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Eyelid surgery or blepharoplasty is often the first form of surgical rejuvenation sought out by patients, both men and women. Often people come in saying that they want to look refreshed because the people around them keep asking them if they are tired or angry, even when they feel absolutely fine. This is because our faces are very expressive, even when we are not making an expression or are in repose. As we age the features have a tendency with gravity to go "down and out" and this gives the appearance of anger and/or extreme fatigue. Patients also often say that their mother or father have eyes that are puffy or overhanging, revealing the genetic nature of this pattern of aging.
In extreme cases when visual fields are obstructed some insurance policies may cover the upper eyelid procedure, but not the lower eyelids. In most cases this is purely a cosmetic elective procedure.
The way the face ages besides hinging on our family genes, is also affected by our environment, by the loss of skin elasticity over time, and the thinning and stretching of the tissues. We see overhanging and drooping skin with gravity, changes in texture and static wrinkles with exposure to the sun and cigarette smoke, and dynamic wrinkles such as frown lines and "crow's feet" with muscle action.
Surgical treatment such as blepharoplasty is directed towards the gravity changes. In the eyelid these are seen as overhanging and puffy upper eyelid skin, and puffiness or "bags" of the lower eyelid. The eyebrows may also be dropping which contributes to the overhang of the upper eyelid skin and causes us to walk around holding our eyebrows up in order to see better - resulting in deep horizontal dynamic forehead wrinkles. Because of this a foreheadplasty or browlift is also considered whenever eyelid surgery is done, the determination being performed by your plastic surgeon on physical examination, and by your desires.
Surgery of the eyelids is done by taking out skin and fatty tissue from the upper lids, and fatty tissue from the lowers. Sometimes skin is also removed from he lowers, but there is a risk of pulling the lower eyelid down with scar tissue and gravity which would expose the white of the eye under the iris or colored part of the eye. For this reason and because in most the same amount of skin is required to cave in slightly as to pouch outwards slightly in the lower lids, the lower surgery is performed without a scar on the outside whenever possible. There is a scar on the upper eyelids in the crease, and out into a laugh line. This is pink for awhile, but tends to fade very well - the eyelid skin being the thinnest skin in the body.
Eyelid surgery does not treat dynamic wrinkles or "crow's feet" or static wrinkles with crepey skin lines and aging texture changes. Do address these patients will sometimes add Botox for the dynamic wrinkles, and skin care, peels or laser for the static wrinkles and textural changes.
