A beautiful pair of eyes highlight the face the most. one of the first evidence of ageing is the ageing of eyes, both upper and lower. Accumulation of fat and evidence of extra skin cause the eyes to look tired, smaller and old. In the lower lid appearance of tear trough is particularly bothersome. The basic problem in an ageing face is the loss of volume in the cheek, loss of support for the eyes which causes the sunken appearance, and extra skin which reduces the width of the eyes. Blepharoplasty is the common name for eyelid surgery. It is said that we see the world through our eyes. Also, the world can also judge us by eyes. Any problem with the eye can, therefore, lead to a major flaw in this judgement. In addition to this, eyes also convey one’s age. Age-related changes occur early in the eyelids, both upper and lower. An eyelid with hanging fat bags can indeed give a feeling that the person is older than they actually are. Another problem that can signify aging is the tear trough deformity. It is a condition in which a hollow crease is present just below the eyes. This condition can actually accentuate the aged appearance. These conditions can be cured using blepharoplasty.
Fat is visible in inner and middle part of the upper lid, with extra skin that is visible as folds. This causes a shrunken appearance of the upper eyelid. The treatment is with a small surgery known as upper blepharoplasty. Extra skin and fat is removed and the eyes suddenly look younger again. The scar of the surgery is invisible.
The lower lid is more complex as compared to upper. The ideal treatment involves correction of extra skin, fat, treatment of tear trough and cheek enhancement. In younger patients, a scarless form of blepharoplasty is done, called trans – conjunctival blepharoplasty.
Cause of an ageing eyelids
As a result of ageing, the skin of the eyelids sags downwards. The fat bags also tend to come out from their original position. Fat bags are those structures that are present over the eyeballs. The eyebrows also sag down in certain persons.
Local anesthesia is mostly administered for this procedure. The procedure begins by injecting local anesthesia over the eyelids. Incisions are made under the eyelashes. The lines of the eyelids cover these scars, as a result of which no evidence of surgery is seen. In trans-conjuctival blepharoplasty, the anesthesia is administered through the conjunctiva. The structures like the protruding fat bags and eyelids are removed. This results in a much younger looking eyelid. In order to cover the tear trough, fat bags can be used. This is to reduce the hollowness that is present under the eyes. The procedure has been popularized by Dr. Ruth Graf (Brazil). Dr. Amit Gupta has obtained intensive training in this procedure from Dr. Graf.
A general treatment protocol that is followed in our centre is:
1. The Youthful ( less than 35 years) – Fillers ( Juvederm Ultra XC) for tear trough with 8 point lift ( Juvederm Voluma) or fat injection. With only fat bags, Trans conjunctival blepharoplasty is best option.
2. Hep and Happening ( 35 -50 years) – Fillers with cheek enhancement . For more lasting treatment, conventional blepharoplasty with fat injection is preferred.
3. Peach years ( 50-60 years) – Fillers + Blepharoplasty.
4. The Experienced Gems ( 60 and beyond) – Blepharoplasty, with consideration of face lift.
Swelling can easily occur over the eyelids as the skin over the eyelids is very thin. It can take almost 3 to 6 weeks for the swelling to disappear. During this period, the patient is advised to wear spectacles while going outside. If the trans-conjunctival procedure is used, chances are conjunctival inflammation may happen. If it is diagnosed that the patient is hypertensive, then blood pressure must be brought under control prior to the surgery. Anticoagulants like aspirin also have to be stopped 1 week prior to the surgery. This is to ensure minimal bleeding during the surgery.