eyelid surgery older man

Eyelid surgery in a patient in their 90’s.

Eyelid surgery is more common as we get older. Our skin becomes more droopy and blocks our vision with age. Many patients wonder if they are too old to undergo surgery. Eyelid surgery is performed on patients of all ages, depending on how the problem is affecting their quality of life and if they are healthy enough to undergo the mild anesthesia used.

How old is too old for eyelid surgery?

We see patients of all ages for eyelid surgery. Many have eyelids blocking their vision or causing tearing.  Most patients come to our office because they are bothered enough by the problem that they know something must be done.  The main question they ask is “am I too old for this?” Chronological age is much less important than biological age, meaning how old do you feel, and how well is your body functioning. Many 90 year olds are in better biologic shape than some 60 year olds, based on how they’ve taken care of themselves and their respective genes.  Thankfully, most eyelid surgeries are done under mild sedation and local injection. The risk to the patient is very low and anesthesia is well tolerated.

Who shouldn’t have eyelid surgery?

Patients with certain chronic illnesses, such as advanced heart or kidney failure, active cancer under treatment, or those with a history of significant reaction to mild anesthesia should avoid elective eyelid surgery. Also, those on blood thinners that can’t be stopped should consider waiting until the medications can be held temporarily for surgery. Anytime we have a question about a patient’s fitness for anesthesia, we request a physical exam with the patient’s primary care physician, who can make additional recommendations.

Eyelid surgery consultations are helpful

An eyelid surgery evaluation can help us to evaluate your overall health and recommend the best possible treatment, which may or not include surgery. Sometimes, surgery can be performed in the office under local anesthesia only, further lowering your risk. Call our office at 801-264-4420 with any questions.

facial plastic surgery - eyelid lift

Upper eyelid blepharoplasty

Facial plastic surgery: Does it make you look younger or more attractive?

A recent study in the Journal of the American Medical Association: Facial Plastic Surgery looked at how much younger people appeared after certain facial plastic surgery procedures.  It involved one rater looking at before pictures and guessing the patient’s age and rating their attractiveness. A different rater did the same with the after photos and the results were compared. On average, the patients looked 3.1 years younger and were slightly more attractive. The problem with the study was that the same person didn’t see the before and after photos together, which is typically where the most difference is noted and what would happen in real life with a patient’s acquaintances.  But it does highlight a question: Does plastic surgery make you look younger or more attractive, and is this actually the goal?

Expectations around facial plastic surgery

When discussing patients’ expectations before eyelid & brow surgery, I try and stress that I’m not trying to shave off years, just trying to improve their peripheral vision with the added benefit that they won’t look as tired or angry.  We all know that there is “good old” and “bad old” when it comes to how people age.  Some patients, although into their 70’s or 80’s, still stand up straight, show good muscle tone and weight, and carry themselves like much younger people. While many patients in their 40’s to 60’s are just the opposite: overweight, sedentary, with poor skin and poor diet.  Plastic surgery isn’t likely to make this second group significantly more attractive or youthful, given all the other factors making them look prematurely older.  A red flag that someone is going to be unhappy after surgery, no matter how good the outcome, is their expectation that changing this one small aspect of their appearance will solve their problem of not feeling young or attractive.  It just doesn’t work like that.

What I hope my patients can understand is that we are all aging chronologically at the same rate, which no one escapes. No one can expect to look younger than the calendar suggests if they aren’t taking the best care of their bodies. We can slow the feeling of inevitable degeneration by first living a healthful life and only addressing those aspects we can’t otherwise change, such as baggy eyelids or a sagging brow, with facial plastic surgery or other procedure.  Patient’s with these realistic expectations are nearly always satisfied with their outcomes and will radiate both youth and attractiveness to the people they know and love.

 

Dark Circles Under Eyes: 5 deep tear trough treatments

We’ve talked before about dark circles under eyes. One of the most common causes is a deep tear trough.  The tear trough is that depression extending from the inner corner of your eye diagonally toward your cheek.  This depression occurs where the facial fat has thinned out and dropped down into the cheeks. The bone of the eye socket is now right below the skin and the two are fairly well attached to each other.  As the skin above and below age and change, this area becomes even more apparent. It can become dark and develop a noticeable shadow, which makes one appear tired and more aged.  There are many options to treat this, and the methods are changing as we better understand facial aging.

dark circles under eyes - Facial filler Juverderm

Juvederm treatment under eyes and around mouth.

1. Make-up:

Many women (and even some men) utilize concealer in this area to lighten the skin and diminish the shadow.  When the problem is subtle, make-up is a great, non-invasive and inexpensive treatment.  As the problem worsens, however, make-up cannot fully hide the changes and may begin to accentuate it.

