J. Clinton Merrick, MD
Merrick Plastic & Hand Surgery
It is often said that the eyes are the windows to the soul. Our eyes convey the complexities of human emotion in ways that words cannot. As we age, however, our eyes can convey an unintended message. Even though a good night’s sleep may revitalize the spirit, the loose skin in the upper eyelids and the bags in the lower lids can give the appearance of fatigue and agedness. In addition, severe drooping of upper lid skin may affect one’s ability to see. Patients seeking remedy for these symptoms have made blepharoplasty one of the most common plastic surgery procedures performed today. In 2016, blepharoplasty was the fourth most common cosmetic surgery procedure with over 200,000 procedures performed in the U.S.
Some inherited diseases result in periodic, severe swelling in the eyelids, which causes an acceleration of the drooping skin in the lids. This can occur early in life, even in the twenties. For most men and women, however, a slow progressive change is seen until treatment is sought often in the fourth and fifth decade of life. Excessive alcohol consumption results in nighttime swelling that can stretch the eyelid skin. Sun exposure robs the skin of precious elasticity, accelerating droop. Smoking has a similar effect with early wrinkling and loss of skin elasticity. Good skin care consisting of daily removal of excess makeup, gentle cleansing, and use of good quality eye firming cream is essential (e.g. SkinCeuticals AGE Eye Complex). Even under the best circumstances, progression of the “tired eyes” look may occur.
In addition to the loss of elasticity our skin develops with age, loss of strength in the internal layers of the eyelids allows the fat compartments in the eye to bulge creating fullness in the upper lids and the bags we see in the lower lids. Further laxity of the supporting ligaments in the upper lids may result in a medical condition known as ptosis (pronounced ‘toe-sis’). This causes one lid to fall below the other lid and sometimes obstruct vision by covering the pupil.
The options for treatment are individualized based on the exact appearance of the lids. Please schedule a consultation for specific recommendations. The initial consultation provides an opportunity to discuss the primary areas of concern, the patient’s expectations, risks, benefits, and expected outcomes.
Several nonsurgical options also exist. Laser resurfacing is an excellent option for some patients. Chemical peels may also be appropriate to tighten and revitalize the skin. Skin pen is a brilliant new way to tighten the lower lid skin without surgery. In cases where significant skin excess is present or substantial bulging of fat exist, blepharoplasty may be the best option.
In many patients, significant skin excess in the upper lid may so severely affect vision that insurance will cover the cost of the procedure. This requires a vision test demonstrating a decrease in visual fields and a consultation with a plastic surgeon.
Surgery on the eyelids is performed on an outpatient basis. This is often done either in a surgery center with a light sedative or in the office. The upper lids are treated with an appropriate amount of skin excision, followed by contouring of the fat pockets beneath the skin. The skin is sutured along the natural crease in the lid with a small stitch under the skin. A small incision along the margin of the lower lid allows for a conservative skin resection and reshaping of the lower lid fat pads. Again, small sutures are used to close the incision. The entire procedure takes about an hour.
The eyelids may appear slightly bruised and swollen for up to a week. Generally, this subsides quickly, allowing patients to return to work between one and two weeks. Most people find that in 8–10 days they are socially presentable. Although the eyelids are sensitive areas, there is surprisingly little pain reported by most patients. Typical pain levels are 2–3 on a scale of 1–10 postoperatively. After about two weeks, the thin eyelid skin is completely healed with very minimal scarring.
Blepharoplasty is very successful at rejuvenating one’s look by giving a brighter, less tired appearance, with minimal scarring, little pain, and a brief recovery.
J. Clinton Merrick, MD – Eau Claire G.I. Associates
For information or to schedule an appointment:
715-514-2550 | 866-242-3499 | merrickplasticsurgery.com
Dr. Merrick sees patients in Eau Claire, Cumberland, Hayward, Ladysmith and Shell Lake.