Cosmetic Eye Surgery

December 04, 2015

Q. My upper eyelid skin hangs down and makes me look tired. How can I fix this?

A. The corrective procedure for tired, saggy upper eyelids is called upper blepharoplasty. The eyelid consists of several tissue layers - underneath the skin is a layer of muscle, then orbital fat, then the membrane which actually pulls upwards on the lash margin to open the eye. In upper blepharoplasty (sometimes shortened to "upper blephs"), a crescent-shaped sliver of skin and underlying muscle is surgically removed, and the defect is then sutured together to create a single line which will form the base of the new upper eyelid fold. Sometimes excess orbital fat is also trimmed to create a more deep-set fold.

It's important to assess each patient individually. In some cases, the underlying problem is not excess eyelid skin, but dropped eyebrows. In these cases, upper blephs won't fix the problem - a browlift is what's needed.

Q. I have dark circles under my eyes. Can this be corrected?

A. The appearance of "dark circles" under the eyes is usually not a skin colour change as such; rather, It's a shadowing effect caused by the altered skin contours associated with facial ageing. The youthful mid-face fat pad descends and shrinks as we age, creating a deep depression commonly known as the "tear trough".  This can already begin to appear during teenage years in some people; most of us will have visible tear troughs by the time we reach our thirties.

In some cases, there will also be lower eyelid skin excess and possibly some forward bulging of the lower orbital fat pads, which creates an "eye-bag". Lower blepharoplasty addresses this skin laxity and reduces fat bulging; but if neither of those is present, lower eyelid surgery will not help. A better approach might be to restore midface volume with either injectable dermal fillers (a simple office procedure) or fat transfer (a type of minor surgery which can be performed under light sedation).

Q. What are the risks of eyelid surgery?

A. All surgery carries some risk. In the case of eyelids, the most serious risk is of uncontrolled bleeding, which can accumulate as a clot behind the eye, pressing on the optic nerve and thereby threatening vision. This is an extremely rare complication, but we should always be mindful of it, and take all possible steps to ensure that any bleeding during surgery is promptly stopped.

Another risk is of removing too much skin in an attempt to maximise skin "tightening". In the upper lid, this can lead to an inability to fully close the eye; in the lower lid, it can create downward tension on the lash line, leading to a type of "bloodhound" look which is very unattractive. Experienced surgeons know how to minimise these risks by ensuring that they don't remove too much skin. Some eyebag patients with very loose lower eyelids may be better off having a more limited procedure, in which fat is trimmed from the conjunctival (i.e. eyeball) side of the lower eyelid, without any skin removal.

Other minor risks can include asymmetry, abnormal scarring, and dry or teary eyes. Again, in the hands of an experienced surgeon, these risks are minimal.

Q. What's the right age for me to have this type of surgery?

A. There's no correct answer to this question. Generally though, if your upper eyelid skin is resting on your eyelashes during forward gaze, or if people are constantly asking after your well-being because they think you "look tired" due to your lower eyebags, then It's probably time to at least have a chat with your surgeon and find out what your options are.

If you are interested in this procedure please contact the me clinic on 1300 852 050 to arrange an appointment with Dr Tony.


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