EYELID SURGERY PROCEDURE OVERVIEW

Palm Beach Institute of Cosmetic Surgery
Plastic Surgery for the Face and Body

Upper Eyelid Lift (Blepharoplasty)
Lower Eyelid Lift (Blepharopalsty)
Transconjunctival

UPPER EYELIDS:

Several factors affect the upper eyelid as we age: sun damage, genetics, smoking and alcohol, all contribute to destroy the youthful upper eyelid that flows into the temple. Initially, the upper eyelid may become puffy eliminating the ability to put on eyeliner and in the latter decades of life, the loose skin will hang down over the eye obstructing the peripheral vision. The correction of this is an upper lid blepharoplasty to remove the skin and, if present, the fat which forms bags in the corners of the eyes.

WHAT ABOUT THE CROW'S FEET?

In the youthful patient, in their mid 30's and 40's, the crow's feet can be easily corrected with BOTOX® Cosmetic injections. These are injections that last approximately 3 months and reduce the crinkling at the corners of one's eye. Another solution is to perform a deep chemical peel of the skin thereby tightening it and reducing the crow's feet.

PTOSIS: WHAT IS IT?

Another vagary of the aging process is downward migration of the upper eyelid toward the pupil (the black portion of your eyeball). This migration of the upper eyelid toward the ptosis over the iris (the colored portion of your eye) is called ptosis. This is due to the tendon becoming detached from the upper eyelid cartilage. A relatively simple procedure to reattach this tendon can be done at the time of one's upper eyelid surgery thereby opening up the eye and getting a more youthful appearance. Unfortunately, the patient has to be able to voluntarily open their eyes during the procedure to be able to gauge the tightening of this tendon.

Frequently, patients will have a combined forehead lift and an upper lid blepharoplasty to totally rejuvenate the forehead and upper eyelid area. The forehead lift repositions the eyebrow in a more youthful position while the upper eyelid blepharoplasty removes the redundant skin and restores the transition of the upper eyelid flowing into the temple area.

LOWER LID BLEPHAROPLASTY:

An interesting problem seen in women in their 20's (an occasional man but rare) is the herniation of fat in the lower eyelids producing "bags". These bags are actually pockets of fat that pooch out against the lower eyelid. By making an incision on the inside of the eyelid, this fat can be teased out in a very simple manner thereby safely restoring the natural contour of the lower eyelid.

SMILING IN THE LOWER EYELID:

Sometimes when people are happy and smile, they develop a fold right underneath the lashes of the lower eyelid. This is a contraction of the orbicularis oculi muscle that is thickened and can be readily corrected with a tiny amount of BOTOX® Cosmetic. By paralyzing just a few fibers of this muscle, one loses the thickness and hypertrophy seen on smiling.

In the latter third and fourth decade of life, as the lower eyelid loses its normal elasticity, it develops wrinkles compounded by the herniation of fat (eye bags). The most efficient way to correct this problem is a lower lid blepharoplasty by the transconjunctival approach which involves an incision on the inside of the eyelid. In order to tighten only minimally the skin of the lower eyelid, it is sometimes necessary to do a pinch excision of the lower eyelid skin or a chemical peel. The chemical peel with tighten the eyelid a millimeter or so and also afford a solution to the crow's feet by carrying the deep chemical peel out laterally into the hairline.

SCLERAL SHOW OF THE LOWER EYELID:

Just as the upper eyelid develops ptosis with migration of the eyelid toward the pupil, the lower eyelid has a similar problem. If you look closely at older people, you will see what is called "scleral show". The sclera is the white part of the eye and the lower outer portion of the eyelid will become rounded and drift downward. This produces a scleral show and is a tell tale sign not only of aging but frequently of patients who had lower eyelid cosmetic surgery. To correct the scleral show and the laxity of the lower eyelid in patients who have not had any cosmetic eyelid surgery, one does a canthoplasty. This involves literally repositioning the lower eyelid higher, tightening it and removing the associated bags of fat if indeed they are present.