As we age, the delicate skin around the eyes can appear puffy or saggy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye bulge. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called blepharoplasty.
Blepharoplasty can be performed on the upper eyelid, lower eyelid, or both. The surgery is performed for either cosmetic or functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and produce tired-feeling eyes. Most often, people choose blepharoplasty to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision, rather than for cosmetic reasons only, it may be covered by insurance.
Blepharoplasty for the lower lid removes the large bags under the eyes. It is unusual for third party payers to cover lower lid blepharoplasty.
The surgery is usually performed on an outpatient basis and can take one to three hours. Upper lid incisions are made in the natural crease of the lid, and lower lid incisions are made just below the lash line. A procedure for lower lid blepharoplasty, called transconjunctival blepharoplasty, removes excess fat through an incision inside the lower lid. Incisions are closed with fine sutures.
Swelling, bruising and blurry vision are common after blepharoplasty. Stitches are removed three to five days after surgery, except in the case of transconjunctival blepharoplasty where the self-dissolving sutures require no removal.
Possible complications associated with blepharoplasty include bleeding and swelling, delayed healing, infection, drooping of upper or lower eyelid, asymmetry, double vision, and dry eye. It is important to note that the puffiness of the fat pockets may not return, but normal wrinkling and aging of the eye area will continue.
Botox is the trade name for botulinum toxin. In its pure form, botulinum toxin is a type of food poisoning that causes muscle weakness. It acts as a nerve impulse blocker, preventing muscles from contracting. In an extremely dilute form, botulinum toxin has many medical applications.
Botulinum toxin can be injected directly into muscles of the face or eye when facial muscles are overactive. Botox causes the overactive muscles to relax. It usually takes a few days for the therapeutic effect to be noticeable. The injections may need to be repeated every 4 to 6 months.
Botulinum toxin is used in ocular conditions such as blepharospasm, an excessive contraction of the eyelid muscles that forces the eyelids closed, and hemifacial spasm, an excessive contraction of the facial muscles on just one side of the face. For certain types of double vision, botulinum toxin can be injected directly into the eye muscle opposite the paralyzed eye muscle. Some wrinkles also become less prominent if injected with botulinum.
Side effects of the injection are temporary. They can include a droopy upper eyelid, double vision, and inability to close the eyelids.
Browlift (or Forehead Lift)
Sun, wind, and gravity affect the skin and muscles of the face over time. One of the most noticeable aspects of aging is a progressive drooping of the eyebrows. This can cause wrinkling of the forehead from raising one’s eyebrows, as well as vertical wrinkles or furrows between the eyebrows. Sometimes the eyebrows or excess eyelid tissue can obstruct vision.
A browlift or forehead lift elevates the brow and smooths forehead skin, and can remove vertical lines between the eyebrows. Incisions are made in inconspicuous places, either behind the hairline, in one of the forehead wrinkles, or immediately above the eyebrows. If an endoscope (a small tube with a fiberoptic light) is used, the incisions can be very small. After the muscles are tightened and excess skin is removed, the incision is closed with sutures. The operation is usually an outpatient procedure that can take several hours.
Swelling and bruising, common after a browlift or forehead lift, begins to subside in seven to 14 days. Numbness and itching are common during the healing process. Sutures are removed within seven to ten days after surgery. Incisions in the hairline may damage hair follicles and result in some hair loss.