You may feel younger than your age, but your eyes may make you look tired all the time and betray your age.
A Blepharoplasty is often the first aesthetic procedure requested in middle age, commonly around age 40-43.
Your eyes are an important focus of your face. People looking at your face look at your nose, then your eyes and then your mouth. If you have beautiful eyes, their gaze may stay right there. Unfortunately, if your eyes looks tired, their gaze may also stay there.
The skin, muscle, fat and eyelashes all contribute to the appearance of your eyes. Age, sun exposure and hereditary factors afftect the appearance of these attributes of your eyes. With aging, the membrane holding the small fat pads of your eye socket in place (the orbital septum) may weaken, allowing the fat to come forward, giving you a "puffy" look ("bags") and increasing the shadows of the lower lids. Also, with aging, the opposite can happen. The upper and lower eyelids can become more hollow in appearance. In addition, lifelong muscle action around your eyes and sun exposure leads to wrinkles of the lower eyelids and deep crow's feet wrinkles. All this adds up to looking "tired" and older than you really are or older than you feel. These changes in appearance can cause emotional distress, unwanted comments from co-workers about how "tired" you look, and sometimes even visual impairment.
Your genetics and sun exposure contribute to how your eyelids age. For that reason, your eyelid surgery should be customized to your needs.
Surgery customized for your eyes...
In past years, many surgeons often did basically the same operation on every patient, removing skin, fat and sometimes muscle from the upper and lower eyelids. We now understand, however, that the operation must be tailored to each patient's particular needs. In some cases, just skin treatment or an office procedure may be what you need. In some cases you may need a surgical procedure. Some patients may need both.
Instead of just always removing tissue from the upper eyelids (upper lid blepharoplasty), some patients may really need a browlift to get a more appropriate appearance.
Instead of just removing fat and skin from the lower eyelids (lower lid blepharoplasty), some patients may actually need volume added to the lids to fill hollow areas such as a deep "tear trough". Fillers like Radiesse®, Restylane™, Perlane™, Elevess™, and Juvéderm™ may help correct the hollow appearance. Operations such as a fat transposition blepharoplasty or SOOF lift may be what you need. In past years a lower lid blepharoplasty almost always included removal of fat. Today we are reluctant to remove such volume from the eyelids. Since there is a strong tendency to lose volume as you age, we now prefer to preserve volume by moving, not removing, the fat pads. A youthful lower eyelid should be a bit convex on profile, not flat or concave.
The appearance of the lower eyelid can also be significantly affected by loss of soft tissue volume (mostly fat) of the inner cheek near the nose and just under the lower eyelid. This flatness tends to give an elongated and washed out appearance to the lower eyelid. In a mid faceift this tissue is elevated up at about a 45 degree angle. This has the affect of shortening the appearance of the lower eyelid, giving back a more youthful appearance.
The dark shadows of your lower eyelids may be due to increased dark pigment in your lower lids, shadows from the fat in your lids, or a combination of both. Lightening the skin , tightening the skin, moving the fat, or removing some of the fat may help. Obagi® skin care, Rhytec Portrait® Plasma Skin Regeneration, or carbon dioxide laser resurfacing can lighten these shadows. To the extent that the dark shadows are from fat protrusion, the lower lid blepharoplasty with fat transposition will help.
Often, an upper eyelid blepharoplasty consists of a conservative removal of excess skin to re-create the upper eyelid crease. A small amount of fat and muscle may also be removed. However, we now understand that loss of volume is a major factor in aging and continues after surgery. Therefore, instead of removing a lot of upper eyelid fat, Dr. Bentkover prefers to tighten the membrane that holds the fat in place. This repositions the fat that has been there your whole life so it no longer protudes so much. If your brow has become much lower with age, an upper eyelid blepharoplasty may be combined with a browlift at the same time or in a prior operation.
A lower eyelid blepharoplasty may flatten the lower eyelid or plump the lower eyelid, depending on what is needed. To tighten the skin and reduce eyelid and crow's feet wrinkles, the lower eyelid and temple skin may also need to be resurfaced. A lower eyelid blepharoplasty can be as straight forward as a conservative reduction in the amount of protruding fat (the "bags") in the lower eyelid. As with the upper eyelids, however, aging in the lower eyelid can result in the opposite problem, a loss of volume. In patients with significant hollow areas in the lower eyelid Dr. Bentkover may choose to move fat from the eyelid into a "tear trough" depression (fat transposition blepharoplasty)or lift the fat of the upper cheek to the eyelid (SOOF lift). To avoid drooping of the eyelid after surgery and a visible scar, Dr. Bentkover usually does his lower eyelid surgery through an incision just inside the eyelid (transconjunctival approach). He generally does not remove lower eyelid skin, but rather often combines his lower lid blepharoplasty with a laser or Rhytec Portrait® resurfacing of the lower eyelids and crow's feet to remove wrinkles and tighten the skin.
Lower Lid Blepharoplasty flattens or plumps your lower eyelids; resurfacing with a laser or Rhytec Portrait® tightens the eyelid skin and decreases the crow's feet wrinkles.
Insurance
Occasionally, your insurance company may pay for part or all of the cost of an upper eyelid blepharoplasty if the procedure is performed to specifically improve impaired vision (as documented on a visual field test). If you think your vision is impaired by your upper eyelids, you should have a visual field test performed in an ophthalmologist's office prior to your consultation with Dr. Bentkover and bring a copy of that test with you to your consultation. Because coverage criteria vary among different insurance companies, it is recommended that you check with your own insurance company to determine the level of coverage and criteria for coverage prior to booking your consultation.
