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Blepharoplasty and Rejuvenation Treatments for Eyes
Eyelid surgery (clinically known as Blepharoplasty) is used to improve the appearance of the eyelids. It can target the upper eyelid (upper blepharoplasty), lower eyelid (lower blepharoplasty) or both eyelids. Eyelid surgery can rejuvenate this eye region by removing loose or sagging skin, and reducing eye bags and other imperfections that affect the appearance of this area. Various surgical and non-surgical procedures can be combined with eyelid surgery to rejuvenate cheeks, eyebrows and the surrounding eye area.
Below we answer the questions that are posed to us most frequently during pre-operative consultations for eyelid surgery.
Which parts of the face can be treated to rejuvenate the appearance of the eyelids?
There are various surgical and non-surgical rejuvenation options to treat eyelids, bags under the eyes, eyebrows, cheeks, the bony orbital rim, tear-troughs, and dark circles under the eyes.
How are the signs of ageing assessed in the eyelids?
Evaluating the eye area requires a careful pre-operative assessment of:
- brow position
- upper eyelids
- lower eyelids
- wrinkles and fine lines around the eyes, such as crow’s feet and frown lines
- dark circles, pseudo-dark circles, and the tear-ducts
- cheek projection.
Can Eyelid Surgery be performed in conjunction with other non-surgical treatments to rejuvenate the eyes?
Over time, eyes can take on a fatigued, aged, and even sad appearance. In contrast with the media’s promotion of this type of surgery, eye rejuvenation surgery cannot correct all age-related issues in this area, and the surgical techniques applied in the past frequently caused the under eye area to hollow with time. Up until the 90s, plastic surgeons performed eye rejuvenation surgery with blepharoplasty, a classic or coronal brow lift, or a temporal brow lift. However, the modern approach is less invasive, thanks to recent developments in cosmetic treatments, such as botulinum toxin injections. Consequently, nowadays, eye rejuvenation uses both surgical and non-surgical options.
How does the brow position influence the effects of ageing?
Brows become heavier and more deeply set over time as a result of a loss in fatty tissue, poor muscle function to regulate movement in the upper part of the face, and the effects of ageing. The eye region starts to show visible signs of ageing and hollowing and the heavy, sagging position of the brow creates a sad appearance.
How can surgery and less invasive options treat the brow area?
Eyelid surgery is based on a wide range of surgical and non-surgical options designed to match the patient’s specific requirements:
- Coronal Brow Lift – rarely used nowadays thanks to the development of less invasive alternatives such as Botox
- Temporal Brow Lift
- Endoscopic Brow Lift – applies a less invasive technique to excise tissue from the brow area. Brows can also be raised to a more youthful position with upper eyelid surgery, thanks to techniques which secure the brows by using the same incision sites as blepharoplasty surgery
- Botox to smooth forehead creases, wrinkles and fine lines around the eyes such as crow’s feet, and frown lines, and to modify brow position
- redefinition of the brow area with fat grafting or hyaluronic acid (improves eyelid contour and conceals hollowing around the eyes.
What are the cosmetic surgery options available for Eyelid Surgery?
An upper blepharoplasty or lower blepharoplasty can be used to rejuvenate the upper and lower eyelids. Eyelid surgery can be combined to treat both areas in one procedure (full blepharoplasty).
Who is an ideal candidate for Upper Blepharoplasty?
As we age, the skin around the eyes starts to droop, and excess skin on the upper eyelids can create hooding of the lids. Excess skin rests on the lash line, and in some cases, it may even obscure vision which makes the eye region look aged and heavy. Occasionally, lids may have fatty deposits usually located around the inner corner of the eye region. Upper blepharoplasty is used to reduce these imperfections.
What does Upper Blepharoplasty involve?
Upper eyelid surgery is used to remove excess skin and eye bags. It is a relatively quick procedure (between 30 and 60 minutes) carried out under general anaesthesia with intravenous sedation depending on the patient’s level of discomfort. Hospitalisation is not necessary, and the patient may return home the same day. Post-operative recovery is also reasonably short as swelling subsides after four to five days and bruising after seven days. Megaestetic uses internal dissolving sutures, sparing the patient one of the more painful aspects of eyelid surgery. The scars are located in the eyelid crease, and they are barely noticeable after a short period.
