The honest answer is, virtually no one except for the people with such severe excess skin in the upper lids that they have lost some of their peripheral vision.
On the other hand, eyelid lifts are one of the most common procedures performed by plastic surgeons. The reason is beautiful eyelids contribute tremendously to beauty and a youthful appearance. Eyelids are also one of the first features to become noticeably “aged” as we grow older. When we talk to someone, we generally talk to their eyes. Eyes are also very expressive, whether happy, sad, quizzical, surprised or even shocked.
As we grow older, upper and lower eyelids show their ages differently. The upper lids usually develop excess skin, which may hang down even onto the lashes. Often we gain fat under the skin of the upper lids making them very puffy. The lower eyelids more commonly start with an increase in fine wrinkles and/or puffiness from the underlying orbital fat, which pushes out into the skin causing the “bags” that we so often see. In more severe cases, the lower lid may even droop leaving the cornea of the eyeball more exposed.
What is the treatment? Usually patients come in for cosmetic reasons. The complaint is often that their eyes look old and smaller. Often the upper eyelids can be corrected with a fairly simple procedure called an upper lid blepharoplasty. In most cases the excess skin is excised (a medical term meaning to surgically remove with a scalpel). Sometimes a small strip of underlying muscle and fat are also removed, and this is followed by suturing the wound closed with tiny sutures.
There are more options for correction of the lower eyelid problems, and this must be more individualized. A skin incision just below the lashes can be made or the incision can be made on the inside of the lower eyelid. The latter would require no sutures (stitches). This incision is used when the problem is simply excess fat or bags. If there is also some excess skin, a laser can be used to tighten the skin. If there is too much skin for this approach, the incision can be made as described above, just below the lashes. The excess skin is then excised and very fine sutures are used for closure. Excess fat can be removed through either of these incisions. My tendency is to use the incision inside the eyelid when possible. Your plastic surgeon will decide which is most suitable for you after discussing your goals.
Eyelid surgery can be one of the most satisfying of all cosmetic procedures of the face. Usually they can be performed under local anesthesia or with mild sedation. The post operative course usually involves swelling and bruising, but the recovery is only a couple of weeks before you can carry on with your usual activities. However, there is still some mild swelling for several months, usually noticeable only by you and your plastic surgeon.
E. Ronald Finger, M.D.