Blepharoplasty (eyelid cosmetic surgery)
If you are searching about ptosis (also called blepharoptosis or upper eyelid ptosis), reasons for ptosis, and therapeutic methods, I should say that this article has been compiled to guide you. In this article, we made attempts to investigate the reasons for ptosis, therapeutic methods, and returning beauty back to the eyes and to research the advantages and disadvantages and complications of blepharoplasty one by one. We, together with you, investigate alternatives to surgery as well.
The eyes are the window to the human soul and psyche. In non-verbal communication and expression of emotions, eyes play a critical role.
With the eyes, one can easily convey internal and mental states like anger, sadness, happiness, surprise, despair, love, etc to others. These characteristics in the eyes remind us how this valuable organ in the humans’ bodies can affect their daily communication.
First we investigate the reasons why the eyelids droop. Aging and degeneration of facial tissues are the main reasons for this acquired ptosis. Although the aging process will be evident in all facial elements, these changes are shown in the upper facial part (around the eyes) much more than the facial lower part.
Blepharoplasty process and eyelid cosmetic surgery method
A careful and thorough examination of the area around the eyes by an experienced blepharoplasty surgeon is of paramount importance before eyelid cosmetic surgery.
In the upper eyelid area, paying attention to the eyebrows status and examining the drooping eyebrows is of considerable importance. In order to acquire the best result from the eyelid surgery, as well as to prevent the incomplete or defective closure of the eyelids complication, the drooping of eyebrows must be eliminated. Failure to take this small point into account can lead to a big mistake in eyelid surgery.
The surgeon, who is not aware of the drooping of eyebrows or does not consider it prior to eyelid surgery (upper eyelid drooping surgery), removes, unconsciously, too much upper eyelid skin, leading to inappropriate closure of eyes.
In general, to prevent the non-closure of the eyes in upper eyelid surgery (upper eyelid drooping surgery), at least 20 mm of healthy skin should remain from the area under eyebrows to the edge of the eyelashes.
Regarding the lower eyelid, the cheeks’ status should be checked before cosmetic eyelid surgery or blepharoplasty.
Correction of cheeks drooping and removing under eye hollows via gel injection or fat injection can yield excellent results from blepharoplasty.
In addition to causing non-closure of the eyelid, removing too much skin in the lower eyelid surgery may cause the eyes to look older.
How do eyelids and the areas around the eyes change with aging?
With age and as the face becomes older, approximately in all people, the eyelid skin sags and many wrinkles form in this area. In some people, excess fatty deposits appear as puffiness in the upper or lower eyelid skin. As the upper eyelid sags, the eyebrows droop and the distance between the eyes and the eyebrows decreases. At the same time with the changes of the lower eyelid, cheeks sag and the fat under the eyes starts to decrease. Sometimes, the aging symptoms differ on both sides of the face. It means that one of the eyelids or eyebrows may have less or more dropping as compared with the other side of the face. Simultaneous correction of this asymmetry during blepharoplasty is essential to attain the desirable result.
What can be done to rejuvenate the eyelids and the area around the eyes?
We know that removing the excess skin via blepharoplasty is one of the ways to rejuvenate the face in people with droopy eyelids caused by excess skin.
Sometimes, there is an unreal droopy eyelid and this view has been created due to the eyebrows drooping. Therefore, by correcting the eyebrows drooping, the eyes’ beauty increases.
In cases where there are many wrinkles around the eyes (eyelids and eyebrows) and the drooping of eyelids is mild, rejuvenation around the eyes can be done through much easier methods than blepharoplasty. One of the best and most common methods is to use facial BOTOX injections in these areas. Correction of under-eye hollows or dimples (tear troughs) is of paramount importance in lower eyelid rejuvenation. Dimples can be corrected via fat injection under the eye or gel injection in this trough. Fat injection in this part can have permanent results.
Upper eyelid cosmetic surgery
The presence of the following criteria in the eyelids of young people provides a more youthful and beautiful look:
The upper eyelid crease contributes to the eyelid beauty. People of Asian origin may have an upper eyelid without a crease, or the crease distance from the edge of the eyelid is short. However, it is interesting to know that women use the distance from the edge of the eyelid to the upper eyelid crease for eye makeup and shadow, and a reduction in this area prevents proper eye makeup.
The distance from the upper eyelid crease to the under-eyebrows area is 3-5 times the distance between the eyelashes edge and the upper eyelid crease (this ratio changes with aging). The upper eyelid covers about 2-3 mm of the iris, while the lower eyelid is tangential to the iris or covers only 1 mm of it.
What changes do we see in the upper eyelid with aging?
With age, four main changes occur to the upper eyelid and the areas around it. These changes should be examined carefully for eyelid rejuvenation.
1. Sagging skin and the increased eyelid skin (lead to a decrease in or removal of the distance from upper eyelid crease to the eyelashes edge)
2. Increased extra muscle tissue in the upper eyelid
3. Fat increasing in volume and fat projection in different areas of the upper eyelid
4. Simultaneous drooping of the eyebrows
Not all people experience these changes to the same extent. To rejuvenate the upper eyelid, it should be thus determined which of the changes has occurred, and what is needed to be done for rejuvenation.
Therefore, in eyelid cosmetic surgery, more fat may have to be removed from one’s eyelid, while more tissue and skin in another one.
What measures should be taken by a skilled surgeon to correct the eyelid drooping?
- Design and calculations
Using the following precise calculations, we can determine the surgical incision site, amount of extra skin that is required to be removed, and the place where the upper eyelid crease is to be located.
Notice: During pre-operative examination and throughout surgery, it should be considered that the distance from the eyelashes edge to below the eyebrow should not reach 20 mm in order for the eyelid to remain beautiful and the upper eyelid natural closure to be guaranteed.
