Eyelid surgery is one of the most common cosmetic surgical procedures requested on the face. The goals may be for functional improvement or both functional and aesthetic. With age, the brow descends and feels heavier
The upper eyelid skin also loses elasticity and this excess of skin may droop low onto the eyelid margin and on the sides, may obstruct peripheral vision. The orbital septum, which holds in the periorbital fat (nature’s shock absorber for the eyeball within the bony socket of the skull) may become stretched and the fat can herniate through, worsening the excess skin and heavy appearance of the upper eyelids. This condition (dermatochalasis) may be hereditary. Similarly, with descent of the midface, the lower eyelids may slacken, become puffy and look tired (bags under the eyes).
For purely functional problems, upper eyelid blepharoplasty alone may suffice, and this can be done either under local, or general anaesthetic. However, it is important to remember that the orbital region, comprising the forehead, brows, upper eyelid and lower eyelids, all form one ‘region’. Hence, rejuvenation of ‘tired looking eyes’, frequently require these separate areas of the same region to be addressed. Lower eyelid lifts also allow for lifting of the midface soft tissues, helping to restore the volume from the lower cheeks to the upper cheeks (blusher areas), thus softening the prominent nasolabial folds. This 4-lid blepharoplasty procedure, with or without a brow lift, can only be done under a general anaesthetic.
During the consultation, I will thoroughly examine you and make my recommendations.
The site of the Incision: For upper eyelid surgery the incision is designed to sit within a natural fold, the length of this incision depends on the amount of excess skin, and on occasion can run laterally beyond the outer edge of the eyelid.
With lower eyelid surgery, I will discuss the anatomy of your lower eyelid and what tissues need to be treated. If you have predominantly excess skin the incision may be placed just below the lower eyelashes, or alternatively, if there are good lower eyelid skin and more bulging of fat, an incision on the inner aspect of the lower eyelid may be used. This is called a trans-conjunctival incision.
The local anaesthetic procedure (for upper eyelids only) usually takes about 60 minutes and is usually well tolerated. In a few cases, if requested specifically, the procedure can be performed under a general anaesthetic. 4-lid blepharoplasty takes about 2 hours and a general anaesthetic.