As you age, the skin and muscles of your eyelids and eyebrows may sag and droop. Dermatochalasis is the excess skin. In addition, you may get a lump, bump, or fullness in the eyelid due to normal fat around your eye that begins to show under the skin. These changes can lead to other problems. For example:
- Excess skin on your upper eyelid can block your central vision (what you see in the middle when you look straight ahead) and your peripheral vision (on the sides when you look straight ahead). Your forehead might get tired from trying to keep your eyelids open. The skin on your upper eyelid may get irritated.
- Loose skin and fat in the lower lid can create “bags” under the eyes that are accentuated by drooping of your cheeks with age. Many people think these bags look unattractive, making them seem older or chronically tired.
An upper or lower blepharoplasty (eyelid surgery) can help correct these problems. Patients often refer to this surgery as an “eyelid tuck” or “eyelid lift” in the upper lid. Please know the eyelid itself may not be lifted during this type of surgery (that is, a ptosis repair utilized for patients with ptosis), but instead, the heaviness of the upper eyelids and/or puffiness of the lower eyelids are usually improved.
Ophthalmologists (eye surgeons) call this surgery “blepharoplasty.” Oculoplastic surgeons are specialized ophthalmologists who have devoted their careers to eyelid surgeries and treatments. You should check the credentialing of your surgeon to see if they are a member of the American Society of Ophthalmic Plastic and Reconstructive Society (or ASOPRS) which means an accredited two-year fellowship trained them as Dr. Michels and Dr. Broadbent. Other physicians or medical groups may claim they are ‘oculoplastic surgeons.’ Still, without this accreditation and training in a two-year fellowship, they have not done a specialized fellowship that would allow them to fully assess the eyelid and its associated tissues and how surgery or medical treatments may affect those tissues and the eye itself.
In a blepharoplasty, the oculoplastic surgeon may remove or change the position of skin, muscle, and fat. Surgery may be on your upper eyelid, lower eyelid, or both eyelids. The ophthalmologist will put sutures (stitches) in your eyelid to close the incision (cut).
- For the upper lid the doctor makes an incision in your eyelid’s natural crease. In some patients, your oculoplastic surgeon can create a new lid crease, which can further improve your symptoms.
- For the lower lid the doctor makes an incision either through the skin just below your lashes or in the conjunctiva (moist inside surface of your lid) where you can’t see it.
In lower lid blepharoplasty, the lower lid's puffiness can be improved by either removing the fat causing the puffiness or by repositioning it, also known as fat redraping. Sometimes skin can also be removed, if excess skin exists, in the lower lid to help tighten the skin, and other modalities such as a laser or chemical peel can be used in conjunction to improve skin quality. If fat redraping is used, it is in effect, done to fill the area between the eyelid and cheek by adding volume to the depleted site that has developed with age.
Many people find that blepharoplasty helps correct their eyelid problems. But how much it helps depends on factors that include your symptoms, eyelid structure, appearance, goals, and ability to adapt to changes. Here are some common ways that blepharoplasty can help:
- Improved peripheral vision (to the sides) and when looking up. You may be able to relax your forehead since you will not rely as much on those muscles to keep your eyes open.
- Many people with bags under their eyes feel that blepharoplasty of the lower eyelid improves their appearance and makes them feel younger or less tired. This is cosmetic surgery. Talk with your surgeon about what you can expect from blepharoplasty.
- Blepharoplasty does not correct all vision problems. For instance, you will not be able to read printed words more clearly just because you had blepharoplasty. Talk with your ophthalmologist about other ways to improve vision, such as with eyeglasses, contact lenses, cataract surgery, or LASIK surgery.
It is your choice whether to have blepharoplasty. Here are some other options:
- You may decide to do nothing. Excess skin, muscle, and fat around your eye will not go away, but it might not bother you enough to do something about it.
- You may be able to have a different type of surgery that will lift your eyebrows. Talk with your surgeon about other surgery options.
- There are other treatments and procedures to improve the appearance of lower eyelids. For instance, you could have Botox injections, filler injections, laser treatment, or a chemical peel. Talk with your surgeon about these and other choices.
As with all surgery, there are risks (problems that can happen) with blepharoplasty. Here are some of the most common or severe:
- Bleeding, infection, or numbness. Temporary numbness of the eyelashes is common for the first month or two but can last longer.
- Changes in how you look, such as bruising, scarring, or asymmetric appearance (one side of your face not matching the other).
- Eye problems. These can include trouble closing your eyes (which can damage the cornea--the part of your eye where a contact lens sits), inability to wear contact lenses, tearing, or dry eye. Temporary dryness is common for the first few weeks.
- Vision changes such as double vision, vision loss, or in very rare cases, blindness.
- Anesthesia problems. Local anesthesia injections can damage the eye area around the eye or cause vision loss. General anesthesia has its risks that you would discuss with an anesthesiology specialist.
- Your eyelids may not look or feel as you would expect after surgery. There are no guarantees about how your eyes will look, how good your peripheral vision will be, or how you will feel after blepharoplasty surgery. This is because people differ in eyelid structure, response to surgery, how well they heal, and expectations about how the surgery will help. Gradual improvement in minor issues usually occurs with continued healing over the first six months after blepharoplasty.
- You may need more treatment or surgery to care for problems after blepharoplasty.