Blepharoplasty or eyelid surgery involves the rejuvenation of the upper and lower eyelids. There are small fat pads that reside behind the eyelids. In the upper eyelids there are two fat pads located closer to the nose. In the lower eyelids there are three fat pads spread evenly below the eye. With youth, the bags are held behind a nice tight membrane. As one ages, these bags can push farther outward and become more noticeable as the membrane weakens, similar to a hernia. The result of this is that people are frequently told they have a "tired look." For mild bags, a filler may be all that is needed to camouflage the appearance. For more advanced cases, the options are to either remove the fat bags with surgery or to reposition the fat bags.
In addition to the fat bags, the skin also begins to sag, a condition called dermatochalasis. The upper eyelid skin can begin to weigh down on the eye, and in some instances, begin to obstruct vision. In this case, insurance may cover the cost of surgery. An important distinction is between the heavy, droopy eyebrow and the upper eyelid. It may be that both need correction or only one. If needed, both the upper and lower eyelids can be corrected at the same time.
Another important aspect is determining what caused the eyelid condition in the first place. It may be genetics (mom and dad), overall health status, and even a number of medical conditions can affect the eye including thyroid problems. When choosing a blepharoplasty surgeon it is important that he or she appreciates the eyes in relationship to the face to avoid the "overcorrected" or "hollow" look.
As far as surgical approaches, for the upper eyelid surgery is begun by making an incision into the natural crease above the eyelid. The excess skin is then measured with a scientific instrument and this determines how much skin is removed. If the fat needs to be addressed, it is removed through this same incision. What's nice about upper eyelid surgery is that it is well tolerated and can frequently be performed in the office under local anesthetic. This makes the treatment more cost effective as well as allowing for an easier first day to recover without the grogginess of anesthesia.
For the lower eyelids, there are generally three approaches. For younger patients who simply have excess fat and the skin remains nice and tight, an incision can be made into the pink part of the eyelid leaving no external incisions. This is called the transconjunctival approach. The nice part of this is that it can address the fat without leaving any visible scars. However, it does not address any skin so it isn't an option for everyone. The next two approaches both remove skin and can address the fat. The first option is to make an incision just below the eyelashes. This is called the subciliary approach. The nice part about this option is that the incision is essentially camouflaged immediately. The drawback is that if you look closely, about 20% of patients with this approach will have a change to the shape of their eyelid. The other option is known as the subtarsal incision. This makes the incision about 3-4 mm lower than the subciliary incision. This helps to minimize the risk of changing the eyelid position but the scar is visible for the first few months. Dr. Guy traditionally opts for the subtarsal incision as a temporarily visible incision is better than a life long eyelid position change. This can all be discussed with Dr. Guy at the time of consultation.