It is said that “the eyes are the windows to the soul”. They are the major focus when people are looking at you, and are also one of the major areas of facial aging. The eyelid skin is very thin, approximately 1/7 as thick as the cheek and forehead skin.
As we age, our skin cells no longer retain water, as they did when we were younger. In addition, external forces such as cigarette smoking, pollution, and pollen aggravate the swelling of the eyelids, which further stretches the skin. The eyebrows begin to sag, the upper eyelid skin stretches and the lower eyelids become puffy. The puffiness of the lower lids is due to the fact that the membrane that holds the eye socket fat in place weakens and the fat protrudes forward, creating bags.
When I first started as a plastic surgeon 25 years ago, the treatment for aging eyelids was the removal of the skin and fat. This tended to give the eyelids a hollowed look. Over the last 15 years, there have been significant surgical innovations. Through these many facial rejuvenation procedures, we have become more conservative with the philosophy of “less is more”. We are lifting the eyebrows through endoscopic incisions, behind the hairline, rather than making the classic “ear-to-ear cut”, or coronal brow lift. The endoscopic lift minimizes hair loss and numbness of the scalp and improves healing time. Upper eyelid excision of fat is more conservative and in some instances, the hollow look that one sees in the upper eyelids is actually filled in with strips of skin where the top layer is removed.
The most significant changes have occurred in lower eyelid surgery. Instead of removing all the fat that “pooches out”, we’re now reinforcing the membrane, shrinking the fat with cautery, repositioning the fat to fill the hollowed tear trough area at the base of the eyelid along the cheek, and repositioning the muscles. This elevates the cheek to a more youthful position, minimizes the downward pull of the eyelid, and retains the almond shape of the eye.