Eyelid Surgery


There is a popular saying that suggests “…the eyes are the window to the soul.” If that is the case, perhaps your mirror is telling you some ‘window treatments’ are in order. According to cosmetic surgeon Dr. Joseph Rucker, a youthful eye is one in which the upper eyelid shows the natural fold at the mid-portion of the lid with no evidence of skin hanging over the fold. Younger people have a large space between the outside of the upper lid and the outside end of their eyebrow. Once we step into middle age, however, our eyes begin to change. We may notice some or all of the following characteristics of aging:

·       Excessive skin of the upper eyelid causing a tired or fatigued appearance with possible obstruction of vision

·       Loss of the fold of the upper eyelid

·       Fat pads both above and below the eye

·       Brow droop

Dr. Rucker explains the aging process. “The complaints of eyelid problems usually occur after the age of 40. When we get older there is progressive loss of elasticity of the skin and the muscle beneath which causes excessive skin sag. If there is associated brow droop, the result is baggy eyelids.”
The indication for eyelid surgery usually revolves around the correction of excess skin or bulging of the upper eyelid, plus or minus the lower eyelid or brow. Addressing lower eyelid skin is cosmetic and usually aimed at improving the overall contour and smoothness of the lower eyelid. By slightly tightening the skin and partially removing or rearranging the fat pad and bulges of the lower lid, you not only have a more youthful appearance, but for some it minimizes or eliminates dark circles. One of the most misunderstood concepts is the link between eyelid appearance and brow position. Lifting the brow to the proper position completes the rejuvenation and helps maintain the “eye opening” effect.

“Because the eye is considered one aesthetic unit, and depending upon the patient’s signs of aging, I often recommend rejuvenating both upper and lower lids along with the brow for a more natural appearance. Patients are surprised to learn that a saggy brow (caused by weakened attachments to the brow bone above the eye itself) contributes to the excessive folding of the upper eyelid skin. Without correcting the brow, you are treating the symptom and leaving the cause. Isolated procedures often call attention to the “unimproved” areas and make the enhanced area obvious.”
Patients often comment on how surprised they are that a small procedure could produce such significant results. Dr. Rucker’s advice to his post-surgical patients? “Patients who undergo upper eyelid surgery should be on some type of a maintenance program in order to keep their new appearance looking fresh.  We recommend topicals that are directed toward their skin type and in some cases advise profractional laser treatments twice a year. Our proprietary product line includes a collagen-enhancing highly-penetrating serum which results in a significant improvement of the wrinkles of the upper and lower eyelid.”

You can simulate the result of an upper lid lift by raising the center and lateral aspect of the eyebrow itself with your index finger.  This will create a greater distance between the brow and the upper eyelid, creating a more youthful appearance and in the case of overhanging skin, will reveal the natural fold of the upper eyelid which has been lost due to excess skin.

·       Rejuvenation can be approached superficially with topical astringents which stimulate the collagen growth and tighten the skin. Learn more about skin care at Enza Essentials' website.
·       Strategically placed Botox injections at the outside margin of the eye can reduce the appearance of crow's feet
·       Restylane used for the lower lids and can minimize the results of fat pads and create a smoother transition between the lower lid and cheek
·       Ulthera, a new FDA approved ultrasound therapy can improve skin texture at and below the surface where deep stimulation of collagen results in subsequent tightening of the skin’s layers   
·       Profractional laser or light microlaser peels
·        Surgical intervention guarantees a more permanent result. A light laser peel may accompany the surgery to optimize the overall effect.  
Article by
Eau Claire Plastic Surgeon