very low eyebrows are a problem, a different procedure called a direct brow lift is recommended. An incision on the top of the head does not hide well in a man with a receded hairline. In a direct brow lift, the skin immediately above the eyebrow is excised and the brows are raised as the closing stitches are placed.
The direct brow lift is also occasionally recommended for a woman, especially if the eyebrows are extremely droopy, or if they are asymmetric and only one eyebrow needs to be raised.
What about my crow’s feet?
The crow's feet can be improved with a skin peel. A peel of the lower eyelids can make the crow’s feet less conspicuous and further tighten and smooth the texture of the lower eyelid skin. The fine, crepe paper wrinkles of the lower eyelids cannot be eradicated with eyelid surgery alone. Here is an example of a chemical peel of the lower eyelids and crow's feet region:
Here is the concept: we don't try to pull skin tightly enough to remove wrinkles. The surgery, such as a face lift and eyelid surgery, are to remove sagging excess skin, but not to tighten the surface. Wrinkles that persist after surgery are corrected with a peel. Please see the section on skin peeling for more details of this technique.
Are my two eyes the same?
Study your eyes in the mirror and see if your eyes are slightly different in appearance. During development, the face is formed from two completely separate halves which join in the middle. Sometimes the joining is not perfectly symmetrical, and many people have eyes which are at different levels or appear to be different sizes.
Asymmetries that occur during development cannot be corrected with surgery, and it is better to notice them beforehand than to find them during your postoperative scrutiny and to wonder if they were caused by the operation.
What else should I consider?
Deciding on eyelid surgery is not a matter of vanity. Caring deeply about one’s physical appearance is not a prerogative only of the young. Our bodies age, but our minds stay youthful. Cosmetic surgery is an attempt to let us see in the mirror a face that better reflects the way we feel.
Keep in mind that this operation is for you. Though a good result may have a pleasing effect on a spouse, friend, or employer, do not expect praise or notice from everyone. You are not doing it for them. They are not paying the fees and incurring the minor inconveniences and risks of surgery. If the changes are more subtle than dramatic, other people may not even notice. Your friends might not be as observant as you are. Cosmetic surgery that is undertaken with the purpose of affecting others nearly always fails to produce the desired results.
Remember that the goal is improvement, not perfection. Strive to look good for your age, not to look twenty years younger than you are. The patient most pleased with surgery is the one whose expectations are realistic and whose motivations are internal--you should want to feel better about yourself.
Improvement in the appearance of the eyes can also enhance self-esteem, imparting a psychological benefit that cannot be measured in a photograph.
What kind of anesthesia is used?
Most likely your surgery will be performed under "twilight sleep" sedation. In "twilight sleep" anesthesia, you are given a medicine through your IV that makes you fall asleep. You feel nothing, and you remember nothing about the surgery. It's usually much more pleasant than having a general anesthetic.
Will there be scars?
Yes. Anytime an operation is done, the body heals by making a scar. It is the task of the facial plastic surgeon to hide the scars as skillfully as he can and make them as thin and inconspicuous as he can.
The incision for upper eyelid surgery is placed right in the crease that forms about one-quarter inch above your upper eyelashes when your eyes are open. It is an excellent place to hide the scar, which heals to an extremely fine line and is almost never a problem. Scars may be hidden with makeup starting one week after surgery.
The lower eyelid incision is usually made on the pink part of the eyelid that you see when you pull your lower eyelid way down. That way, there is no visible scar at all.
Will the surgery stop my eyes from aging?
No. Sorry. But the results of surgery are very long lasting, usually more than ten years.
When will I be able to go home?
If you live out of town, you will probably be able to go home the morning after surgery. Remember, though, that Dr. Denenberg will want to see you one week after surgery. We can help you make your arrangements.
When can I return to work?
Count on staying home for a minimum of one or two days after surgery. This will allow you to restrict your activities to a minimum during the first part of the healing period. You may return to work after two or three days if your activities involve no lifting or strenuous activity. At this point, you may want to hide behind sunglasses, or you may want to wait until your eyes look more normal before you return to work.
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