This eyelid lift corrects the droopiness and puffiness of aging eyes that make us look older than we are. Blepharoplasty surgery, or the eyelid lift as it is sometimes called in layman's language, primarily gives us a more rested appearance by reducing the excess skin and fatty tissue which can develop in both the upper and lower eyelids with aging. Many times this surgery can be performed under local anesthesia in our in-office surgical suite.

A special marking pencil is used to mark the upper eyelid crease and calipers are used to gauge the amount of excess skin contained in the upper eyelid in a method called a pinch technique. The skin is then removed and excess fatty tissue from the middle (medial) most portion of the eyelid is also removed. In some cases the upper eyelid muscle may be contoured. The incision is closed with dissolvable sutures and/or sutures that run underneath the skin and can be painlessly removed after one week. Within approximately one week the incision conforms to the natural contour of the eye and is hidden in the eyelid fold. Laterally it blends in to the fine eyelid creases in the outer part of our eye. In the lower eyelid an incision is made several millimeters below the eyelash line and is carried laterally into the skin crease. The skin and muscle are reflected down and three fatty tissue pockets in the lower eyelid are opened and excess fatty tissue is removed. The skin and muscle are then repositioned and excess skin is removed. The incisions are closed with interrupted dissolvable sutures.

If the only problem in the lower eyelids is bagging secondary to excess fatty tissue, then no skin will need to be removed and there will be no external incision. In this case, the fatty tissue is removed from inside the lower eyelid with no incision on the outside of the eyelid. If excess fatty tissue has resulted in stretching of the lower eyelid skin, then both fatty tissue and skin need to be removed in the traditional blepharoplasty with an external incision.

The entire eyeball is surrounded by fatty tissue which medically we call adipose tissue. A thin membrane called the orbital septum holds this fatty tissue into position. With aging, the fatty tissue can bulge forward, especially in the lower eyelid, and form a hernia, just like in any other part of the body. The dark circles that people complain of are not due to pigmentation in the lower eyelids, although that can occur in rare instances, but is usually due to a shadow effect caused by this excess fatty tissue. This results in a convexed bulging to the lower eyelid with a resultant concavity which causes the shadowing effect. This is the reason the condition may appear more severe in various kinds of light.

The condition may be worsened during a woman's menstrual cycle, or when one is eating or drinking an increased sodium intake. Both of these conditions result in an increased fluid retention by the body. The fatty tissue attracts this fluid which results in an increase in bulging in this area. If the condition is detected early, the fatty tissue can be removed simply by using a laser on the interior part of the lower eyelid and removing the fat without any external incision. This is called a transconjunctival blepharoplasty. The fatty tissue is removed and the skin redrapes into its normal position. However, if the condition has persisted too long or the skin laxity has markedly increased, then both skin and fatty tissue need to be removed. This would be the traditional blepharoplasty or eyelid tuck.