The eyes are the most expressive feature of the human face. When you look at someone’s face, the first thing that gets your attention is the eyes. For that reason, the eyelids are very important to a person’s appearance. The upper eyelids specifically can present folds in some people early in life secondary to hereditary conditions, and in other people later in life secondary to relaxation of the tissues that occurs with aging.
The deformity of the upper eyelids that requires aesthetic or corrective surgery is specifically for two reasons. First, there can be the presence of excess skin, which may reach such proportions as to obstruct the vision when the upper lid skin falls down over the eyelashes. Second, there can be the presence of periorbital fat that protrudes forward secondary to relaxation of the tissues, creating noticeable fat bags.
The muscle that elevates the eyebrows is located in the forehead as a secondary elevator muscle of the upper third of the face. Many times, often without realizing it, a person tries to compensate for this excess tissue of the upper eyelids by elevating the eyebrows, which then causes horizontal wrinkles on the forehead. Early correction of the eyelid problem helps to avoid creating these sometimes permanent horizontal forehead wrinkles. When well performed, the surgery is relatively simple and not painful, and people usually have the quick recovery. The surgery can be achieved under local anesthesia, and the sutures can be removed as soon as 4 days after surgery. For that reason, patients actually do not need to take time off from work to undergo this procedure.
The surgery consists of removal of the excess skin and the fat that creates the bags. The incision is performed in the natural upper eyelid crease. The surgery results in an inconspicuous scar, even for males, since the scar is well hidden in that fold. For women, removal of the excess skin and fat allows easier application and better wear of makeup, since when the tissue is removed, the tarsal plate (i.e. the area above the eyelashes) is uncovered, making it easy to properly apply makeup and have it stay in place.
As stated before, the patient will no longer need to elevate the eyebrows in order to see well forward, so the creases in the forehead should improve with this surgery. Many times patients come to consultation complaining of horizontal forehead lines and are requesting treatment with Botox. A patient who has excess skin of the upper eyelids needs to correct that problem first before the proper treatment with Botox can be performed; otherwise, the frontalis muscle, which is the elevator of the eyebrows, will be weakened/paralyzed by the Botox, not allowing the patient to elevate the eyelids and therefore leading to difficulty seeing forward.
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