Eyelidplasty is designed to reduce the fat and excess skin that cause hooding of the upper eyelids, as well as puffiness and bags under the eyes.  This diminishes the tired or sad appearance producing a more well-rested look.  Most people also develop some drooping of the brow with age.  Correction of this drooping or brow ptosis requires browlifting usually performed endoscopically.  This minimizes incisions, trauma and recovery time compared to traditional browlifting.  Whether you require eyelidplasty, browlift or both must be determined during a medical consultation. Crow’s feet and crepey changes in the lower lid must be treated with laser resurfacing, chemical peels or Botox.  Resection of the “frowner” muscles treated by Botox and  formerly approached through a browlift can now be performed through the upper lid incisions avoiding additional surgery.  Treatment of the tear trough can also be performed at the time of eyelidplasty as well as lid support procedures if the lower lid is excessively lax or retracted due to aging  or previous surgery.

Surgical Technique
The procedure is usually performed under local anesthesia with sedation  in the office operating room.  Eyelidplasty is commonly performed at the same time as facialplasty.  Incisions are made in natural skin lines to allow elevation of skin or skin and muscle.  Excess fat is removed and skin trimmed.  The lower eyelid operation can be performed without an external incision from inside the eyelid (transconjunctival).  This approach allows removal of fat bags and has now been adapted for patients with excess lower lid skin using a skin pinch technique that avoids disruption of the active structures of the lower lid.  In some cases, laser resurfacing or chemical peel of eyelid wrinkles can be performed at the same time.  Excess fat can be replaced in depressed grooves at the lower border of the eyelid to create a more youthful, natural look (fat redraping into the tear trough -sometimes called arcus marginalis release or septal reset).  Eyelid laxity can be corrected if necessary, by tightening the support structures of the lid (canthopexy or canthoplasty).  These structures tend to loosen with age.

After the Operation
Swelling and bruising should be expected for approximately 1 week after the operation.  The Aquecool mask applied during the first day or two will greatly reduce this.  Stitches are removed within 3-5 days.  The eyes will be more prone to tearing and fatigue for the first few weeks.  Eye drops or ointment are required until this subsides.  Contact lenses may not be worn for at least 1 week.  Heavy exertion must be avoided for 2 weeks.

Patient pictured above presented with previously existing eyebrow asymentry, which was not addressed in eyelidplasty procedure