Our eyes are the windows to our face. It is of paramount importance that they are functional and, at the same time, aesthetically pleasing.
Problems with eyelids can affect both young and old. There are ethnic variations which may warrant aesthetic correction too. Whatever procedure we carry out should blend with the rest of the body and the face. There are familial lower lid eye bags, lid fat herniation in younger patients which give a very tired look. In older patients there are intrinsic and gravitational symptoms and signs of ageing in the eyelids. The intrinsic problem would need a combination of surgical correction and simultaneous laser resurfacing.
The upper eyelid problem is mainly focused towards hooding, fat herniation and lateral brow ptosis. The latter will affect the contour of the eyebrow. The action of the depressor muscles of the forehead will also affect the upper eyelid aesthetics. The lower lids are usually troubled by the eye bags and excess skin. The other anatomical abnormalities are the loss of canthal definition and weakness of the tarsus, which are part of the ageing process.
Upper blepharoplasty, plus or minus lateral brow ptosis correction, will improve the majority of eyelid problems and give a beautifully contoured lid and a proportionate brow. The incision of upper blepharoplasty is made along the tarsal fold. Excess skin and muscles are excised in a pre-planned quantity. We carry out a procedure called "open sky technique" where the fat is exposed and excised in a contoured fashion. The muscle is repositioned in the mid line with an anchor suture and the skin is repaired with very fine sutures. If lateral brow ptosis correction is required at the same time a small incision is made in the scalp. The brow is freed and the excess scalp is removed and repaired so that the scars are barely visible. The benefit of the brow lift in patients needing excess skin removal is that the scars will be hidden and will give a natural contoured aesthetic outcome.
In the lower lid we carry out a procedure called "septal reset" where the "excess fats" are not removed but repositioned. The eye bag presentations are mainly as a result of weakness of the septum and the muscle and not due to excess fat. Removal of this fat used to be the norm in the past and unfortunately is still practised in many centres. If the fat is removed, in a few years it will give a sunken, concave appearance which is not an aesthetically pleasing outcome.
An incision is made just below the eyelashes, the skin is raised carefully and the muscle is split which exposes the herniated fat. The fat will be repositioned with tiny sutures. The muscle will be tightened and the limited amount of excess skin will be removed followed by repair. These procedures are usually carried out under a local anaesthetic with oral sedation. Ninety per cent of the eyelid surgery in our clinic is carried out in this fashion, as a day case. Some need to be admitted on a planned arrangement due to distance travelled or unavailability of anyone to supervise after discharge.