Surgical Solutions for Youthful Eyes
Posted: Tuesday 27 April 2010 11:28am
When eyes have excessive loose skin and fat bags, the gold standard rejuvenation treatment is still cosmetic surgery, known as blepharoplasty.
People will often choose surgery over “stopgap” treatments in these situations because the results are fast and immediately noticeable, although the eye area will be swollen and bruised for up to two weeks or more. Patients can usually return to normal activities after a few days.
What you should expect:
A successful operation should give the patient a more youthful and rested appearance, with excess skin folds and fat bulges removed and eyelid creases improved.
Blepharoplasty is now often performed on an outpatient basis and may only involve local anaesthetics. But while it is a fairly simple procedure, it is still surgery. Choose your doctor carefully and prepare yourself by finding out how the procedure works.
When the problem is more than cosmetic:
Saggy or droopy eyelids, known as ptosis, is the excess skin or fatty tissue in the eyelids that causes them to sag or droop. Ptosis usually begins to occur in adults between the ages of 45 and 50, but genetics can also play a part and show up in much younger people.
Gravity and the loss of muscle tone results in the outer edge of the eyebrows drooping. The eyebrow droop causes the upper eyelids to protrude and sit on top of the eyelashes.
“Upper eyelid surgery, or upper blepharoplasty, can help freshen and revitalise your face by reducing the appearance of heavy, sagging upper eyelids and associated puffiness,” says Sydney plastic surgeon Dr Michael Miroshnik.
“In some individuals, the upper eyelid skin becomes so baggy and excessive, that vision itself starts to be impaired. These people benefit functionally, as well as cosmetically, from upper eyelid rejuvenation.”
People may not even realise their vision has become impaired by ptosis – unrecognised symptoms may be frequent headaches, tiredness particularly after prolonged reading, loss of some upper portions of your visual field, raising of the eyebrows to see or read and frequent blinking or eyelid twitching.
> Check out a 3D animation video of upper eye surgery here
What blepharoplasty involves:
During blepharoplasty, the surgeon will usually make an incision along the crease line of the upper eyelid and use the laser to remove the excess tissue. Very fine stitches are used to close the incision. Within six weeks thin incision on upper eyelid will be barely visible and hidden by the natural fold of the skin.
The lower eyelid is done in almost the same way, but the incision may be made along the lash line instead of the smile crease. In some cases when there is an accumulation of fat under the eyes (bags under the eyes) and skin does not need to be removed, doctors may suggest a transconjunctival blepharoplasty. In this procedure, the incision is made on the inside of the lower eyelid and the fat is removed. Dissolving stitches are used and there is no visible scar.
“I don’t like to do both eyelids at once,” says Newcastle, NSW, plastic surgeon Dr Eugene Hollenbach. “People can talk tough at outset but when surgery is done the recovery can be more difficult to cope with when both upper and lower lids are swollen and bruised.
“I prefer doing the lower lid at the outset – that enables me to work at outside corners of upper eyelids first, so when eventually I do the upper bleph I can get a better result.
“I use a CO2 laser [rather than a scalpel] to perform blepharoplasty because there is less swelling and bruising.
“We’re more likely now to combine bleph with resurfacing laser and treatments like Thermage to tighten skin and stimulate collagen. We also work with fillers, including Platelet Rich Plasma (PRP). Combination treatments are more common nowadays.
“We also Omnilux light to help with healing and enzyme masks. It can take six months for the overall effect of treatments to kick in while surgery heals.”
Who is not suitable:
“I turn people away in their 20s unless genetics give them lots of loose skin and fat bags,” says Dr Hollenbach. “The 30s is a good time to start because men and women still look young and it just adds to that.
“I would also turn down patients because they have dry eyes or they’ve had a previous blepharoplasty and there isn’t much skin left to work with.”
Ballpark cost: $3000 each for upper and lower lids. A bonus for people with ptosis, says Gold Coast plastic surgeon Dr John Flynn, is that a Medicare rebate may be available when vision impairment has been an issue.