Why is Lower Blepharoplasty performed?
Over time, the lower eyelids can develop loose skin with a crepe-paper like appearance and bulging of underlying fat which significantly ages the features. Skin becomes less compact, and the eye region (orbital rim) starts to hollow, creating a gaunt look.
What steps are involved in Lower Blepharoplasty?
Lower blepharoplasty is performed with either the skin incision method or the transconjunctival method.
How is the skin incision method applied in Lower Blepharoplasty?
This method is the most common technique used in eye rejuvenation surgery. The incision is placed just below the lower lash line. Previous techniques completely removed eye bags; however, over the years, surgeons have come to see that this approach accentuates a hollow appearance of the orbital region. Currently, this is the most popular technique to reposition displaced fat with or without removal of the deep fat. Excess skin is meticulously excised to avoid distorting the natural contour of the eyelid to prevent secondary conditions such as the outward rolling of the lower lid (ectropion). Lower blepharoplasty can be combined with other surgery and non-invasive treatments to reposition the cheeks, lift the outer corner of the eye (clinically known as canthoplasty), or the use of skin-muscle grafts to restore a natural lid contour. Eyelid rejuvenation surgery improves the contour of the lids; however, it cannot eradicate periorbital wrinkles such as crow’s feet. Addressing these signs of ageing requires either Botox or hyaluronic acid dermal fillers. Skin tightening procedures take about an hour, sometimes longer depending on the technique. Lower blepharoplasty is routinely carried out under local anaesthesia, but some patients may require intravenous sedation, or, in some instances, even general anaesthesia. Anaesthesia choice depends on whether the patient requires overnight hospitalisation for surgery. Once more, residual scarring is barely noticeable a short time after surgery.
What is Lower Blepharoplasty with a transconjunctival incision, and how is it applied?
This technique is commonly used in younger patients with significant fat bulges under the eyes. The incision is concealed inside the lower eyelid; therefore, there is no visible external scarring. This technique cannot remove excess skin.
How long does Eyelid Surgery take?
Eyelid surgery takes from between 30 and 60 minutes up to 3 hours. Shorter operating times are often a big selling point to convince patients that eyelid rejuvenation surgery is a quick, risk-free and straightforward procedure.
What are the options for patients with visible signs of ageing and hollowing around the eyes?
Nowadays, it is possible to perform an augmentation blepharoplasty, using the fat grafting around the eyes. Periorbital micro fat grafting can be combined with blepharoplasty surgery to address volume loss in hollow areas, decreased skin elasticity and to reduce the gaunt appearance of the orbital rims, in one procedure. Hyaluronic acid dermal fillers may be used as an alternative treatment for the same purpose.
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How and why are cosmetic treatments used to address periorbital ageing?
Wrinkles around the eyes become noticeable over time. The delicate skin surrounding the eyes becomes thinner and loses tone and elasticity, and deep wrinkles (crow’s feet and frown lines) develop caused by repeated facial expressions. These imperfections are commonly treated with Botox; however, hyaluronic acid may be used alongside Botox to target skin concerns effectively.
How can dark circles under the eyes be treated?
Several factors cause dark circles around the eyes:
- an accumulation of broken capillaries which can show through as dark patches
- withered eyelid skin with wrinkles, which appears darker depending on the light (pseudo-dark circles).
Nonsurgical options such as chemical peels and laser treatments achieve some degree of improvement, but generally, the results are quite disappointing. A lower eyelid lift can treat pseudo-eyebags.
How can cosmetic surgery and minimally-invasive treatments rejuvenate the cheek area?
As skin ages (or cheeks have not developed the desired volume), this part of the face takes on a sunken, flat, saggy appearance due to elasticity loss in the skin and supporting tissue. Cheek implants, hyaluronic acid fillers, fat transfer cheek augmentation, or cheek lift surgery to redefine the malar region can be used to rejuvenate this part of the face. The right choice is determined after discussing the patient’s individual requirements and goals.