A couple of years ago, I was getting ready for my daughter’s engagement party. I remember thinking to myself, “What’s the point of putting on makeup?” My upper eyelids were drooping to the point that they had started to affect my vision. The eyelid bags underneath looked like half-filled saggy water balloons. I looked like a bloodhound.
I put on my big sunglasses and went to the party, feeling much older than my 46 years. The wedding would be six months later, and so I thought that I had better do something about it now.
I didn’t want to turn back time. I like my laugh lines. Every wrinkle tells a story. But those eyes! My eyelids made me look 20 older!
The day following the engagement party, I booked a consultation to find out what I could do and opted for eyelid surgery. I had upper and lower blepharoplasty (top and bottom eyelid surgery) to lift my eyelids and get rid of those awful bags under my eyes. The results were amazing. I had people approach me at Caitlin’s wedding asking me if I was Caitlin’s sister!”
~ Carmen A.
Eyelid surgery, which is also called upper and lower blepharoplasty, is an effective way to correct droopy eyelids, bags under the eyes, puffy eyelids and/or under-eye sagging. The procedure recontours and reshapes the upper and/or lower eyelids by trimming away excess skin and fat from the eye area to create a more youthful appearance.
This blog post is an excerpt from Dr Barnouti’s book “Your Guide To Modern Plastic Surgery: How To Enhance Your Natural Beauty And Avoid A Plastic Surgery Disaster” which is available now on Amazon.
Upper eyelid surgery performed with laser rejuvenation. Notice the improvement in the skin quality of the lower eyelids without direct surgery to the lower eyelids. It is often a bonus to have lower eyelids skin improvement when performing upper blepharoplasty, provided a lateral tunnel has been created for blood pooling.
Close attention needs to be paid to the pre-operative condition of the eyelids, surrounding tissue and bone structure to create a natural appearance and prevent an “operated-on look”. Removal of excess skin and fatty tissue will tighten the eyelids and restore an attractive almond shape to the eyes while meticulous attention to surgical detail can avoid a “hollowed” appearance or unwanted complications.
Ancillary procedures can be performed at the same time as eyelid surgery to optimise the outcome. These include: laser, fat injection, a brow lift and/or facelift. In a typical eyelid plastic surgery procedure, an incision is made in the natural line of the upper eyelids, normally in the creases of the upper eyelids.
Incisions for lower eyelid surgery are made just below the eyelashes or inside the conjunctiva, which is the inner surface of the eyelid. Working through these incisions, the skin is separated from the underlying fatty tissue and muscle. The excess fat bulges are then removed and transposed (rearranged). If required, I trim away any sagging skin and muscle. The incisions are then closed with very fine sutures, and the final scar is virtually undetectable six weeks after surgery.
Upper Eyelid Surgery
With the ageing process, the skin of the upper eyelid tends to sag. This is not only aesthetically displeasing but also makes one appear older. In severe cases, it places gravitational pressure on the eyelashes, obscuring vision and making the eyes look and feel tired.
Upper eyelid surgery to remove excess upper eyelid skin is a delicate operation. During this 60-minute procedure, the excess skin is trimmed, the saggy portion of the muscle is excised or tightened and the fat bulges removed. Sutures are removed after seven days.
When I perform upper eyelid surgery, I create a tunnel to the lower eyelids in the most lateral part of my incision. This reduces the risk of pre-septal haematoma. A small amount of blood trickles into the lower eyelids, producing a PRP effect. Notice the slight improvement in the lower eyelids, even though I have not operated on the lower eyelids.
This is the result of upper eyelid surgery. Notice the slight improvement to the lower eyelids even though I have not operated on the lower eyelids. A plasma rich protein effect through a lateral tunnel.
Lower Eyelid Surgery
The presence of lower eyelid bags can often indicate the person is overworked, tired or the ageing process is starting to take its toll. For this reason, many patients decide that they want to change what their eyes say about them by opting to have lower eyelid surgery.
Different types of incision are made with lower eyelid surgery. The most common is the subcilliary, in which the incision is made just underneath the line of the lash. This approach is used when the skin is loose and requires removal in addition to the removal of the bulging fat pads.
If there’s a pocket of fat underneath the lower eyelids, but there is no loose skin to be removed, then the preferable approach is a transconjunctival one where an incision is made on the inside of the lower eyelid with no external scar. This approach is often used in conjunction with laser treatment to rejuvenate the lower eyelid skin.
The objective of this delicate surgery is to smooth out the bulges, remove the bags from underneath the eyes and make the skin snugger.
Removal and redrapping of lower eyelid fat bags through an internal transconjunctival incision. The key point is to avoid excess fat removal as it will produce undesirable hallowing.
Lazy Eyelid Surgery
Some people are born with lazy eyelids and some develop the condition later in life. Either way, a “droopy eyelid” or “lazy eyelid” gives one an appearance of looking sleepy and unfocused. The reason for a droopy eyelid is a functional weakness of the eyelid-opening mechanism, called the levator. Lazy eyelid surgery, sometimes called ptosis correction surgery, corrects these droopy eyes by tightening the levator muscle. It is a very delicate procedure and should only be performed by experienced specialist plastic surgeons.
See more eyelid surgery before and after photos here >>