Aging Eyelids

Aging Eyelids

Dr. James Rosing, board certified plastic surgeon in Newport Beach at Allure MD Plastic Surgery and Dermatology reviews the Aging Eyelid: Anatomy, factors that impact the rate of change, and treatment options.

The eyes are a window into the soul. Though, when it comes to the peri-orbital (around the eye) skin and soft tissue, you cannot rely on the appearance to reflect much about the person at all.

While it is possible to understand the emotions of another person at least partially by simply looking into their eyes, there is a consistent incongruence with regards to the appearance of the eyes (speaking to the aesthetic of the skin and soft tissue around the eye itself) and how the person feels. The discrepancy between what we see in the mirror and not only how we feel but also how we perceive ourselves, is precisely what creates a rational motive to do something about it.

As age takes its toll on the eyelids and periorbital tissues, skin excess accumulates both at the upper eyelid crease weighing down the lid itself as well as in the lower eyelids creating crepe-like skin that droops and casts shadows below. Excess skin at the upper eyelids can advance to the point of redundant skin reaching the eyelashes impacting the normal visual field. The skin of the lower eyelids loses elasticity and attenuates revealing details of the underlying fat pads of the lower periorbita which accentuates the depth of the 'tear trough'.

Aging differences we appreciate from person to person are largely independent from our behaviors and manifest our genetic makeup. The way soft tissue drapes over the bony elements of the skull relates to the size, shape, and growth rate of the bone. The amount of space between the orbital rim and the globe varies from one person to the next. Over time, as laxity ensues with a loss in skin elasticity, the degree of periorbital aging and the rate at which it appears, is related to the underlying structure. The anatomic changes that occur with aging of the eyelids such as excess drooping skin of the upper eyelids, and bags under our eyes, can make us look tired and weathered.

Blepharoplasty Procedure: Removing Skin Excess from the Upper Eyelids

Dr. James Rosing performs upper eyelid skin excess removal (blepharoplasty) in the office, under local anesthesia.

"Upper blepharoplasty is one of the most underutilized plastic surgery procedures by both women as well as men. I think for most people, contemplating any procedure performed near the eye is anxiety provoking. Though I can quite confidently say, patients who have undergone the procedure consistently report one thing; they wish they had done it sooner. The procedure is delicate, though straight forward, with subtle though notable results, and has a short recovery."

The aim of upper eyelid plastic surgery, blepharoplasty, is to remove all excess skin above the upper eyelid crease. I perform the marking for upper blepharoplasty by having the patient sit upright facing forward with eyes closed. I then mark the natural upper eyelid crease defined by the superior border of the tarsal plate, typically 9-10 millimeters above the lash-line. I then use a forceps to gently grasp the excess skin that folds over the crease until it is taught without having the effect of opening the eyelid and mark the location.

The same technique of marking continues from the nasal portion of the upper eyelid to the temporal portion of the upper eyelid. This creates a segment of skin above the upper eyelid crease that is redundant and can be surgically removed and the edges approximated with a suture. In doing so, the person before was unable to see their upper eyelids when looking in the mirror, and after can fully see their upper eyelids.

The result is subtle though significant and successfully transforms one from looking tired to refreshed and vibrant. The eye seems to appear more open again, creating an energetic and youthful aesthetic. For the lower eyelids, often repositioning periorbital fat (fat transfer) into the groove at the tear trough is effective to smooth the lower eyelid contour eliminating shadowing. I find eyelid surgery to be among the most attractive types of surgery, as it is minimally invasive to patients, provides a consistently satisfying result, with very little downtime.

The eyes are a window into the soul. Though, when it comes to the peri-orbital (around the eye) skin and soft tissue, you cannot rely on the appearance to reflect much about the person at all.

— Dr. James Rosing