The patient is a 52 year old woman who complained of puffiness of the upper and lower eyelids. She thought she also had some puffiness in the inner part of her upper eyelids and could feel the skin hanging and weighing down onto her upper eyelids. She said that over the years it had become difficult to apply and keep make up on her upper eyelids because it rubbed off because of the excess skin.
At her procedure which was done comfortably under conscious sedation, skin from the upper eyelids was removed along with some fat from the inner portion of the upper lid. Fat was removed from the lower eyelid via small laser incisions made inside the eyelid (transconjunctival approach). Enough fat was removed from the lower eyelids so that the lids would be flat but not hollow. No treatment was required for the lower eyelid skin. Postoperatively, most of the swelling was gone by five days. The patient was very happy with her cosmetic result. She was able to wear make up by six days when she also returned to work.
Though the eyelids occupy a very small part of the face, eyelid surgery can be very gratifying for patients seeking cosmetic and functional improvement of skin excess, prominent fat (eye bags) as there is usually a significant change to the patient’s appearance. This may be because others spend so much time looking at our eyes in communicating with us. Patients often state that eyelid surgery to gain cosmetic and functional improvement was one of the best things they ever did for themselves. That’s because of not only the cosmetic improvement that can be gained from this small surgery but because of the many functional improvements that can be part of the goals of their procedure. Improving the function of the lids can include making improvements in dry eyes that some patients can get when they become older by doing certain procedures during eyelid surgery and also avoiding some eyelid procedures that may cause dry eyes as patients age. One of the biggest functional improvements a patient can get from upper eyelid surgery is an improvement in their vision, especially when the upper eyelid skin hangs over the pupil. Patients generally report that their vision is improved even when the skin is excessive but not directly covering the pupil. Another functional improvement from upper eyelid surgery is relief from the heaviness of the skin excess when it is weighing down on the lid that can make patients feel like they are tired. Skin removal of the upper lid can provide significant improvement. As mentioned in this patient, when there is skin excess of the upper lid, it can be difficult to both apply and keep make up from becoming smudged.
One of the most common questions asked by patients when they have prominent fat in the lower lids causing eye bags is whether skin requires removal when the fat is removed because fat removal might lead to skin looseness. This patient had a significant amount of fat removed from the lower lid and no skin was removed nor was skin tightening required with the laser.
