Did you know that the muscles that control your eyes are the most active muscles in your whole body? We blink approximately 12 times every minute. Seeing takes such a massive effort, around half of our brain needs to be working to make it happen! The muscles around our eyes move every time we blink, smile, laugh, frown, or basically do anything that involves looking and moving. Add to this that the tissue around the eye is some of the thinnest anywhere on the body, it’s no wonder that the skin around the eye is one of the first signs to show ageing. Dr Damian Marucci, plastic surgeon in Kogarah NSW performs a large number of blepharoplasties, or eye-lift surgery, each year, and gave us the following info to gain a better understanding of blepharoplasty and how we can better “open our eyes”.
What happens to our eyes as we age?
Basically speaking, gravity always wins. There is stretching and loss of support of the tissues around the eyes. This can result in “hooding” of the upper eyelid skin, especially on the outer part of the upper eyelid skin near the temple. This is a classic early sign of ageing. In the lower eyelids, in addition to the accumulation of fine lines, there tends to be a bulging of fat over the bony margin causing a “bag” and “tear trough”.
The upper eyelid skin excess can come to rest on the eye lashes themselves, partially obstructing vision. The lower eyelid skin excess doesn’t tend to cause problems with vision, but people are unhappy with the appearance of it.
How do we fix it?
We have a number of methods of improving the appearance of the eyes. There are non surgical options such as botox or dysport. There are anti wrinkle injections that weaken the muscles that cause lines around the eyes. The most common way this is used is to attack the “crows feet” on the outer part of the eye and the “frown lines” at the inner part of the upper eyebrow. Anti-wrinkle injections can also be used to weaken the muscles that elevate the eyebrow on the inside, so that there is a reflex elevation of the eyebrow on the outside (a non surgical brow lift). The other non surgical option involves the use of fillers. Fillers can be used to eliminate the deep seated creases in the frown line and crows feet area. Fillers can also be used to soften the appearance of lower eyelid bags. Lower eyelid bags must be treated with caution when using fillers as the skin is very thin, so make sure the person doing the injecting knows what they’re doing!
Surgical correction is often required, usually in conjunction with the non surgical treatments to give the best overall result. Improving the hooding of the upper eyelid involves removing excess skin and (if present) excess fat. This surgery is safe, fast and recovery is rapid.
Surgical treatment of the lower eyelid bags is more controversial. There are many different approaches described over the years, but the general idea is to redistribute the fat in the lower eyelid, tighten the lower eyelid to improve its appearance and only remove extra skin or fat if it is absolutely necessary.
What happens during eyelid surgery?
Upper eyelid surgery, or “blepharoplasty”, can be performed under general anaesthesia (a full anaesthetic), or sedation with local anaesthesia. I have performed the occasional upper eyelid procedure purely under local anaesthesia, but I think some form of sedation makes things more comfortable for everyone. The specific details of upper eyelid surgery depend on what the issues of concern are. Most commonly, the issues are excess skin on the outer part of the upper eyelid and excess fat on the inner part. Your surgeon will carefully measure the amount of excess upper eyelid skin that is to be removed. In addition to removing this skin (with the scar hidden in the upper eyelid fold), often a small parcel of fat on the upper inner part of the eye is removed. A single long suture brings the wound together and then paper tape is placed on the wound. I allow my patients to shower lightly from the following day and the sutures are removed the following week. Although the scar extends all the way along the crease of the upper eyelid and out onto the outer rim of the orbit, it heals amazingly well and is barely visible in no time.
Lower eyelid surgery (“lower blepharoplasty”) is a bit more involved. I perform lower eyelid surgery under a general anaesthetic but the patients still go home the same day. If possible, I prefer to approach the lower eyelid fat through the inside of the lower eyelid. I will redistribute this fat over the lower rim of the orbit in order to eliminate the lower eyelid bag and carefully remove any excess fat. Care is taken not to remove too much fat as this can give the eyes a skeletal “hollowed-out” appearance in the long term. Most lower blepharoplasty surgery involves repositioning or (at the very least) tightening the lower eyelid to improve the appearance and to counteract scarring. I will then remove any excess skin just below the lower eyelashes. Again, this is closed with a continuous long stitch which is removed the week after surgery.
Some patients have an eyebrow that is too low, requiring a brow lift. The most common ways of lifting the outer part of the eyebrow involve scars in the scalp and using long instruments to release and elevate the soft tissues of the outer upper eyelid. I find most patients DON’T need this to be done, although the results can be spectacular in the appropriate patient.
How long does it take to recover from eyelid surgery?
I advise all my patients to try to arrange 2 – 3 weeks away from the limelight if at all possible. There can be bruising which can take that long to resolve. Patient are instructed to use cold packs, 20 minutes on and 20 minutes off, for 2 hours at a stretch in the days after the surgery. Avoid any lifting, bending over or exercise. The sutures are removed at a week and you should be starting to get back into life a week or two after that.
Thanks Dr Marucci! If you’d like to find out more about eye surgery, brow lifts or anything else with Dr Damian Marucci“>Dr Damian Marucci give his clinic a call on 02 9588 6374 to arrange a consult. If you want to read more about eye surgery, brow lifts or Dr Marucci first, check out the blogs below: