Wrinkles around the eyes are frequently the earliest signs of aging. Bags can develop under the eye, brows sag down and an excess fold of skin develops in the upper eyelid.
Wrinkles can be smoothed by removal of excess skin. Usually a large amount of skin can be removed from the upper eyelid still allowing the eyes to close. Skin removal can be extended laterally to help improve crow’s feet lines. Only a conservative amount of skin can be removed from the lower eyelid. If too much skin is removed, the lower eyelid can be pulled down. Problems which can occur include seeing the white of the eye below the iris (scleral show) and dry eyes from the increased exposure to air. The scars from Blepharoplasty surgery heal very well and infections are rare.
Some deeper tissues are removed in Blepharoplasty surgery. Recent research has shown that aging results in a natural loss of soft tissue volume. This has resulted in recent changes in Blepharoplasty surgery. Very little of the deeper tissues are removed while removing the excess skin.
If the Levator Muscle, which elevates the upper eyelid becomes stretched people will develop a sleepy appearance. The levator muscle is in the next layer deeper to the circular muscle which closes the eyelid. The levator muscle can be tightened during an upper Blepharoplasty surgery. If droopiness of the eyelid or if the excess fold of skin is severe enough to obstruct vision, insurance may cover the surgery. Ophthalmologic visual field exams are required to document obstruction of the visual fields.
Chemical peels can be used to tighten the skin of the eyelids and remove blotches of pigmentation and sun damage. The result is more variable and costs less than surgery. A chemical peel can lighten dark circles around the eyes. Full face chemical peels are frequently recommended that there will not be a line of demarcation between peeled and untreated skin.
Removal of bags under the eye requires lower Blepharoplasty surgery. Traditionally the fat in the bags is simply removed. When there is a groove between the thicker nose/cheek skin and the thinner eyelid skin, the fat can be tucked into the area of the groove. This results in a smoother contour between the eyelid skin and the upper cheek. If no skin needs to be removed, the incision can be hidden inside the eyelid (transconjunctival incision).
Non-surgical methods of filling in the groove are achieved by the injection of fillers such as Restylane or fat injections. Restylane is ideal because it is soft and clear; it is, however, temporary. Fat injections have a variable survival, but what survives is permanent. The fat can be seen through the thin skin if injected close to the surface of the skin. Liposuction is required with fat injections to harvest the fat.
The aging lower eyelid can spontaneously sag and show whites of the eye below the iris producing scleral show. As the sagging worsens the eyelid can fall forward and the pink flesh of the inside of the eyelid becomes visible. This is called an ectropion. When an ectropion develops, the tears cannot drain and must either evaporate or drip from the eyelid. Repair requires removal of a vertical wedge of eyelid margin and/or tacking the outside corner of the eyelid higher inside the outer rim of the eye socket (canthopexy). A canthopexy is sometimes performed in cosmetic lower eyelid surgery to improve the slant of the eye or to prevent ectropion which can occur when wrinkled skin is removed from a weak lower lid.
The excess fold of skin in the upper eyelid can be partially caused by droopiness of the eyebrow. Since Blepharoplasty surgery will not elevate the eye brow, a brow lift surgery is helpful to remove the excess fold of skin from the upper eyelid and give a more awake appearance.
Through incisions in the scalp, brow lift surgery elevates the brows by shifting the skin upwards or by removing a strip of scalp. The depressor muscles between the brows form vertical furrows giving the appearance of being mean (glabellar furrows). These depressor muscles can be removed through upper Blepharoplasty incisions, or through brow lift incisions.
It is more difficult to conceal the brow lift scars in men with receding hair lines. A browplexy is a conservative brow lift alternative which has no scalp or forehead incisions. The brow is tacked to a slightly higher position through an upper Blepharoplasty incision.
A simple skin removing upper Blepharoplasty surgery can be performed in the office under local anesthesia. Dr. Andersen performs Blepharoplasty surgery in the operating room for the following conditions: repair of levator muscles of the eyelids, insurance covered Blepharoplasty, removal of the brow depressor muscles, brow pexy, brow lift, lower Blepharoplasty, canthopexy and repair of an ectropion.
Fast healing in the eyelids allows removal of the stitches 3 – 5 days after surgery. Recovery requires about one week leave of absence from social life or wearing sunglasses to conceal bruising and swelling.
Please call the office for the cost of the different eyelid and brow procedures.