Eyelid and Periorbital Area

It has been said that “the eye is the window of the soul”. It seems to be true since we can always see one’s mood through his/her eyes. Lit up eyes give an impression that one’s in a happy mood, full of spirit, and is experiencing the splendor of life. On the contrary, dim eyes indicate sadness, illness, lack of spirit, or even lack of sleep. Eyelid and periorbital area contribute a major part in defining eye appearance.

Lower eyelids that are swelled or wrinkled give an impression that one is tired or doesn’t sleep enough. These, along with flabby eyelid (often called “eye bags”), clearly don’t lead to a fresh and attractive look. This is also particularly true in older people, in whom the firmness of skin and supporting structure is decreased due to aging. Moreover, loss of fatty tissue in this population can cause an appearance of sunken eyes. Wrinkles and flabby skin also happen on the upper eyelids, on which it can disturb the field of vision.

Another matter of eyelid appearance is the presence of a fold on the upper eyelid. An upper eyelid that has a fold are called a double eyelid. Although not necessarily true, it is widely perceived that double eyelids are more attractive than single eyelids. An example is how dancers and brides often apply make-up to give an impression of double eyelids. Contrary to popular belief, those of oriental heritage don’t necessarily have single eyelids. Half of this population has double eyelids, although the folds are lower than other ethnic groups.

Under the lower eyelids, another issue that can cause an unfresh look is the presence of a groove on the border of the cheek which looks like a canal where tear flows. This condition is called a tear through deformity. It can be worsen by the presence of an area which looks darker or bluish, called a dark circle eye.

Unlike the lower eyebrows of men, an ideal eyebrow for a woman is one located above the orbital rim, has a high arch, and forms a peak before declining on the lateral edge. In an aging woman, an eyebrow is located lower, and is more prominent on the lateral side.

Blepharoplasty

Blepharoplasty is a surgical procedure done on the upper and/or lower eyelid to refine the appearance of the eyelid. For upper blepharoplasty, incision is made hidden in the normal eyelid fold. The principle is to reduce and relocate the fatty tissue under the eyelid, pull the muscles and connective tissue, and remove excess skin. Lower blepharoplasty is performed through an incision right under the line where lower eyelashes grow, or on the inner part of the eyelid if skin removal is not necessary.

Unlike facelift and necklift which are usually done on those in their 40-50’s, blepharoplasty can be done on a wider range of age, even on teenagers and older people on their 80’s. An example of blepharoplasty procedure done on teenagers and young adults is the double eyelid surgery. This procedure is done on the oriental ethnic group who don’t possess a clear-defined eyelid fold. Middle aged candidates often wish for a clear-defined upper eyelid fold. A widely accepted but misleading concept is the wish to have a higher eyelid fold like the Caucasian ethnic group. This concept often leads to an unnatural look. Older candidates can gain benefit from blepharoplasty by refining their unenergetic look and also by fixing their field of vision caused by flabby upper eyelids. Lower blepharoplasty can be useful for those with wrinkled lower eyelids and baggy eyes.

After the surgery, stitches will be removed after approximately 1 week. Eyelids will be swelled, bruised, and may be accompanied by mild pain for 3-5 days. Eyedrops can be given to avoid dry eyes. You should place your head upright and use cold compression to reduce swelling and pain. You can use sunglasses for outdoor activities to avoid sunlight. Eye ointment will be given for 1 or weeks for the surgical scar. Final outcome after healing will be seen in 3-6 months.

Complications including apparent surgical scar, temporary vision disturbance (usually due to eye ointment), temporary inability to fully close upper eyelids, bleeding and bruising, dry eyes, and sense impairment on the eyelids.

There are alternative procedures for facial makeover other than blepharoplasty, such as forehead lift or brow lift, Botox injection, chemical peeling, laser resurfacing technique, and peeling or bleaching.

Brow Lift

Brow lift is a plastic surgery procedure aimed to repair the location of eyebrows in older women. With this procedure, the eyebrows are returned to their original ideal location above the orbital rim.

Standard technique is performed through an incision on the hairline area or upper eyelid. The skin is separated from the underlying tissue then the underlying tissue is pulled and stuck to the facial bone. The newest technique for brow lift is endoscopy, in which the pulling procedure is done through a minimal incision.

Periorbital Rejuvenation

Periorbital rejuvenation is the form of surgical and nonsurgical intervention to refine periorbital area, done as an adjuvant procedure of blepharoplasty and brow lift. Generally, blepharoplasty and brow lift is already followed by a fresher and brighter look. Periorbital rejuvenation is performed to refine the area by adding deficient tissue, manage crow’s feet, frown lines, glabellar lines, and the soft wrinkles of the lower eyelids.

Requirements for the above procedures are:

• Overall health in good condition

• Stop smoking, drinking alcohol, and consuming blood thinners

• Doesn’t have a serious medical condition on the eyes, e.g. glaucoma

Procedures will be done after local anesthesia on periorbital area. Additional sedation can be given to produce drowsiness and calming effect.

(Source: Prasetyono TOH. Rejuvenate your eyes. Bazaar 2009 Feb;Chapter 4:42-5.)