The eyelids are usually the first thing that gives a person’s age away. It may involve either the upper eyelids sagging or the lower lids, which is usually manifested by “bags.” Genetics, life style and simply the aging process will dictate when someone should have this procedure.
Typically the upper eyelids acquire more skin which ultimately hangs down to and sometimes over the edge of the lid and even lashes. Sometimes people inherit excess skin in the upper lids, and this is typical of Asian people or those with Asian ancestry. This problem can be corrected with an upper eyelid lift called an upper lid blepharoplasty. This surgery can be done under either local or general anesthesia. My preference is mild sedation and local anesthesia. The procedure takes an experience surgeon 30 minutes to an hour, according to the amount of skin and whether fat must be removed as well. The results are usually spectacular, if done correctly, and the scars are imperceptible in most cases.
The lower eyelids are often more complex. Some skin may have to be removed as well as the fatty “bags.” If the only problem is the loose skin, and it’s not too excessive, a laser may correct the problem satisfactorily by tightening the skin. If removing excessive fat is the only goal, this can be done through an incision in the inside of the lower eyelids called the transconjunctival blepharoplasty, and there is no scar. If necessary, this may be combined with the laser when the skin is minimally excessive. If a skin incision is needed, there is a faint scar in the skin of the lower lid just under the lashes. If both an upper and lower lid blepharoplasty is required, they are done at the same time.
One can expect some black eyes post-operatively and swelling for a few weeks. It’s a small price to pay for beautiful eyes for decades to come. Often the eyes look better than they have ever looked before, but proper technique is necessary, and I recommend a plastic surgeon certified by the American Board of Plastic Surgery.
E. Ronald Finger, M.D.
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