The Eyes Have It

Created on 01st August 2008

Lisa Jennings investigates eyelid surgery...

The eyes are the windows to the soul, so they say, but if your eyelids start to droop it's like pulling the blinds down. Ageing around the eyes can led to skin folds and eye bags, with the lack of elasticity being particularly noticeable on upper eyelids. A young person's skin is stretchy enough to take up the slack when the eyes are open. As we age, the skin is unable to do this, so when the eyes are open a fold of skin forms above the upper eyelid crease. This can be exacerbated in the very elderly to such an extent that the fold can fall over the eyelid and interfere with vision - but all it takes to fix it is a simple trimming of excess skin.

A further down-side of ageing is that the eyeballs recede slightly into the eye sockets. This pushes the fat around them forwards, forming soft lumps under the skin called eye bags. This fatty protrusion can be inherited, in which case it can become noticeable at a much younger age. Eye bags tend to affect the inner and middle parts of the upper eyelid, and the length of the lower eyelid. As well as giving a ‘droopy' look, excess skin folds and eye bags can cause eye make-up to become smudged at the lid folds.

Andrew Skanderowicz FRCS, medical director of the London Cosmetic Surgery Centre and co-author of Every Woman's Guide to Cosmetic Surgery explains, "The aim of eyelid surgery is to reduce excess skin and flatten eye-bags. There is no simple surgical technique that will restore the position of the eyeball to its youthful location. Before surgery it is recommended to have an eye test to assess vision as well as tear production."

The Procedure

To correct drooping eyelids, an incision is made in the lid crease. For eye bags, an incision is made starting at the outer side in a crow's foot crease, and extending under the eye lashes. In both cases, excess fat, skin and, if necessary, muscle are then removed through the incision. The procedure is generally performed under sedation and local anaesthetic, although a general anaesthetic can be used for nervous patients.

Andrew Skanderowicz says, "If a patient has good skin tone but protruding fat under the lower eyelids, the surgeon may perform a ‘transconjunctival blepharoplasty'. The lower eyelid is pulled forwards and an incision is made on the inner surface of the lid, which allows access to the fatty pockets of the lower eyelids. Excess fat can then be removed and no stitches are required. However, this tends to be an operation for young patients as it will increase the wrinkles if the lower eyelid has already lost tone."

"Some surgeons treat the skin with laser or dermabrasion at the same time as performing this transconjunctival removal. However, if there is a significant amount of spare skin, most surgeons use the formal skin-excision technique."

Aftercare

Sutres are generally removed within three to five days, and bruising usually vanishes after ten days. There may be swelling for a few weeks, but scars can be covered by make-up after a few days, and fade over time so that they can only be seen with close scrutiny.

Contact lenses should not be worn for at least a fortnight afterwards, and during the first two weeks after the operation (and for two weeks before surgery) patients should avoid alcohol and aspirin-containing drugs. Quick movements should also be avoided.

To treat bruising and swelling, patients can apply cold water compresses for five minutes per hour in the first twelve hours after treatment, then three times daily for three days. Ointment and eye drops can be applied at the surgeon's discretion. Normal activities can be resumed in seven to fourteen days.

Open your eyes

Andrew Skanderowicz, "The results of a successful blepharoplasty can be dramatic and extremely pleasing for the patient, as well as long lasting. Eyelids without creases and bags will look much younger and the eyes will often look larger." By opening up your eyes to the possibility of eyelid surgery, you could take years off your appearance.
CSMUK