Aging and the Eyes

Some of the most visible signs of aging can be seen on the face. Sagging skin, fine lines and wrinkles are commonly associated with older age. Several changes are also taking place around the eyes. The upper eyelids can droop or become puffy. The fat pads underlying the upper cheeks lose volume. The skin around the upper and lower eyelids loses its elasticity and stretches. In addition, the supporting tissues around the eye weaken and are pulled down by gravity. That causes the natural pocket of fat under the eye to bulge or protrude, leading to the appearance of sunken eyes and lower bags.

Eyelid Surgery

The procedure to fix droopy or sagging, puffy eyelids is called blepharoplasty. It can be done on the upper and/or lower eyelids. Blepharoplasty is the third most common cosmetic surgical procedure in this country. According to The American Society for Aesthetic Plastic Surgery, 231,467 blepharoplasties were performed in the U.S. in 2005. More than 85 percent of patients are women. It's most commonly done in patients 51 to 64.

Lower Eyelid Blepharoplasty

The traditional surgery for fixing lower eyelids uses an incision made just below the lower eyelashes. Working through the opening, doctors remove excess fat and skin. Muscle may be tightened. Sometimes the under-eye fat is redistributed to restore a more natural appearance. Then, the incision is closed. There is a slight risk of scarring or asymmetry in positioning of the lower eyelid.

Another approach to fixing the lower eyelids is called transconjunctival blepharoplasty. Instead of working through the outside, a tiny incision is made inside the lower lid. The surgeon can redistribute the fat under the eye and make adjustments to underlying support structures. Scott Wells, M.D., an Aesthetic Plastic Surgeon with Park Avenue Plastic Surgery Center, says the incision doesn't even require stitches and closes up on its own in about 24 hours. The patient's appearance can be further enhanced and maintained by using lasers or chemical peels to tighten and rejuvenate the skin around the eyes.

Wells says some patients with lower eyelid concerns may be candidates for non-surgical treatments. BOTOX injections can relax the muscles around the eye and reduce a wrinkled, aging appearance. Pulsed light treatments and lasers can help improve the health of underlying collagen and firm up the skin in the lower eyelids. L. Mike Nayak, M.D., a Facial Plastic Surgeon at Saint Louis University, uses injections of fillers to "fill in" the depressions and eliminate the hollowed look under the eyes.

Most importantly, Wells stresses patients do their homework before seeking advice. Look for a physician who is board-certified in plastic surgery and has experience with the procedure being recommended.

For general information on eyelid surgery: The American Society for Aesthetic Plastic SurgeryAmerican Society of Plastic Surgeons