The evolution of cosmetic eyelid surgery

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Like many cosmetic procedures, removal of upper eyelid skin began as a result of necessity. Many people have excessive skin of the upper lids, which have become more pronounced with aging to the point that they have visual impairment.

Until a physician came up with the idea of excising the skin, people with this problem resorted to using tape to hold the lids up so that they could see.

Initially, surgery was indicated only as a medical necessity, and insurance companies will often consider covering the procedure. Usually, skin has to cover at least half of the pupil for insurance coverage.

Now, the most common reason for upper lid surgery (blepharoplasty) is for cosmetic reasons. Under local anesthesia, the excess skin has to be carefully measured and removed. Sutures are then used and the patient is to use ice soaks for several days to reduce swelling and bruising. Sutures are usually removed in five days.

The most common complaint for requesting a blepharoplasty is the patient looks tired all the time, and they feel they appear older than their actual age.

Another issue, often not recognized by the patient, is deep forehead furrows. They wish to soften these lines using Botox or Dysport; however, it is actually the heaviness of the upper eyelid skin causing them to constantly lift their brow for better vision. This in turn causes premature forehead wrinkles.

Often removing the excess eyelid skin will resolve forehead wrinkles and is actually a less costly alternative to Botox or Dysport, which have to be injected intermittently forever. Plus, injections won't alleviate excess upper lid skin.

Regarding the lower lids, there are several reasons why patients have issues and also several surgical options. The most common complaint is "bags and shadows" under the eyes making the patient look older and tired.

Often there are only pockets of fat that have accumulated (a genetic factor) and these can be removed with an incision inside the eyelid itself. If there is also excess skin, this can be removed as well. Additionally, others may have just excess skin and no fat pockets and only require skin excision surgery.

The patients compliance with their surgeon's post-operative instructions are especially important with these procedures to minimize any risks and reduce the recovery time. This may include ice soaks, eye drops or ointment and avoiding looking downwards excessively during recovery.

Eyelid surgery can be a medical necessity, but more commonly requested these days for cosmetic reasons. Although about a week recovery time is needed, these procedures can make dramatic improvements in the patient's appearance, and patients are usually elated with the results.

As with most surgery options, the final result is seen after several months.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand associates.com

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