As we age and our thin eyelid skin loses its elasticity and loosens, the excess skin may fold over the eyelids causing an obstruction to vision. The upper eyelids often become hooded, drooping, sagging or bulging and the eyes look and feel tired. Excess fat within the eyelid can push the eyelids down and make them feel heavy. Patients often complain of forehead discomfort from overused muscles that strain to lift sagging skin in the eyelid area.
Blepharoplasty surgery to remove the excess skin and muscle is the required surgery for upper eyelid hooding and drooping eyelids. Sculpting sub brow descended fat within the eyelid can help open up the eyelids. Blepharoplasty is sometimes required for medical reasons (called functional blepharoplasty) whilst at other times it is done for cosmetic reasons. In most cases, a functional eye lift is performed to remove the loose excess skin and underlying soft tissue from the upper eyelid in order to lift it from the visual axis as it can droop low enough to impair vision for driving or other tasks.
Another functional problem patients face with drooping baggy upper eyelids is difficulty in wearing makeup as it smudges. They may also have difficulty wearing glasses or contact lenses, whether from the baggy upper or, indeed, sometimes lower eyelids. There are also other medical conditions that may require functional eyelid surgery which include:
- Irritation from excess folds of eyelid skin rubbing together.
- Watering eyes at the outside corner where the tears drain down a skin fold
The oculoplastic surgeon will assess the upper eyelids and do measurements, check the ocular health and tear film, take photographs then plan the eyelid surgery relative to the problem as all baggy eyelids are different. The oculoplastic surgeon then explains what will be involved in the surgery and what to expect after the surgery. It is always helpful if you bring along photos of when you were younger to show the surgeon.
As with cosmetic blepharoplasty, functional blepharoplasty most often is performed by oculoplastic surgeons, under local anaesthetic as a day case. The aim of blepharoplasty surgery is to improve the function of the upper eyelids, improve the cosmetic appearance, and maintain your natural look, but with less baggy excess tissue.
Blepharoplasty is mostly done on upper eyelids. Sometimes the lower eyelids require removal of excess skin and fatty tissue, usually for cosmetic reasons. However, the use of synthetic hyaluronate fillers in the lower eyelids and tear troughs (TearFill) means that fewer patients require lower eyelid blepharoplasty.