Do you feel your hooded, sagging, or baggy eyelids make you look old and tired? You’re not alone. While the aging process affects us all differently, it is very common for patients to describe changes around the eyes as some of the first signs they are looking older. You can see these changes in some of the eyelid surgery before and after photos we’ll share in this blog post.
What Causes Eyelid Aging?
Many things can alter the appearance of our eyes outside of simply aging. These may include environmental factors such as sun exposure, weight fluctuations, the type and quality of your skin, the presence of allergies, and your genetics. Many of these things we simply cannot control. However, we can influence some factors, including sun exposure and weight stability.
Although the upper and lower lids can both be affected, they should be analyzed individually per patient to determine what may be the best options to improve one’s appearance.
How Do the Upper Eyelids Change?
The upper lids get heavier with time for a number of reasons:
- Increase in skin: During the aging process, the skin loses its elasticity. We often think of this as it relates to the face or even our bodies. It also changes the characteristics of our eyelid skin, causing more redundancy of our upper lids. If severe enough, this laxity may even affect our vision, particularly in the upward and outward gaze.
- Deflation or loss of fat: We tend to lose fat in certain areas of the face as we grow older. The area around the eyes, particularly in the brow region, can become deflated, resulting in a lowering of the brow position and increasing the fullness in the upper lid.
- The presence of fat: As our skin loses its elasticity and thins, fat may become more noticeable, particularly in the inner aspect of our upper eyelid, creating fullness or puffiness there.
How Do Lower Eyelids Change?
The lower eyelids are a bit more complex than the upper lids, with several factors often contributing to the aging process. During our examination, each of these factors is carefully analyzed to determine which is present and can be addressed with surgery. Here’s what may be discussed:
- Increase in skin: Like the upper eyelids, the lower eyelid skin can lose its elasticity and become redundant. This can give us “crepe-like skin” with fine lines or simply extra skin. The degree and type of skin excess help us determine whether surgical excision or a laser would be best used for correction.
- Baggy eyelids: The lower eyelids are often described as “baggy” as we age. There are a few reasons for this. First, we have fat that helps cushion our eye and protect it. With time, the thick membrane that supports it becomes thinner and more attenuated. This results in the visibility of the fat supporting the lower part of our eye. Additionally, we tend to lose fat along the eye socket bone, making the fullness of the lower eyelid even more noticeable. This results in an elongated appearance of the lower eyelid, highlighting the aging process.
- Dark circles: Many patients complain that they have dark circles on their lower eyelids, making them appear more tired than they are. There are several reasons one may experience this.
- Loss of fat on the eye socket: As we discussed above, loss of fat along the bone of our eye socket can create a “hollow” appearance, resulting in shadowing and a tired appearance.
- Pigment: Depending on how much sun exposure one gets, patients may complain of darkness along their lower eyelids, which may make them appear more tired.
- Thin skin: Thin lower eyelid skin may result in dark circles by allowing the underlying muscle to “shine” through, giving a dark appearance and thus a tired look. Additionally, some patients have small blood vessels in this area, which collectively result in a darkening appearance.
Is Eyelid Surgery the Best Option?
As a plastic surgeon in Dallas, I carefully analyze these areas of my patient’s eyes and determine the cause of the aged appearance. Here are a few examples of some treatment options:
1) Loss of volume in the eye region: In younger patients, particularly, this may be the first sign of aging. Despite having good quality skin and a lack of redundancy, they may still appear older than desired. In this case, fillers can help restore lost volume; and in this region may even last a year or more. Injections are done in the office under a topical anesthetic and have minimal downtime.
2) Skin redundancy and excess fat: These symptoms usually require a more aggressive surgical approach. The one exception would be crepe-like skin of the lower eyelid, which can be addressed in the office with a laser skin resurfacing treatment.
3) Dark circles under the eye: The treatment varies with the cause. Pigmentation can be addressed with topicals or laser treatments. Blood vessels in this area can also be treated with lasers, and you can learn more about these treatments in this related blog post. Volume loss resulting in shadowing can be treated with fat or filler products.
In many patients, changes in the upper and lower eyelids are the initial signs of the aging process. Remember: These changes are very much patient-specific and require a detailed analysis to determine what the correct procedure is for each patient. There are no “cookie cutter” approaches to cosmetic surgery; rather a tailored and specific plan is put forth after a detailed consultation. Make sure you do your homework and see a board-certified plastic surgeon.