What’s and eyelid surgery?

Blepharoplasty is a latin word which means changing the shape of the lower and upper eyelids. So, basically an upper lid blepharoplasty involves removal of excess skin and in some cases excess fat from the upper eyelid. The lower blepharoplasty is about tightening the lower eyelid, getting rid of the eyelid bags and the aim here is to end up with a smoother lid-cheek junction. If we’re performing a four-lid blepharoplasty, then this means that we’re removing a tiny bit of skin from the upper and lower eyelids and correcting the ‘suspension system’ of the lower eyelid.

What to do for a more fresh and a younger look?

The condition of the eyelids are very crucial for fresh looks. Especially, the wrinkling around the eyes, the eye bags and the saggy loose eyelids give us a more tired and unenergetic look. Therefore, it’s really important to correct all those deformities by lower and upper blepharoplasties, if needed combined with canthoplasties to have a more fresh and younger look.

Lower eyelid problems:

There are mainly 4 problems in the lower eyelid.
1- Tear trough deformity
2- Lower eyelid bagging
3- Lower eyelid dark discoloration
4- Lower eyelid laxity.

So, what is tear trough deformity?

Everyone has this issue already or eventually everyone will have it. Tear trough issue is due to an anatomical structure, a ligament. But, by time as we get old, because of the volume loss, we see that tear trough deformity, that depression, more prominently. So, yes the main reason behind tear trough deformity is mostly the volume loss in the midface.

Well, how do we correct it?

For mild deformities, fillers do a good job but for severe cases, especially with eyelid bags, surgery is mostly indicated.
If you are in the early stages of eyelid bags, then sometimes fillers can camouflage the problem. However, for medium or severe cases, generally surgery becomes a must. In some cases, eyelid bags can be seen together with very deep tear troughs or eyelid laxity. In such scenarios, the extent of the surgery might need to be even more detailed than just a limited lower eyelid surgery. For younger patients, the surgery is performed through the lower eyelid incision inside the eye but for cases who have skin laxity we might need to make an incision immediately underneath the lashes. The first technique leaves no scars outside the eyelid but the second technique leaves a very hardly noticeable scar along the lash margin.

Another common problem is the skin discoloration in the lower eyelids and that is due to two main factors one of them is the real discoloration which means the skin is actually has a different color and the second one is due to shadow of the deformities of the surrounding tissues. (Such as depression of the tear trough and the eyelid bags) So, the treatment depends on the reason of the discoloration. If, this is due to the shadowing of the surrounding deformities, then we have to correct what causes the shadow, which is either tear trough or lower eyelid bags or both. In such cases, we can also use fillers to cover up the issue to some extent if we have excessive eyelid bag which is causing that shadowing then, surgery is again indicated. But, when it comes to real discoloration issues, some injectables like peptides, glutathione and vitamins and the other mesotherapetic agents do a good job (although they may not reverse the whole process back totally).

And the fourth problem, the lower eyelid laxity is again the weakness or looseness of the hard tissues of the lower eyelid along the margin. In some cases, lower eyelid elongation is also a part of the story and the correct indication here is to shorten the lower eyelid.

How can we test if there really is lower eyelid laxity?

Try to pull up your skin forward and then leave it and see how long it takes to come to its original position. If the time period is long, then yes, your lower eyelid is loose and this is called a snap test. So, in cases with laxity, surgery is the only solution which involves shortening and/or tightening the lower eyelid in a horizontal way. In some cases, we might also need to change the fixation point of the lateral eyelid corner, this way, we can just pull up the lateral corner of the eye with respect to the medial corner level.