"All the great artists realized the eyes convey both attention and emotion."
With any surgery on the eyelid, the artistic goals should consider all the appearance of the two key features of the region: the position and shape of the eyelids, and their relationship to the eyebrow. Surgical procedures on the upper and lower eyelids are performed at the Edina, Minnesota practice of Dr. Edward Szachowicz. If you are interested in eyelid surgery and live in the Minneapolis-St. Paul area, we can help. In this section, the focus will be on rejuvenation of the eyelids.
Surgery on upper eyelids is performed to address excess skin and fatty protrusions in the upper eyelid, and may include a brow-lift at the same sitting. Surgery on lower eyelids improves the fatty bulges that form in that region. Loss of tone in the lower eyelid may require tightening of the muscle of the lower eyelid. Fine lines and a crepe-like appearance in the skin of the eyelid are best treated with laser skin-resurfacing.
The aesthetic goal of surgery in the region near the eye is to transform a sad or tired appearance into an open and friendly look. As the eyes convey not only attention but also emotion, a careful analysis is important.
Asymmetry is common with both eyebrows and eyes, and some measure of asymmetry will remain after surgery. Also, most people are surprised to realize how the position of the eyebrow influences the amount of excess skin in the upper eyelid — the more the brow sags, the more excess skin accumulates around the upper eyelid. Many times, surgery on the upper eyelid and a brow-lift (forehead lift) are performed at the same time for optimal results.
Considerations that influence the choices of eyelid-surgery include:
- a history of dry eye or excessive tearing,
- a very deep or shallow placement of the eye, and
- position and tone of the eyelids.
Surgical Procedures on the Upper Eyelid (Upper Blepharoplasty)
A procedure on the upper eyelid begins with marking the incision in the crease of the upper eyelid, with the person in an upright, sitting position. Any protrusions of fat are outlined at this time as well.
- Excess skin and muscle are removed as marked beforehand.
- Any fat causing puffiness in the upper eyelid is then removed. Most often bulges occur in the inner part of the upper eyelid near the nose.
- The incision is then closed using a delicate suture that weaves under the skin, to avoid the formation of stitch -marks or tiny cysts. A paper tape is then placed over the edges of the skin edges during healing.
Surgery on the Upper Eyelid Combined with a Brow Lift
The TransBleph Direct Brow-Lift is a newer approach to elevate the outer eyebrow at the same time as surgery is done on the upper eyelid . This combination gives optimal rejuvenation to the eye-area with the advantage of only one incision in the eyelid.
The incision in the upper eyelid is in the crease, the same as it usually is in surgery on the upper eyelid (blepharoplasty), and the procedure then includes a release of the eyebrow at the bony ridge above the eye. The eyebrow is elevated into the desired position and is then anchored in place to the brow-bone with a bio-absorbable fixating device called an endotine. With the eyebrow now in a more youthful position, and the hooding removed by elevating the outer portion of the eyebrow, only the true excess of skin in the upper eyelid is removed. The incision in the crease of the eyelid is then closed normally using fine sutures.
A small implant holds the raised eyebrow in the desired position until healing is complete, and then it is absorbed naturally by the body. This procedure is warmly accepted by people who already feel that they have too much skin on the upper eyelid and want a more complete rejuvenation of the eye-area than just a routine blepharoplasty can offer. Recovery is similar to surgery on the eyelid alone.
This procedure is an excellent option for those with a high forehead or thinning of scalp-hair, and it is preferred for the earliest signs of relaxation of the brow.
Surgery on the Lower Eyelid (Lower Blepharoplasty)
1. Treatment of Fatty Bulges of the Lower Eyelids with a Transconjunctival (hidden incision) Approach
Dr. Szachowicz will make an individual assessment of the condition of your skin on the lower eyelids, of the tone of the eyelid, and of fatty protrusions in the lower eyelid. If there is no excess skin, and there is good tone in the lower eyelid, then a "hidden incision" or transconjunctival blepharoplasty may be the best option. Dr. Szachowicz believes in preserving the fat around the eye, and chooses to reposition the fatty bulges into a smooth layer that softens the bony rim and gives a full, youthful result. This is the most common approach for rejuvenation of the lower eyelid. Most procedures on the lower eyelid look their best when combined with elevation of the cheek which occurs during a facelift procedure.
Transconjunctival surgery on the lower eyelid:
- Begins with a small incision hidden on the back surface of the eyelid;
- The fatty bulges are exposed and opened along the lower bony rim of the eye;
- The fatty bulges are then draped over the bony rim, creating a smooth layer of fat that provides fullness in the hollows under the eyes; and
- The incision is closed using dissolvable sutures
If any excess skin is present, a small "pinch excision” of skin is done along the margin of the eyelash. Any creped appearance of skin of the lower eyelid is best treated using Fraxel laser resurfacing to thicken the thin, delicate skin of the eyelid.
2. Treatment of Fatty Bulges of the Lower Eyelid Using Re-suspension of the Muscle of the Eyelid
If the lower eyelid has lost tone, then tightening the muscle of the lower eyelid may help to re-suspend the eyelid. With this approach the excess fat is removed, and the muscle of the eyelid is tightened to support the eyelid. This proceeds as follows:
- An incision is made just beneath the lash-line, and the layer of skin and muscle is exposed.
- Excess fat is removed, and the muscular layer is tightened into the outer corner of the eye.
- Excess skin in trimmed, and the wound is closed using a fine suture.
Recovery from Surgery on the Eyelid
Surgery on the upper and lower eyelids does require that you do no heavy lifting or strenuous activity for 1-2 weeks after the surgery to minimize the risk of bleeding around the eye. Swelling usually diminishes at one week . Residual bruising then fades thereafter. Dr. Szachowicz uses homeopathic arnica Montana pellets and gel after surgery to accelerate healing. Fraxel laser-resurfacing of the skin of the eyelid is usually planned any time after six weeks of healing.
Risks of Surgery on the Eyelid
Most people have no complications. Major risks such as visual loss are extremely rare. Infrequently, the shape of the eyelid or its posi- tion may change, and some fatty protrusions may re-occur. Dr. Szachowicz, an experienced surgeon, will discuss with you the benefits and risks of surgery on the eyelid.
Learn More About Surgery on the Eyelid and Facial Plastic Surgery
If you want to know more about approaches to rejuvenation of the eye and brow, contact our Edina office to learn more and schedule a session using computerized video-imaging to simulate your result. We proudly offer eyelid surgery at our Minneapolis-St. Paul-area practice.