Eyelid surgery (blepharoplasty) is one of the quickest, least invasive procedures to improve your appearance. However, there are other options to consider, such as Botox, fillers, browlifts and cheeklifts. Blepharoplasty is most effective if you have excess skin in your upper eyelid, but otherwise youthful features. This may be a family trait that you have noticed as young as 30 years old. With natural aging, the upper eyelid skin loses elasticity and begins to droop over itself, sometimes resting directly on or below the eyelashes.
To determine if you might be a candidate for upper eyelid blepharoplasty, look in the mirror and use a small Q-tip or cuticle stick to roll the excess skin of your eyelids into the crease. If this appears to fix the problem, your blepharoplasty may be a simple as trimming the excess fold of skin in the office under local anesthesia.
If heaviness of the eyebrows is a problem, lift your forehead straight up with the palm of your hand while looking in the mirror. If this improves the appearance of your eyelids, your surgeon may also recommend a forehead lift or endoscopic brow lift.
If your upper eyelids are so heavy that they obstruct your vision, you may have a medical condition known as ptosis of the eyelids. Look in the mirror. Does your eyelid cover any portion of your pupil (the dark hole in the center of your iris)? Do you see better if you hold your eyelids out of the way with your fingers? If so, Medicare or your insurance company may be willing to pay for repair of the eyelids.
Although many patients complain of bulging fat in the lower eyelids, cosmetic surgeons have come to learn that in most cases there is not excess fat in the lower lids, but a loss of volume in the cheeks. The fat loss begins in the 20s and usually becomes apparent in the early 30’s. Take a look at old photographs from your high school and college years. Most likely, you had small shadows under each lower eyelid. With aging, these shadows are not necessarily darker, but they have sagged lower.
Smile while looking in the mirror. As the cheeks bulge upward into a smile, does this improve the appearance of your lower eyelids? Press upward with your fingers under the cheek bone to hold the cheek in place while you relax your smile. If any of these maneuvers improve your lower eyelid, you may wish to consider a filler such as Sculptra, Radiesse, Belatero or Juvéderm. Fillers can often be injected in a few minutes, with immediate improvement.
Lastly, pull down on your cheek with your fingers. Does the lower eyelid easily pull away from the eyeball? Does the eyelid snap back readily when you let go? Do your eyes frequently water or become red and irritated? If so, you may have developed a loose tarsal ligament in the lower eyelid. It will be very important to discuss this symptom with your surgeon. In some cases, repair of the ligament is medically necessary.
Medical conditions can increase the risk of eyelid surgery. Be sure to discuss your complete medical history with your surgeon, including potential problems such as glaucoma, dry eyes, thyroid disease, diabetes, hypertension, and the use of any blood thinners including Coumadin, Plavix, aspirin, vitamin E, and large doses of herbal supplements such as garlic and ginko biloba.