The eyes are the first things we notice when we meet someone new. Beautiful eyes can make up for other features that are less than ideal. Likewise, eyes that are tired, droopy, or swollen may not reflect a vibrant inner self. It is often said that the earliest signs of aging are around the eyes. You may feel that the eyes looking back at you in the mirror every morning are old and tired looking, or maybe people are always questioning whether or not you had a good night’s sleep because of your eyes.

I like to use the “picture frame” analogy: the beautiful part of the eye is the eye itself, particularly the iris. This is the colored round part of the eye, and it can be brown or blue or green…many color variations. This is what we see when we look into another person’s eyes. This is the “picture”. Everything around this “picture” is like a picture frame. The upper lids, the brows, and the lower lids all frame the pretty picture. When we are young, the open soft smooth frame compliments and accentuates the picture, and it is a thing of beauty.

However, as we age, the “frame” changes. The brows can descend, crowding the upper lids. The upper lids themselves often stretch and become droopy. The lower lid tissue often gets wrinkled; fat pockets pooch out and create “bags”. Add some crow’s feet wrinkles to the sides and now the frame begins to dominate. No longer is the pretty picture (iris) the main thing but it becomes dominated by the aging tissues that surround it.

Fortunately, cosmetic procedures can improve this aging process, and restore the “picture” with a procedure called blepharoplasty.

A blepharoplasty can be performed on the upper lids and/or the lower lids.

Whether the reason for the undesirable changes is excess skin of the upper lids, or the fatty pockets of the lower lids or wrinkles in both areas, surgery can be tailored for each individual patient

Lower lids with a “tired eyes” appearance are usually as a result of migrating eyelid fat. This fat is held back by a thin wall of fibrous tissue called the orbital septum, which sags over time. The fat, held firmly back by this wall in youth can bulge with age, giving you “baggy” upper and lower eyelids. Blepharoplasty trims this extra fat and tightens the wall, restoring a youthful contour. Sometimes we will reposition fat into some of the hollows beneath the fat in order to create a smoother skin surface. These hollows may include the “tear trough” which commonly deepens with aging.

Our goal is always to achieve a natural rested fresher appearance, achieved with the procedure(s) we feel are best for that individual patient and perform this as safely and comfortably as possible.

THE SURGERY

Eyelid lifts can either be done alone or together with face and neck lifts or eyebrow and forehead lifts. If done alone, the operation takes about two hours for all four eyelids (both upper and both lower eyelids). Blepharoplasty of the upper eyelids alone typically takes about 30 minutes and is most often performed under local anesthesia only as an office procedure.

The lower lid surgery is a bit more delicate and we believe is more safely and effectively performed using an IV sedation anesthesia, letting the patient sleep during this approximate one hour & 15 minute procedure. It is easier for the patient to remain completely still if sedate, and is more comfortable, too. This is typically performed in an accredited surgery center. This may be performed either with an incision in the skin just below the lids or by going behind the lids through the “back door”, and leaving no visible incisional scar.

When hollows such as the tear trough and possibly other depressions creating “shadows” are present, we might suggest use of filler such as Restylane to help restore some volume under the skin. This can be performed as a stand-alone session in the office or as part of a surgery.

For patients who have wrinkles under the eyes, we may recommend a resurfacing procedure to improve this. A deeper chemical peel is often helpful in creating new skin, which can be smoother, lighter, and tighter once healed. Sometimes the peel is performed at the same sitting as the other surgery.

THE RECOVERY

All surgeries create a bit of swelling and possibly bruising that peaks about day 3. After this, improvement occurs and most patients look acceptable within seven to ten days. Fair-skinned patients will show a little more bruising than swarthy darker skinned patients. Minimal blurry vision quickly resolves. Sunglasses allow you to go out in public immediately after surgery, and make-up can be worn within about one week (if a peel has also been performed, it may require 10 days of time.) Normal (but not physical) activity can be resumed the next day and week-by-week more physical activities can be performed. We usually discourage strenuous exercise until about 3-4 weeks, and sometimes longer.

OTHER OPTIONS

Sometimes eyelid lifts are combined with other procedures that are focused on repositioning and helping stabilize the eyebrows. Dr. Chatham will discuss whether you might benefit from this combined procedure during your initial consultation.
 

Visit our plastic / cosmetic surgery offices located in Louisville, Kentucky (KY) and New Albany, Indiana (IN).