2. Skin lightening creams:

In certain people and ethnic groups, the skin in this area darkens. This can be due to actual pigment changes in the skin or from very shallow blood vessels just below the thin skin. When it is pigment related, skin lightening creams, such as hydroquinone, can be effective.  When starting this type of treatment, it is helpful to consult a skin specialist or aesthetician highly experienced in its use. Start with a weaker concentration (no higher than 4%) and use it for a short time until you are sure you aren’t especially sensitive.  Slowly increase the use and concentration until the desired effect is achieved. Rarely will these types of creams completely fix the problem, but they can make a noticeable improvement.

dark circles under eyes - Hydroquinone skin cream

Hydroquinone skin cream

3. Phototherapy:

Intense pulsed light, and even some laser treatments, are used to lighten skin pigmentation and tighten skin in the under eye area. Often this is proceeded by use of a topical lightening cream and possibly a short course of Retin-A to maximize effect.  Again, this should be done by someone with a lot of experience in administering the whole treatment.  Different skin types react differently, so be sure your practitioner explains how they are tailoring your treatment to you personally.

4. Facial Filler:

Hyaluronic acid fillers such as Juvederm, Belotero, and Restylane are well suited to treating the tear trough area when the problem is loss of facial fat volume.  Filling this area back up with a substance that is similar to the building blocks of normal collagen can give a new youthful appearance to the mid-face. It is relatively inexpensive, costing around $500 for a treatment. In many cases it lasts 12-18 months.  Filler is injected with a small needle into the space directly above the bone and then massage around until it appears smooth.  In a few weeks, it softens up be hardly be felt.  It is a safe procedure with some occasional bruising taking place. When injected deep, the chances of it getting into a blood vessel and causing problems in uncommon, although this is the greatest risk. See Dr. Harris explain more about facial filler in a short video here.

dark circles under eyes - Belotero facial filler

Belotero facial filler

5. Lower eyelid fat repositioning and blepharoplasty:

When fat in the lower eye socket begins to come forward, it creates a bag in the lower eyelid. A crease forms at the bottom of the bag over the bone of the eye socket. Lower eyelid surgery (blepharoplasty) is performed to move fat from this bag into the upper cheek and tear trough, which fills in the depression and returns the fat to a normal location, where it was before it descended into the cheek.  In some people, a portion of the fat is also removed. In others we also remove a small amount of skin below the eyelashes. All of these techniques serve to smooth out the transition from the eyelid to the cheek, which is a hallmark of a youthful, rested appearance. See our gallery for eyelid before and after photos.

If under eye shadow or bags are a problem for you, give us a call for a free consultation at (801)264-4420, or email Dr. Harris directly at [email protected].

In our office, we see people everyday who are dissatisfied with the appearance of their lower eyelids and are seeking lower eyelid blepharoplasty. Whether it be due to bags that have formed or deep tear trough lines, the lower eyelids can make give us a tired or even ill appearance. We’ve written before about lower eyelid bags and shadows and it is important to figure out if your problem can be easily remedied, or if surgery is in order. When, with the help of an oculoplastic surgeon, you determine that you will need some surgical intervention, it helps to know your options and the best techniques to achieve a good result.

 

lower eyelid bags

Lower eyelid bags

What lower eyelid blepharoplasty (eyelid lift) complications can occur?

Over the past 30-40 years, lower eyelid blepharoplasty has changed tremendously. As surgeons have gained a better understanding of facial anatomy, facial aging and how the tissues respond to surgery, their techniques have evolved. The standard practice for lower eyelid blepharoplasty used to be creating an incision below the eyelashes, dissecting through the muscles and soft tissue layers, exposing and removing fat, then removing excess skin and closing up.  This technique worked for some, but very often caused scarring in the lower eyelids, which pulled them down and/or out away from the eye.  Patients would end up with dry, irritated eyes, eyelid redness, and possible inability to close the eyes.  Others may not have scarring, but the removal of fat alone would cause a hollow appearance, especially in thinner patients.

How is lower eyelid blepharoplasty performed today?

Techniques evolved and most surgeons have updated how they perform the surgery.  We now commonly make our incisions through the inside of the eyelid to access the excess fat.  This avoids dissecting through tissues that commonly cause detrimental scarring.  The three fat pockets of the lower lid can be partially removed, or the fat can be moved into areas, such as the tear troughs, where it is missing causing a sunken appearance. Once the fat is repositioned or removed, a small amount of extra skin can be removed through an incision below the eyelashes, without any dissection that can cause scarring.  We also will often tighten the lower eyelid from the outside corner to ensure it stays in a youthful position and doesn’t pull down or away.

What is the recovery for lower eyelid blepharoplasty?

Eyelid surgery almost always causes bruising and swelling, though this may vary in intensity.  Bruising resolves in 1-2 weeks and swelling can take 1-4 weeks, but longer in some individuals.  Pain is minimal, but some have itching as they heal.

What will I look like after lower eyelid blepharoplasty?

Check out our before and after photos by clicking here.  Here are a few examples:

upper and lower blepharoplasty

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty

If you have questions, email Dr. Harris at [email protected], or call our office at (801)264-4420. To read what other surgeons have written on the subject, start by clicking here.