Patients often seek advice regarding their eyelids. Eyelid sagging can begin in the 30s and 40s. The upper eyelid skin can actually increase in surface area as well as succumb to the weight of the brow as we age. That is to say, the eyelids sag is not only extra skin but also pushes down upon by the falling brow. I always include these two facts during eyelid lift or blepharoplasty consultation.
Therefore it is important to understand and accept the fact that the primary purpose for upper eyelid tightening or lifting is to remove the excess skin. There is a normal crease about 1 cm above the lash line in most non-Asians. This can be a perfect location for the initial incision or the resultant scar after the upper lid eyelid lift. This incision can be extended laterally sufficiently to remove almost the entirety of the excess upper eyelid skin. If a patient wants a brow lift this would complete the treatment.
Upper Eyelid Lift
Often times the upper eyelid will have excess fat and this can be removed. But essentially the upper eyelid lift is a skin operation. The lower eyelid procedure is basically designed to remove the fat pockets or bags. As we age the fine membrane restricting the lower lid fat which supports the globe begins to weaken. As this fine membrane weakens-the fat supporting the eyeball moves anteriorly and becomes visible as bags. These lower lid bags can be very disheartening for those of us who wish to maintain our most youthful look.
Lower Eyelid Lift
The lower lid operation can be performed either by an incision along the lower lid lash line or inside the lower lid. The external incision, in my opinion, is more beneficial because it allows the removal of all of the excess fat in its different compartments. Also, it allows a thinning of the muscle. This can reduce wrinkling or crows feet. Furthermore, a slight trim of the skin can give the lower lid less laxity. However, it is essential for the surgeon to remember that the lower lid surgery is primarily a fat operation and not a skin operation. This is important to prevent lower lid sagging away from the eyeball. This is ectropion.
In summary, upper eyelid lift foreskin tightening and lower eyelid lift for fat removal are very effective tools to combat the effects of aging and to maintain a more youthful facial appearance. I highly recommend it.