As already described under aging changes in facial skin, downward shifting of the brow and fullness of the upper eyelid skin are the earliest signs of the normal aging process to become evident. Frequently, swelling of the eyelids, at first present only in the morning, seems to hang on longer each day, and eyeshadow makeup becomes smudged at the lid folds.
Progressive upper lid fullness over a long period of time may produce overhanging skin folds that result in partial visual obstruction. Some conditions leading to rather early aging changes are repeated swelling due to allergic or related systemic problems, and a variety of anatomical characteristics that are genetic in origin.
In addition to the wrinkling and sagging of the eyelid skin, so-called “bagginess” may become evident under the lower eyelids and at the inner corners of the upper lids. This is the result of protrusion or out-pouching of the fatty tissues under the lid. Occasionally, this tendency is strongly familial in origin, becoming noticeable at a relatively early age, sometimes in the mid-twenties. More often however, the fullness is developmental in nature and appears at thirty-five or forty, becoming even more marked in the forties and fifties. All of the genetic aspects previously mentioned (dry thin skin, etc.) also contribute to early development of this condition. The preference for early surgical correction applies here as it does to facial surgery in general.
When the condition of the eyelids has progressed to the point of visual impairment, or to the point where the muscular fibers around the eyelids have become overstretched, repair becomes more difficult. Sagging of the overstretched skin requires removal of the excess in all directions to achieve maximum benefit. Long-standing problems therefore require greater surgical change; at the same time, they are less amenable to excessive displacement of the skin without jeopardizing final results.
Fortunately, the results of early treatment can be highly successful. There may be more wrinkling or fullness in the skin as years go by. Once fatty tissue “bags” are removed, however, they generally do not return. Correction may be performed along with the facelift operation or as an entirely separate procedure when this area alone is primarily involved. Attention is paid to fat preservation with repositioning with or without minimal resection of the bulging fat to avoid a gaunt or tired look.
Eyelid surgery / Blepharoplasty may be performed under local or general anaesthesia. Surgical incisions are so placed that they will hardly be visible after several months have elapsed. Initially, they may appear as small red marks just to the side of the eye; as time passes, however, they fade into the normal lines ordinarily found in this area. The excess skin and any overstretched muscle fibers are removed from the upper lids along with the protruding fatty tissue. Similar correction is performed for the lower eyelids; in this area, however, specific attention is directed to the elimination of excess skin without undue tension on the lid margin. During eyelid surgery the same meticulous attention is directed toward small bleeding points as in any other procedure, and repair of incisions is performed with very fine suture material.
The shape of the eye itself is not altered except in unusual conditions.
Sutures are removed on the third or fourth post-operative day. As noted, this operation involves the eyelid structures and the surrounding soft tissues alone. Hazards or risks in this operation involve unfavourable healing, surgical wound infection (very rarely), or prolonged postoperative swelling and discoloration. The last can be particularly troublesome when darker pigmentation is present before eyelid surgery. Additional post-operative problems (infection, bleeding, etc.) are no more frequent than in other types of surgical treatment.
You will remain in hospital for one day and your recovery will take approximately five days.
Plastic Surgeon Dr. Saul Braun operates from the Netcare Rosebank Hospital, situated in the up-market Northern Suburbs of Johannesburg.