When is eyelid surgery needed
The difference between a drooping lid, ptosis and a lowered brow, under-eye bags, and when surgery is not needed.
"I have slept well, but everyone says I look tired." Most patients who come for eyelid surgery start with that sentence. The area around the eyes is the part of the face that ages first, because the skin there is the thinnest on the body. But not every droop means an operation. Let us tell them apart.
Signs that surgery may be needed
- The skin of the upper lid falls over the lashes and make-up becomes difficult
- Your field of vision narrows when you look up and to the side
- Your forehead and brows are tired by the end of the day, because you tense the forehead muscle to raise the lid
- Under-eye bags stay all the time, whatever your sleep or salt intake
- Your gaze looks heavier than in your old photographs
Three different problems, three different solutions
Patients usually say "my eyelid has dropped", but three different causes may lie behind that, and each is treated differently.
- Excess skin: the skin of the lid loosens with age. The solution is upper blepharoplasty.
- Ptosis: the muscle that lifts the lid has weakened and the eye stays half closed. Cutting skin does not help here; the muscle has to be tightened.
- A lowered brow: the lid is in place, but the brow has dropped and presses on it. In that case a brow lift is needed.
The wrong diagnosis means the wrong operation. That is why your eyes are assessed separately at the examination: open, closed, looking up and looking down.
About under-eye bags
A bag is in fact fat from the eye socket bulging forward. Creams and massage do not remove it. In younger patients the fat can be removed from the inside of the lid, leaving no mark on the skin. If the skin has loosened too, the incision is made just below the lash line.
When surgery is not needed
- The puffiness appears in the morning and goes during the day: the cause is fluid, and surgery does not help
- The main complaint is dark circles: that is a matter of skin colour and vessels
- There are only fine lines: botox and skin treatments are more suitable
- There is untreated dry eye or thyroid disease: these must be brought under control first
How long the result lasts
The result of upper eyelid surgery usually lasts more than ten years, and bags of the lower lid often never return. Ageing does not stop, but the clock is turned back a good way. The scar is hidden in the natural crease of the lid and becomes almost invisible within a few months.
After good eyelid surgery people do not ask what you have had done; they say you look rested.
