As we age, the skin on our eyelids naturally bulges, sags and droops, pulling the brow down with it. For some people, the resulting expression is a real drag.
“Fullness over the upper eyelid can make us always look tired, and some people always look upset,” says Dr. Fadi Abbass of The Face Institute in Chagrin Falls.
Most people who undergo eyelid tucks (blepharoplasty), brow lifts (forehead lift) and mid-face lifts to lift lower eyelids simply want to restore their youth. Sometimes, they produce pictures of what they looked like years ago — other times, they pinch loose skin and want it removed, says Dr. Steven Goldman of Beachwood Plastic Surgery and Laser Center.
Goldman says patients tend to clip pictures from magazines to describe their ideal. “They might come in with a Vogue and say, ‘I really like Keira Knightley’s eyes,’ ” Goldman says.
Other patients complain of wrinkles or dark circles, which can be treated through laser surgeries or chemical peels, adds Dr. Michael Wojtanowski of Ohio Clinic for Aesthetic and Plastic Surgery in Westlake.
“We want to know what bothers the patient when he or she looks in the mirror,” Wojtanowksi says, noting that sags and wrinkles are a different bag. “The procedure is customized to the individual’s anatomy.”
But is it possible to turn back the clock? Can plastic surgeons iron out 20 years of time lines and crow’s-feet, flatten puffy eyelids and defy gravity, which pulls down brows as we age?
“In general, blepharoplasty is a slam dunk,” Wojtanowski says of the outpatient procedure, which generally takes one to two hours. These days, eyelid tucks are the most common surgery he performs on male patients. “That is an area where men tend to age sometimes even prematurely to women,” he points out.
“The goal of these surgeries is to rejuvenate someone so they look better,” Wojtanowski continues. “Good cosmetic surgery for rejuvenation should not be detectable by strangers.”
Age is a key factor in determining the appropriate eye procedure, says Goldman. For example, younger patients tend to present with lower-eyelid droop — sags and bags. In some of these cases, Goldman performs a mid-face lift, which can reposition the cheek with respect to the lower eyelid. Think “lifting and tightening.”
For people who complain of eye droop, Abbass recommends an eyelid tuck tailored to the patient’s needs. “For older patients, we usually remove some of the redundant skin, which involves an incision in the lower lid. This is usually hidden under the eyelashes, and in the upper lid, the incision is hidden in the natural crease of the upper lid.”
In general, restoring youth in the upper eye region requires lifting the brow, which will widen the space between the eyelid and brow, opening up the face and relieving a descending brow, Goldman says. He prefers to perform brow lifts rather than eyelid tucks, which remove fat. “The problem with removing fat is you can create a hollowed out look,” he says.
Tighter doesn’t always look younger. “In fashion model photos, you’ll notice a fullness under the brow,” Goldman adds. “Newer techniques attempt to preserve the fullness so when the eye is open it looks smooth.”
[Eyelid surgery follows breast augmentation as the fourth most common plastic surgery procedure performed in 2005, reports the American Society of Plastic Surgeons.]
Blink Twice — If you carry liquid tears in your purse to combat dry eyes and you can’t wear contact lenses, eyelid procedures may not be for you. “You can sometimes make a dry eye even worse,” Wojtanowski says, although in some cases, it can alleviate the problem.
Also, patients who have had prior eyelid surgery should be cautious with new surgeries. Removing too much fat can make the eyelid difficult to open and close, he adds.
Abbass says patients with a history of thyroid problems should discuss this condition with their surgeon before undergoing an eyelid procedure.
Honest Consultation — Because various types of rejuvenation surgery address different aspects of aging in the eye region, surgeons require a consultation that includes an honest conversation concerning the patient’s goals for the procedure. Before-and-after photos of past patients, computer imaging and even magazine pictures of models are helpful tools.
In general, eyelid procedures require minimal downtime and recuperation requires five to seven days, Wojtanoswki says.