Is Skin-Only Blepharoplasty Enough For A Refreshed Look?

When it comes to ageing around the eyes, if the only problem is excess skin and everything else is in good form then you may be suitable for a Skin-Only Blepharoplasty. This only occurs in a small group of patients however and is most effective in younger patients when the remaining eyelid tissues haven’t yet aged and the support mechanisms are robust and strong.

Common misconceptions

Last week I saw a 55 year old lady who consulted me for upper eyelid surgery. When I told her that her upper blepharoplasty will be done in a hospital under general anaesthetic she responded with:

‘My sister had an upper blepharoplasty. It took 1 hour and was done under local anaesthesia. Why is mine different?’

I am often asked this question because people commonly think an upper blepharoplasty is just a snip of the excess skin.

This question is relevant as eyelid surgery is increasing in popularity and is currently ranked among the Top 5 Cosmetic Surgery Procedures.

My response is that all eyelids age differently and it is important to correct what is wrong. Skin-only (or skin-snip) blepharoplasty addresses one single aspect of the many factors that cause ageing around the eyes.

Marketing hype does not reflect scientific accuracy

Some practitioners refer to any treatment involving the eyes as blepharoplasty. blepharoplasty is often preceded by a word that implies ease and simplicity such as laser, non-surgical, lunchtime, skin-only, or skin-snip, which is mostly marketing jargon. These techniques are effective in some patients who exhibit signs of eyelid ageing but they don’t have the ‘horsepower’ to replace a surgical blepharoplasty.

Modern blepharoplasty

Karl Ferdinand von Graefe (1787-1840) was a German Surgeon and a pioneer of plastic and reconstructive surgery. He coined the term blepharoplasty in 1818 to describe surgical techniques used to repair eyelid deformities following eyelid cancers.

Modern blepharoplasty is a surgical operation that not only treats excess skin but also simultaneously addresses deeper tissues such as fat, muscle, connective tissue and tendons by a combination of 3 surgical techniques namely removal of excess tissue, reposition of tissue that has moved and reinforcement of tissues that are weak.

Excess skin is one aspect of eyelid ageing but the other aspects such a as excess fat, increased muscle activity and bulk, lose connective tissue, weak tendons and droopy eyebrows are equally important and all need to be addressed for best results. 

Ageing changes can alter the position of the eyelid in 5 ways

Ageing changes the position and appearance of the eyelids and the position and appearance of the eyebrows in the following ways:

1. The eyelid can droop (also called Ptosis)
2. The eyelid can move up (eyelid retraction)
3. The eyelid edge can be turned in due to muscle over-activity (entropion)
4. The eyelid edge can be turned out due to muscle weakness (ectropion).
5. The eyelid muscle may be weak or scarred and eyelid closure may be incomplete risking damage to the eye

Ageing can alter the position of the eyebrow in more than one way

Since eyebrows are critical one should consider their position with regards to upper eyelid surgery. For example, are the eyebrows high, low or just right?

If the eyebrow is too high, it is due to compensatory activity for a droopy eyelid by an overactive forehead or frontalis muscle. The treatment is to correct the cause of the droopy eye.

If the eyebrows are low, removal of skin only will pull the eyebrow down even further. As time goes and ageing changes weaken the tissue the eyebrows will move further down forever. It is like trimming the curtain when the problem is a sagging curtain rod. 

Ageing changes the appearance of eyelids in more ways than one

Ageing changes the appearance of eyelids by causing excessive fullness, excessive hollow eyelids, absent eyelid crease, asymmetric eyelid crease and a high eyelid crease.

When you realise all the factors that contribute to ageing of the eye area, it is easier to understand how a skin-only procedure may not be enough to achieve your aesthetic goals.

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