The “eyes are the windows to the soul”. Only the eyes and mouth are animated in a human face and therefore the eyes can elucidate happiness, intelligence, strength, beauty or reverie. With age, tissue descends, lose support or atrophy. This can devolve into a look of sadness, fatigue, lassitude or anger. What and now to reanimate the lid structure!
Even though I was on the editorial board of “Advances in Ophthalmic Plastic surgery”, and contributed to the text book “Blepharoplasty”, I regard every eyelid case as challenging. Lid skin is the thinnest, hairless skin of the body and is irreplaceable. The upper lid acts as a window washer protecting the conjunctiva and cornea by keeping them wet and aseptic. The lower lid sits as a stable trough with its lateral edge higher than its central edge, to direct tears toward the nose. In eyelid surgery, function is as important as aesthetics.
If the upper lid is overly bulky, redundant or dropped so as to interfere with vision – it should be operated upon. In fact with appropriate and timely documentation many of these procedures are insurable.
Only a small amount of deep fat can be taken from the upper lid. Over time, excess fat removal produces a gaunt, cadaveric eye. Brow fat may be taken where it no longer supports the lateral brow, but has fallen. The muscle which determines lid posture on the eyeball can be shortened or repaired if there is a droopy eye. The upper lid almost always swells but never bruises. All lid sutures biodegrade with no need for removal. The result of upper lid surgery is a crisp, clean upper lid fold, an invisible incision, and a lifelong result.
Lower lid surgery can be done either inside or outside the lid. I prefer the external approach as it is safer to the eye but also allows complete control of the lid and cheek. The internal approach only allows bag removal.
An incision at the lower lid lashes for the following:
The lower lid result is immediate and permanent, but there is, no matter my efforts, a small amount of bruising.
I do lid or blepharoplasty as, an outpatient with the patient gently asleep. There are no bandages or pain. Resolution of surgery is approximately 1 week. Traditionally, my patient’s vision is much more comfortable without eye strain during the latter parts of the day. There is some accommodation outdoors which is now brighter as more light is entering the unobstructed eye.