Since the 10th century, A.D., surgical procedures of the eyelids have been undertaken. Originally, most eyelid surgery focused on treatment of functional problems of the upper eyelid, which caused an inability to see. It was not until the late eighteen hundreds that aesthetic surgery of the eyelids was undertaken to improve cosmetic appearance. At that time, physicians realized that in the aging eye, it was the atrophy of the fibrous tissue that allowed for protrusion of the orbital fat to a more prominent position.
In the nineteen fifties, it was noted that there were several elements to the aging eye which could easily be corrected by surgical procedures. These included drooping of the brow, excess skin and muscle, herniation of the orbital fat and, to a degree, excess muscle around the eyes. Things that respond poorly to standard eyelid surgery are crow’s feet radiating from the eye and fine wrinkling around the eyes. Dark circles, as will as excess fat below the eyelids, known as festoons, are also not easily treated with standard eyelid surgery.
Eyelid Surgery Procedure | Virginia, Maryland, DC The typical incisions for the upper eyelids are made approximately nine to eleven millimeters above the upper eyelash line. In advance of surgery, while in a sitting position, a patient is marked while the eyes are both open and closed. Using a special pair of tweezers or forceps, the amount of excess skin which can be safely removed is determined while the patient’s eyes are closed. Markings are made to allow for the exact intraoperative removal of excess skin and fat.
With regard to the lower eyelids, the incisions can be made either at the eyelash line or inside the eyelid itself. The inner eyelid incision is reserved for those patients who have minimal excess skin, but rather only excess fat herniation. All the incisions for eyelid surgery heal extremely well. Indeed, it is frequently said that the eyelids are the most forgiving area of the body with regard to scars. Incisions, in and around the eyelids, heal beautifully and are difficult to see shortly after surgery.
The typical healing response for eyelid surgery is rather brief. Many patients are swollen for a period of seven to ten days. Some bruising, progressing to mild discoloration of the cheek surface, is often seen for up to two weeks after surgery. The major risk associated with eyelid surgery is ectropion, which is defined as a pull-down of the eyelids due to either excess skin removal or scar tissue. Most of the time, ectropion is transient in nature. Were it to occur, it typically responds well to daily massage or taping of the eyelids while the patients are sleeping. Visual disturbances from eyelid surgery have been reported, but are very unusual. Those patients who make poor candidates for eyelid surgery include those that have dry-eye syndrome or low tear production, as well as those patients who have hyperthyroidism and very prominent eyes.
Eyelid surgery is somewhat different in the Asian patient. An anatomic difference between western and asian eyes is a lack of an upper eyelid crease in many Asian patients. Those asian patients who wish to produce such a crease can do so with relative simplicity. This involves creating an adhesion or attachment of the upper eyelid muscle to the skin. This attachment normally occurs in Westerners and in some Asians, but is absent in others. The healing time is similar to that for other eyelid surgeries.
An important point to note is that drooping of the upper eyelids can be multi-factorial in its etiology. In some patients, excess fat and skin in the upper eyelid alone cause drooping of the lids and brow. In others, drooping of the brow itself causes the appearance of excess skin and fullness. Some patients who request upper eyelid surgery are truly better candidates for brow lifts, which can now be done endoscopically. Some patients require both an eyelid and brow lift procedure to optimize the outcome. Only a thorough physical examination will allow for an adequate diagnosis of the underlying problem.
Surgery for upper eyelids is frequently performed under local anesthesia with intravenous sedation and has minimal associated discomfort. Most patients require no more than Tylenol in their post operative care. Cosmetic surgery is not for everyone. Finally, some patients have true obstruction of their visual fields from ptosis or drooping of their upper eyelids. For these patients with adequate ophthalmologic documentation, many insurance companies, including Medicare, will offer some coverage for this procedure.