2. Skin removal (Sometimes together with the excess muscle in the upper eyelid)
The most stable measure taken in upper eyelid surgery is to remove the excess skin caused by aging. By removing the sagging skin and complying with standards, we can make a very useful change to the area around the eyes and rejuvenate it without being concerned about complications. Many young people with mild eyelid drooping need only this change and no other measure is required to be taken.
3. Excess fat correction or fat displacement
After removing the excess skin and muscle from the upper lid, some fat is removed from more puffy areas in some people. Fat is not removed in the same way in all patients. In some people, fat is required to be removed only from the middle part of the upper eyelid, while in other parts, excess fat is removed from the inner part of the eye.
Moreover, in some people, the excess fat may be removed in both regions. Finally, a number of individuals have no need to remove fat; and more importantly, sometimes it is necessary to transfer fat only from where there is excess fat towards the part that is low in fat to attain the best result after eyelid cosmetic surgery.
The figure below shows the areas from which fat may be removed.
This method can significantly improve the result of eyelid surgery. It also makes the result of eyelid surgery last longer (for many years).
4. Eyebrow elevation and fixation at the same time with upper eyelid correction from the surgery incision site
Simultaneously with upper eyelid cosmetic surgery, the surgeon can slightly lift the eyebrows from their place and fix them. In this method, the end of the eyebrow (eyebrow tail) is released from the underlying tissues and transferred to the upper parts, then sutured to the lower tissues in a new place.
If you tend to undergo eyelid cosmetic surgery, it is good to know that you will naturally experience sagging eyebrows in the future years, which causes the symptoms of drooping eyelids to return. The effect of eyelid cosmetic surgery will last more if the eyebrows are fixed. Therefore to achieve a better result, eyebrow fixation is recommended. This technique somehow guarantees the permanent effect of cosmetic surgery.
Frequently asked questions about blepharoplasty
Question: Why don’t some people look much younger following eyelid surgery?
Answer: Paying attention to the symptoms and signs of aging in the eyelid and removing them is of paramount importance in eyelid cosmetic surgery. Remaining any of the aforementioned four symptoms unchanged can prevent a satisfactory result in surgery. What we have been dealing with over the years and perhaps is overlooked more than anything else is lack of attention to the eyebrows status and creating a natural distance between the eyes and brows.
This typically occurs in people with drooping eyebrows and is not taken into account during eyelid surgery. The result of the eyelid surgery will not be very satisfactory until the eyebrow drooping is corrected.
Question: Why aren’t the eyes closed following the cosmetic upper eyelid surgery?
Answer: Sometimes, due to lack of pre-operative calculation, too much skin is removed from the upper eyelids and this error leads to the upper eyelid dysfunction. The main reason why a surgeon makes such a big mistake is not examining the eyebrows status and not complying with the pre-operative standards.
Question: Why not only do the eyes not look younger following upper eyelid surgery, but they also look a little hollower and older?
Answer: In previous years, many surgeons tended to remove the upper eyelid fat. But today, with the advancement of surgical techniques, they have found that this should be done with caution as much as possible.
In many cases, instead of fat removal, we had better transfer the fat only from one area to another in the eyelid to get a better result.
Question: Can eyelid ptosis be seen in a very young person?
Answer: The sagging upper eyelid signs do not necessarily occur due to the changes in the eyelid itself. The two forms are distinguished only through careful examination. In some people, drooping eyebrows are inherited and we may also see signs of drooping eyebrows in a 3-year-old child.
To make clear this issue, the persons with drooping eyebrows should be compared with their close relatives and the signs of drooping eyebrows in other family members must be investigated. In the following example, you will better understand the sagging eyebrows effect on the eyelids.
In the above example, the patient attended for upper eyelid surgery, but a careful examination indicated that the sagging eyebrows have created a view similar to drooping eyelids. Therefore, by endoscopically correction of drooping eyebrows and without any eyelid surgery, the eyes form has changed and rejuvenation around the eyes can be clearly observed.
Therefore, seeing changes caused by aging in eyelids does not necessarily indicate the need for eyelid surgery.
Question: Can eyelid asymmetry be corrected in the upper eyelid cosmetic surgery?
Answer: In eyelid cosmetic surgery, the surgeon usually tries to correct asymmetries. But we should know that these asymmetries will not be corrected completely because this issue depends fully on the other facial muscles and the muscle on one side of the face is always stronger than the other side. This is also true for other parts of the body. Sometimes one arm or leg is bigger or even stronger than the other. Therefore, this issue all depends on the facial muscles.
As can be observed in the above figure, the facial asymmetry has been removed to some extent.
Finally, we draw your attention to Dr. Akbar Bayat’s recommendation for eyelid cosmetic surgery applicants: “The surgery applicants must see the sample of the performed surgeries so that they can decide to undergo the surgery with comprehensive and complete information about all aspects of surgery.”
Advantages of upper and lower eyelid drooping surgery – blepharoplasty in this center
Upper eyelid cosmetic surgery
- Correction of eye puffiness or fat on the eyelid if any
- Correction of puffiness under eyebrow if needed
- Correction of eyebrow drooping if needed
- Correction of lacrimal (tear) gland if needed
- All of the above corrections are made through a single delicate incision.The incision line is made on the crease behind the eyelid and will not be visible at all.
Lower eyelid cosmetic surgery
- Removing fat under the lower eyelid if needed
- Transferring this fat to the hollow area under the eyelid
- The lower corner of the eyelid is lifted upward and fixed if needed
- The incision and suture line location is exactly beside the lash line, which is not visible to the naked eye at all