Eyelid Surgery - Process and Procedure
The Upper Eyelid
Most people dissatisfied with the appearance of their upper eyelids will point out extra skin hanging down towards their eyelashes, as well as "puffy" areas in the lid itself. As mentioned earlier, with age the skin of the lid thins, stretches and becomes less elastic. This "extra" skin is unsightly, but can also impair vision. The "puffiness" is actually fat normally surrounding and cushioning the eyeball. Over time, the structure that normally retains this fat behind the lid may weaken, allowing some fat to slip forward and produce a bulge in the lid. Modern eyelid surgery takes advantage of the existence of a natural crease in the upper lid; the incision is placed in this crease, so that the final scar is no more noticeable than the crease itself. Excess skin can be removed, and the bulging fat can be removed as well.
The Lower Eyelid
Traditionally, lower eyelid surgery was performed through an incision just below the eyelashes, after which excess fat and a small (usually very small) amount of skin was removed. Over the past 10 years, surgeons have increasingly realized that generally very little skin was removed. Also the fine lines on the lower eyelid were not treated by this surgery. With improvement in resurfacing techniques, a newer, and more logical procedure has come to the fore. Transconjunctival blepharoplasty allows cosmetic surgery of the lower eyelid to be performed without any visible scars. By making an incision on the inside of the lower eyelid, the fat bulges of the lid are approached more directly. For the patients with fine wrinkles on the lower eyelid, the skin can be resurfaced to smooth the lines, as well as tighten and contract the loose skin of the lower eyelid. Occasionally, the more traditional approach is used when excess skin needs to be removed.
Upper eyelid surgery may occasionally be covered by insurance, if there is a significant impairment of vision, but blepharoplasty is generally a cosmetic procedure. Cosmetic eyelid surgery is very rewarding for both the patient and surgeon, since the results are seen quickly and patients can return to their usual activities within a few days.