Eye Lift (Blepharoplasty)
Young eyes have a smooth upper lid, with a well-defined crease and no excess skin. Older eyes have excess skin, and may have some bulging medially (meaning near the midline). This bulging is actually fat inside the orbit. The orbital septum is a layer of connective tissue that keeps the fat inside the orbital cavity from bulging out. As we age, this layer of connective tissue weakens, allowing the fat to bulge out. In addition, our skin stretches and droops as we age.
So how do we fix this? It’s actually a relatively simple procedure:
- Take off the excess skin. The resulting scar is well-hidden in the crease of the upper eyelid.
- Remove the bulging fat. Removing just a pinch or two of fat smooths the contour of the upper eyelid.
Upper eyelid lifts are occasionally covered by insurance. For the procedure to be covered, the upper eyelid skin has to be drooping so much that it actually obstructs your vision. In order to find out for sure, you will need to see your ophthalmologist for a visual fields exam, which will determine if your excess eyelid skin is blocking your vision.
Lower eyelids age in a similar way to the upper eyelids. In addition to skin becoming more lax, the fat around the eye becomes more noticeable as well. This fat is held back by a thin layer of connective tissue that stretches from the cheekbone to the lower eyelid. This connective tissue weakens and stretches as we age, allowing the fat to “pooch out”, resulting in bags under the eyes.
The diagram to the left is a cross section of the eye. The big circle on top is the actual eyeball, or globe. The cheekbone is highlighted in orange, and the lower eyelid is highlighted in green (this is actually the tarsal plate, a firm supportive layer of the lower eyelid, but for our purposes calling it the lower eyelid is close enough). The blue line highlights this connective tissue layer, the orbital septum. You can see the fat behind it, highlighted in light yellow.
Lifting the lower eyelids is similar to to lifting the upper eyelids with one major difference:
- The excess skin is taken off
- The bulging fat is removed
- Here’s the difference– the lower eyelid is sometimes tightened. The canthal ligament, which is the tough connective tissue that supports the lower eyelid, is suspended higher into the outer corner of the bones that make up the orbit. Not every patient needs this, but it is commonly done to help provide support to the lower eyelid during the healing process.
Eyelids are a delicate area, so you can expect some bruising and swelling after surgery. The bruising usually resolves within 1-2 weeks, and mild swelling may persist for up to a month or longer. Most patients experience discomfort after surgery rather than true pain. This often takes the form of a dry eye or irritated eye. You may be given eye drops or ointment to help with these symptoms. In terms of activity restrictions, patients are limited from engaging in heavy lifting or vigorous exercise for a month after surgery. Return to work depends on what type of job you have, and if you prefer to wait for all bruising and swelling to go back prior to returning to work.
Before and After Photos***
***All patient results may vary, these procedures are for cosmetic purposes only and results are not guaranteed, nor are permanent. All patients are different and in no way will any procedures be alike, nor the recovery period.