People are always telling me I look tired. I sleep great. I’m not tired at all. Why do I always seem to look so run down? Patients will often ask these and similar types of questions. The answer is often the eyes. Drooping upper eyelids, baggy lower eyelids and a heavy eyebrow can combine to give even the most vibrant, well-rested individual the appearance of being tired and run down.

Eyelid surgery or blepharoplasty is one of the most commonly performed cosmetic surgical procedures. In most cases blepharoplasty is a cosmetic surgical procedure, designed to improve not only the appearance of the eyes, but the overall face as well. Blepharoplasty can also be performed to improve a patient’s vision. Excess skin from the upper eyelids often obscures the patient’s vision when looking up.

A functional blepharoplasty can remove the extra skin and improve the ability to see in an upward gaze. The forehead and eyebrow are also significant contributors to the appearance of the eyes and therefore the entire face. The normal position of the natural brow is related to the bony orbital rim or eye socket. Cosmetic or normal ratios of the upper eyelid height to the eyelid/eyebrow distance exist and aid the surgeon in achieving excellent results.

The forehead/brow complex is an important contributor to a successful cosmetic result. The myriad of options and techniques available to treat defects of the forehead and brow is beyond this article. Your facial surgeon will assist you choosing which options are best suited to your particular situation.

Surgery of the upper eyelids involves removing excess skin, muscle and fat. The resulting surgical scar is carefully hidden in the eyelid crease. The results transform eyes from tired and droopy to open and awake. Female patients find they are now able to apply makeup to the platform of the eyelid, rather than it being covered by excess skin.

Lower eyelids may be addressed either through the skin, by an incision just below the eyelashes or “transconjunctivally” through the inside of the lower eyelid, an approach which heals without scarring. When significant laxity exists the lower lid may need to be re-suspended in order to hold its contour against the eyeball.
The instrumentation for performing the actual surgery is diverse. While many cosmetic surgeons continue to rely on surgical scalpel techniques, the use of laser and radiofrequency surgical options are decreasing not only operating time, but recovery time as well.

No other feature conveys as much about us as the eyes. Whether performed to achieve cosmetic or functional improvement, alone or in conjunction with other facial surgical options, blepharoplasty is the procedure, which addresses the most critical cosmetic feature of our face, the eyes.

(Editor’s Note: Derek K. Boyden, DDS is president of Olympic Surgical Associates Inc. He may be reached at (360) 895-0588.).