Your eyes are a focal point on your face. They give others clues about your age, mood, and whether or not you are tired or well rested. The eyelids often show the effects of aging, gravity, sun exposure and smoking before the rest of the face or neck, which is why many people elect to have eyelid surgery as a starting point. The protruding fatty tissue from your eye sockets that causes bulging above or below the eye can be an inherited trait that shows up early in life or the result of aging that occurs in both men and women.
At first, the bags or sagging under your eyes may be most noticeable when you are tired, but eventually they become visible all of the time. Eyelid skin and muscle thin and stretch with time. Bulging fat pockets result when fat pads that cushion the eyes begin to fall forward, pull away from the bone of the lower eyelids and sag. Since the eyes are a central feature of the face, rejuvenating them is critical to achieving a more youthful appearance.
Aging may cause a hood to form over the eyelashes where your upper eyelids have become heavier and fuller. Upper lid blepharoplasty can get rid of droopy or hooded eyelids and eliminate the protruding fat bags above and below your eyes. In some cases, cosmetic eyelid surgery may be combined with surgery to correct a functional problem such as weakness of upper eyelid muscles called "ptosis" that can decrease the range of upward vision.
The goals of eyelid rejuvenation techniques are to remove excess skin, reduce fat deposits or reposition them, to tighten lax eyelid muscles, and to re-establish a natural crease in the upper lids. In the past, surgeons removed more skin, fat and muscle. Today, we preserve the fat whenever possible to avoid creating an “operated-on” look or to eliminate causing hollows.
Plastic surgery on the eyelids does not directly correct the dark circles under the eyes, but it can eliminate the dark shadowing effect caused by bulging fat pockets and loose and redundant skin. Also, eyelid surgery does not lift sagging eyebrows as this requires a brow or forehead lift that can be performed in tandem with eyelid surgery. Botulinum toxin injections, peels and laser therapies can reduce fine lines and wrinkles near the eye.
Cosmetic eyelid surgery may need to be revised in the future if there is very loose or thin skin, but the rejuvenation effect of blepharoplasty generally lasts ten years or more and often times does not need to be repeated.
Our Plastic Surgery Center can remove the puffy look or “bags” under your eyes and take away that “tired “ look through a procedure called lower blepharoplasty. Most often Dr. Filiberto will use the external approach and make an incision near the inner tear duct of the lower eyelid. We extend it into the crow's feet area where lines already exist to make the thin scar less noticeable. We then lift the skin and muscle to remove a small amount of fat and trim excess skin and muscle from the lower lid. If you have a pocket of fat beneath your lower eyelids, but do not have any loose skin, we may recommend a transconjunctival blepharoplasty. This procedure is usually performed on younger people with fatty lower eyelids and taut skin. The transconjunctival method utilizes an incision hidden inside the lower eyelid to leave no visible external scars. Through this incision, we can expose and trim the excess fat. The incision is closed with dissolving sutures and is left to heal on its own. A lower eyelid tightening procedure may also be performed at the same time during either surgical approach, but if significant skin and muscle laxity are present, we will use the external approach. During lower eyelid surgery we can also address the "tear troughs" or deep grooves that result when there is an obvious demarcation at the junction of the lower eyelid area and the cheek. We can improve the tear trough area to create a smoother look through fat removal, fat injections or by displacing the existing fatty deposits.