UPPER BLEPHAROPLASTY (Eyelid Lift)
With aging, extra undesirable skin accumulates in the upper eyelid. Increased fatty tissue producing a heavier looking upper lid also becomes more noticeable with age. The extra skin and fat hide the normal upper lid crease that is associated with the youthful upper eyelid. During eyelid surgery, this excessive skin, fat, and muscle is removed. This procedure can be accomplished with limited anesthesia, local or with a variety of sedation techniques.
The result is a smoother upper eyelid with a well-defined crease. The position of this surgical scar in this crease makes it almost invisible with time.
Recovery is relatively rapid. Discomfort is minimal and analgesics are usually not needed after the first few days.
Lower Blepharoplasty (Lower Eyelid Surgery)
Aging results in changes in the appearance of the lower eyelids. Due to loosening of the supporting layers of the eyelid, the fatty tissue that normally surrounds the eye begins to herniate (protrude) outward, producing the characteristic bulges of the lower eyelids. “Bags” beneath the eyes normally develop with age but sometimes are seen in young adults. When seen in young adults this tends to be a family trait.
Another characteristic of the aging lower eyelid is a deepening of the fold that sits between these fatty bulges (bags) and the cheek. This area of depression, we call the “tear trough”, tends to accentuate the “herniated fat pads.” It also accentuates the “dark circles” beneath the eyes. As this groove develops it lengthens the distance between the eyelashes and the cheek. IIt makes the lower eyelid look long. Youthful lower eyelids appear short.
Fine wrinkles develop in a crisscross pattern that resembles crepe paper. This is another component of the aging of the lower eyelid. These lines are not improved with surgery. Chemical peels have been helpful in improving this sign of aging.
Surgery is effective in improving many of the age related changes in the appearance of the lower eyelid. Lower blepharoplasties (eyelid surgery) are designed to improve the appearance of the “bags”. This can be done by either removing the protruding fat or tightening the loosened eyelid layer that holds the fat in place. These approaches result in 
restoring the youthful shape of the lower eyelid.
In an attempt to add volume to the area of depression below the protruding fat pads (the “tear trough”) some of the same fat which is often removed can be repositioned to fill the “tear trough” at the time of the eyelid surgery.
A non-surgical option to improve the appearance of the lower lid is to fill the tear troughs with one of the commercially available filler agents. This is appropriate for those patients who have minimal bulging fat pads but deeper tear troughs. We have been pleasantly surprised that the longevity of the filler material when placed in the “tear troughs” is not measured in the usual months seen when fillers are placed in other parts of the face but in years.
