There are some things in life that are unavoidable, and ageing is one of those things. Sadly the ageing changes start around the eyes and are first noticed in your late 30s or 40s and get worse with advancing age. The upper eyelid, eyebrow and the lower eyelid play important roles in the aesthetics of the eye area. Dr Naveen Somia, Vice President of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), explains the effects of ageing in the eye area and what can be done to reverse the ageing changes.
Common Signs Of Ageing Around The Eyes
The common ageing changes in the upper eyelid noticed by patients are:
- Excess eyelid skin that is thin, loose and crepey.
- Excess skin resting on your eyelashes and covers the ‘eye shadow space’.
- Droopy or saggy eyelid causing eyelid ptosis and a tired and dull look.
- Excessive upper eyelid fullness due to bulging and sagging fat.
- Excessive upper eyelids hollow and sunken eyelids due to retraction of fat into the eye socket.
- Absent or a very high eyelid crease.
- Asymmetric eyelid crease.
- Uneven position of the eyelid margins (which is often due to a droopy eyelid).
Since the eyebrows are closely linked to the upper eyelid they play an important role in the appearance of the eye area. Here are common ageing changes in the eyebrows noticed by patients:
- The high arched raised eyebrow.
- The droopy eyebrow.
- Uneven and asymmetric eyebrow.
Ageing changes in your lower eyelid are to a large extent determined by the ageing of the bone in the under eye area and to a lesser degree by the skin and soft tissue. This may sound counter-intuitive but it is true. As you age the bone in the under eye area shrinks, and as a result, the eyebags bulge, the eyelids become loose and saggy and the under eye grooves become deeper.
The common ageing changes in the lower eyelid noticed by patients are:
- Excess thin and crepey skin.
- Excessive bulging fat causing eyebags.
- Excessive hollowing due to soft tissue and bony loss.
- The lower eyelid is pulled down (eyelid retraction).
- The lower eyelid edge is turned out due to muscle weakness due to age or scarring from previous eyelid surgery (ectropion).
- Droopy corners of eyelids giving the eyelids a “sad look”.
- The lower eyelid edge can be turned in due to muscle over-activity (entropion).
Surgical Options For Eyelid Rejuvenation
– Upper Eyelid, Lower Eyelid and Brow Surgery
Your Specialist Plastic Surgeon can recommend a procedure that would help rejuvenate the eyelid area. Occasionally procedures can be combined if deemed necessary.
Upper Eyelid Surgical Procedures
If your only problem is excess skin and every other supporting structure of the eyelid is in excellent condition, then a skin-only Blepharoplasty is appropriate. Unfortunately, this only occurs in a small group of patients when the remaining eyelid tissues are capable of maintaining robust and strong support to the eyelid. This procedure removes the excess upper eyelid skin, usually under local anaesthesia and takes about 45 minutes.
The second is comprehensive blepharoplasty. This procedure treats excess skin and simultaneously addresses deeper tissues such as fat, muscle and connective tissue. Excess skin is one aspect of eyelid ageing but the other aspects such as excess fat, increased muscle activity and bulk, loose connective tissue, weak tendons and droopy eyebrows are equally important and all need to be addressed for the best results. This can take up to 90 minutes.
The third procedure is Ptosis (droopy eyelid) correction. In this condition, the muscle that opens the upper eyelid becomes overstretched and loses its ability to open the upper eyelid. This is similar to an overstretched rubber band that has lost its elasticity. Surgical tightening of this loose muscle restores the function of this muscle and fixes a droopy eyelid. Since a droopy upper eyelid co-exists with multiple ageing changes of the upper eyelid, both these operations can be combined to restore the function and aesthetic of the most important part of your face. This combined operation can take up to 120 minutes.
Brow Lift Surgery
Since the eyebrows are closely connected to the upper eyelid and the aesthetics of the brow influence the overall appearance of the eye area, brow lift surgery is often combined with upper eyelid surgery.
A very high arched eyebrow or uneven eyebrows are caused by the upward pull of an overactive forehead muscle (frontalis). This is a subconscious response to a droopy eyelid that restricts vision. Correcting the droopy eyelid is essential because this will address the cause.
If the eyebrows are low and droopy then a brow lift done at the time of upper eyelid surgery is effective. A brow lift can be done either endoscopically, or by an external or internal approach. The external approach causes a scar that is visible for 3-6 months and gradually fades.
Lower Eyelid Surgery
Lower Eyelid rejuvenation is possible by correcting the following ageing changes using surgical techniques:
- Excess skin
- Excess bulging fat
- Loose and saggy eyelids
- Deep grooves under the eyebags, and
- Flat and droopy cheek.
Lower Eyelid Rejuvenation
So when it comes to a lower eyelid rejuvenation, you have four options that can be used either independently or in combination, depending on the problem you wish to correct:
- You can remove excess skin by a procedure called ‘pinch’ blepharoplasty.
- Remove excess bulging fat by transconjunctival fat removal where the cut is made inside the lower eyelid and the excess fat removed.
- Tighten the eyelid by a procedure called Canthopexy. This is similar to tightening a sagging clothesline.
- Correct the deep grooves by releasing the Arcus Marginalis and the Orbito malar ligament combined with fat transposition and reposition the droopy cheek. This procedure is called a midface or cheek lift. It is very effective in addressing ageing changes in the under eye area.