It’s All in the Eyes… Part 2
First, let’s talk about the upper eyelids. Young eyes have a smooth upper lid, with a well-defined crease and no excess skin. Older eyes have excess skin, and may have some bulging medially (meaning near the midline). This bulging is actually fat inside the orbit. The orbital septum is a layer of connective tissue that keeps the fat inside the orbital cavity from bulging out. As we age, this layer of connective tissue weakens, allowing the fat to bulge out. In addition, our skin stretches and droops as we age.
So how do we fix this? It’s actually a relatively simple procedure:
- Take off the excess skin. The resulting scar is well-hidden in the crease of the upper eyelid.
- Remove the bulging fat. Removing just a pinch or two of fat smooths the contour of the upper eyelid.
One common question I am asked- are upper eye lifts (blepharoplasty) covered by insurance? The answer, as always, is that it depends. For the procedure to be covered, the upper eyelid skin has to be drooping so much that it actually obstructs your vision. If you have so much excess skin that it’s difficult to see your eyelashes, it very well may be covered by your insurance. In order to find out for sure, you will need to see your opthalmologist for a visual fields exam, which is basically a test to determine if your excess eyelid skin is blocking your vision.
Now what about the lower eyelids? Lower eyelids age in a similar way to the upper eyelids. Excess skin develops, and the fat in the orbit begins to push on the orbital septum (the connective tissue holding it back), causing bulging and bags under the eyes. The major difference between the upper and lower eyelids is that the lower eyelid can also develop laxity, meaning it becomes slack.
Lifting the lower eyelids is similar to to lifting the upper eyelids with one major difference:
- The excess skin is taken off
- The bulging fat is removed
- Here’s the difference– the lower eyelid is tightened. The canthal ligament, which is the tough connective tissue that supports the lower eyelid, is suspended higher into the outer corner of the bones that make up the orbit. Not every patient needs this, but it is commonly done to help provide support to the lower eyelid.
Do you have any experience with eyelifts you would like to share? Or any questions you would like to ask?