By COOPER SCURRY, MD

Surgery around the face can be either cosmetic, reconstructive or functional. In other words, facial surgery can be performed to correct a particular problem (functional), to restore the face to a previous state (reconstructive) or to change certain features to look more desirable. Such surgeries can be performed for either the upper or lower eyelids. 

Upper Eyelid Surgery 

Upper eyelid surgery is often performed for either cosmetic or functional reasons. Patients commonly present to their plastic surgeon requesting removal of loose skin of the upper eyelids. The upper eyelid skin and heavy eyebrow tissues can contribute to decreased peripheral vision. Sometimes a patient notices this decreased peripheral vision while riding a bike or driving their car. Other patients who love to read notice themselves holding their eyebrows upward at night when they are trying to read. Some patients are noticed to have decreased peripheral vision while they are being evaluated by their eye doctors.  

When patients present to my office for evaluation of their bothersome upper eyelids, I have found that the most important detail of the visit is my physical exam. I find that patients fall into one of three categories. In category #1, the patient has some loose skin of the upper eyelids and is a great candidate for undergoing removal of this skin by upper blepharoplasty. A limited upper eyelid surgery like this is routinely performed in the office with light sedation and local anesthetic. In category #2, the patient is one in which the heaviness of the brow tissue means that a patient will not get a good result unless they undergo some version of a brow repositioning procedure (a.k.a. “brow lift”) in addition to the upper blepharoplasty. These types of brow procedures have become very powerful, effective and sneaky. I say sneaky here because the scars from these procedures can be very hard to find. Finally, a category #3 patient simply falls between the #1 and #2 patients. These category #3 patients could get by with only the upper eyelid surgery, but would do best and have the most long-lasting result if they chose to have both procedures.  

Lower Eyelid Surgery 

A common complaint from many patients about their lower eyelids is “the bags.” The puffiness, fullness or bags of the lower eyelids are best treated surgically. This lower eyelid fullness is caused by fatty tissue that lives within our eye socket. There is a thin membrane of the lower eyelid that is supposed to contain the fatty tissue within the eye socket but, as we age, and in some families, this thin membrane weakens over time and the fatty tissue begins to seem to bulge outward. While there are lots of important intricacies of the lower eyelids, one of the safe and conservative ways to treat these fatty tissues is to make an incision on the back surface of the eyelid for the sake of preserving and protecting the skin and the muscle of the lower eyelid. Such an approach can go a long way in preserving and protecting the important position of the lower eyelid after such a surgery. After approaching the fatty tissue of the lower eyelid in this manner, these fatty tissues can be conservatively removed or alternatively repositioned. Other lower eyelid procedures such as laser or chemical peel can be performed simultaneously in order to smooth the wrinkly skin of the lower eyelid. Finally, some lower eyelids are indicated for a tightening technique during surgery.  

In conclusion, surgery around the eyes can make a huge difference in helping a patient to look younger! When cosmetic surgery of the face is performed, the results should be very natural. A patient should always “look like themselves” when the bruising and swelling has resolved. 80% of bruising and swelling should be resolved within about two weeks time. If you have an event coming up, like a wedding or reunion, you should try to give yourself about two months to be completely healed. The goal of these surgeries is to look like you did about 10-15 years ago.  

Start the process by seeking out a surgical practice and come see one of us! We’d love to meet and talk to you in our office during a detailed and personal office consultation. If you live a ways away, I’m glad to meet you on Zoom or via a FaceTime phone call. Give us a call and jump on the consultation schedule.