The eyes are the first features noted when people meet. And having puffy, sagging or wrinkled eyelids can convey a false image of being tired, sad or old. Luckily there are many techniques that can reverse these physical signs. The actual technique(s) chosen depends on what combination of deformities is present. Are the eyebrows too low producing an appearance of excess skin over the upper eyelashes and hooding or hanging of skin towards the outermost part of the eye? This condition is treated with one of several browlift procedures. In addition to the descent of skin below the eyebrow, is there excess skin in the upper eyelid proper? And are these conditions associated with puffiness from fatty protrusions? Upper eyelid surgery (blepharoplasty) with removal of skin and fat is the treatment for this. Of course, it is critical that the eyebrows are in their proper position above the orbital rim before eyelid surgery is considered. To perform an upper blepharoplasty when a browlift should have been performed will result in pulling the eyebrows even lower and producing a small, contracted appearance in this area.
Finally, when considering deformities of the lower eyelid, we look at the degree of puffiness or hollowness, wrinkling, pigmentation, laxity and vertical descent below the orbital rim. Puffiness is easily handled by fat removal from the back or conjunctival side of the lower eyelid. On the other hand, occasionally fat has to be pulled forward from within the orbit to fill out hollowness of the lower lid. Laxity of skin usually requires minimal excision, though resurfacing using the LASER or chemical peeling agents can sometimes be sufficient. And resurfacing is certainly the treatment of choice for wrinkling and most pigmentation problems. Finally, vertical descent of the lower lid below the orbital rim may require more extensive procedures such as a midfacelift which pulls the entire cheek upwards.