Dermatochalasis in the lower lids most commonly occurs with some fat prolapse, or eyebags, a cosmetic aesthetic problem and does not impair vision. If there is lid laxity with the lower lid dermatochalasis, there may be signs of eyelid sag or ectropion and symptoms of watering.
Lower lid dermatochalasis is treated with lower lid blepharoplasty which is titrated to patients’ individual needs depending on the the proportion of skin excess, fat prolapse and lid laxity.Dermatochalsis occurs with increasing age and is more common in patients who smoke and those with a familial predisposition to loose skin around the eyes.
The examination of dermatochalasis is essentially the examination of eyebags.
Prior to surgery, a full ophthalmic examination is necessary. This includes checking visual function as well as undertaking tests to exclude eyelid and eye surface conditions such as blepharitis, dry eye, eyelid laxity or any other conditions that could be exacerbated by a blepharoplasty. The patient’s entire face and eyelids are examined during the consultation.
A visual field test may be required to determine the extent of visual impairment from eyebags or other conditions.
It is common for photographs to be taken both before and after the procedure.
The patient will be asked how the eyebags affect them, determining whether the problem is cosmetic or also affects vision. It is also useful for the patient to provide photographs taken prior to the eyebags becoming noticeable, for instance from two to five years younger, to aid in understanding the individual cases.
The treatment is the same as for eyebags.
A blepharoplasty can be done for cosmetic purposes or to improve vision. The purpose of a blepharoplasty is to correct excess folds of skin (dermatochalasis) and drooping eyelids (eyelid ptosis), or to reduce baggy lower eyelids. Fine wrinkles can be treated with laser resurfacing or a gentle chemical peel if desired.
A periocular and facial trichloracetic acid peel can performed at the same time as blepharoplasty surgery. Regular tretinoin treatment can greatly improve the quality of the skin.
Upper eyelid blepharoplasty
Incisions are typically made in the upper eyelid skin crease, where they heal best and scarring remains well hidden.
The incision is made along the natural eyelid skin crease a few millimetres above the eyelashes. The height of the incision varies in men and women and is commonly placed lower in Asian blepharoplasty patients who have a naturally low skin crease, unless ‘Westernisation’ is requested.
An elliptical piece of skin and muscle is removed using a blade and a Colorado needle, which greatly reduces bleeding and helps keep tissue damage to a minimum. The skin incision is then closed using delicate sutures.