Question: I feel like my eyes make me look older and more tired. Is eyelid surgery the right thing for me to change this?
Answer: As I tell my Dallas patients, the aging process affects us all differently. That being said, it is very common for our patients to describe the changes around the eyes as some of the first signs they are looking older. There are many things that can alter the appearance of our eyes outside of simply aging. These may include environmental factors such as sun exposure, weight fluctuations, type and quality of skin, the presence of allergies, and your genetics. Many of these things we simply cannot control. There are some that we can influence including sun exposure and weight stability. While 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. Considering eyelid surgery (blepharoplasty)? Younger and refreshed eyes can be achieved!
Let’s Talk About the Upper Eyelids
The upper lids get heavier with time for a number of reasons:
- Increase in skin – During the aging process, the skin can lose 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, it may even affect our vision particularly in 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, 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.
Let’s Talk About the Lower Eyelids
The lower eyelids are a bit more complex than the upper lids and may have several things contribute to the aging process. During our examination, each of these factors are carefully analyzed to determine which are present and may benefit from surgical improvement. 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 helps 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 this becomes more prominent. First, we have fat that helps cushion our eye and protect it. With time, the thick membrane that supports becomes thinner and more attenuated. This results in visibility of the fat supporting the lower part of our eye. Additionally, we tend to lose fat along the eye socket bone and check 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 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, in some patients they may have small blood vessels in this area they collectively result in a darkening appearance.
For aging eyelids, what treatment options are best?
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 much 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 if the sole reason for aging can be addressed in the office with a laser. An upper lid blepharoplasty requires an elliptical excision of the excess skin of the upper eyelid and possibly removal of a small amount of fat on the inside aspect of the upper lid. This is often done in the office under a local anesthetic. Most patients experience some swelling and bruising. Sutures come out around 5-7 days. Once out, camouflage make up may be used. Much of the swelling is gone around 10 days but the final result may take up to 6-8 weeks. A lower lid blepharoplasty is a bit more complicated procedure and is performed in the operating room. With this operation a small incision is made on the inside of the eyelid as well as an incision along the lashes. Skin excess, fat, and redundant muscle are all addressed by this procedure. Recovery is comparable to the upper eyelid.
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 but 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.
If you’re ready to look and feel your best, request a consultation online or call us at (214) 645-3112 (Dallas) or (214) 645-2353 (Frisco) to schedule an appointment.