It has been said, “The eyes are the window of the soul.” Being our most precious sense organ, our eyes are protected in a socket of bone called the orbit. In order for them to function and move properly, they are surrounded by fat. This fat serves as a cushion and a lubricant, as well as a protectant mechanism. Since human beings greet other humans by eye contact, the appearance of one’s eyes can convey a look ranging from fresh and sparkling to fatigued or sad. In some individuals who are predisposed to this condition, the upper eyelid often develops a hood-like covering extending down to the eyelashes. The lower eyelid fat frequently bulges producing the “bags” which are frequently seen below the eyes.
The forehead skin is continuous with the skin of the scalp and the eyebrows. It tends to be particularly susceptible to the force of gravity and in most individuals the eyebrows gradually descend to a point lower than their normal position. As this occurs, it makes the distance between the eyebrows and the upper eyelashes very small. Many women often unconsciously hold their eyebrows elevated so that their upper lids can be visualized.
This is surgery to restore the normal ,youthful, rested and energetic proportions of the eyebrows to the hairline. Incisions may be varied from endoscopic stab incisions to coronal ear-to-ear incisions over the top of the scalp to those in front of the hairline. The muscles that hold the brows in position relaxes and stretches with age as does the skin . With browlift, the muscle is raised and repositioned. The corrugator muscles that pull down the medial eyebrows are also weakened to relieve the “11” lines between the eyebrows. Surgery is almost always done in the office and is usually an easy recovery. Be sure to tell us if you are predisposed to migraines.
If the hooding of the upper eyelids is not caused by malposition of the brows, often a simple removal of excess eyelid skin may be the answer. This is always an office procedure and should be a painless recovery. A small incision is made at the eyelid crease and is virtually invisible when healed.
If you are interested in relieving the circles under your eyes or handling that bulging fat, then you are interested in lower eyelid blepharoplasty. Simple fat removal can be performed through a transconjunctival incision but if skin repositioning is desired, a subciliary incision (beneath the eyelashes) will be necessary. This allows access to the fat compartments of the lower eyelid and allows for tightening or reposition of the lower eyelid muscle and removal of skin if desired. Often this procedure can be expanded to release of the muscle attachments and lifting of the midface which will also have some effect on the nasolabial folds and even help with position of the corner of the mouth. With any subciliary incision there is risk of change in the lower eyelid position (scleral show or ectropion).
(Look for updates to this discussion with expanded descriptions and diagrams in the near future)