Upper Eyelids Tightening – Bagged Eyes
The aesthetic appearance of a human face depends very much on the form and state of the eyelids. If, for instance, the plains of the upper eyelids are hardly or not at all visible anymore (“bagged eyes” because of too much tissue sagging from above, the face presents the impression of fatigue. This is not a rare finding also in younger people, mainly based on a genetic disposition. Mostly, “bagged eyes” appear as people age. The reason is nearly always is a surplus of the eye-ring muscle. Since the upper lid is tightly bound to this muscle, too much muscle sags down with the skin according to gravity and partially even buries the upper lid. This then leads not only to the facial appearance of fatigue but also to a narrowing of the field of vision. Each wrinkle in the upper eyelid corresponds to a small muscle bundle. It is the tight binding between skin and muscle of the upper eyelid that makes the muscle bundles in the upper eyelid directly well visible. Often there is an asymmetry between the muscles of the two upper lids in a face which needs being considered in the surgical planning.
The upper lid tightening (upper lid reconstruction) is usually performed by local anesthetic in the surgery day clinic. In addition, there is an infusion of a tranquilizing medication. The first procedural step is a precise analysis of the upper lid anatomy with the upper lid muscles and fat deposits and an exact marking of the intended incision sites.
To obtain a lasting optimal result of natural appearance by upper lid reconstruction surplus skin, and most of the time also the ocular ring muscle as well as fat deposits need to be reduced or removed. Reduction and tightening of the ocular ring muscle is a major step and should be left only to an experienced plastic surgeon. Only this procedure provides for a long-lasting rounded lid form without wrinkled skin. Lid tightening by skin removal only, i.e., without muscle reduction, usually lasts just about 2 years with subsequent disappointment of the patient.
Lid lifting usually is done in the day clinic of the surgery and with a set of 3.5 magnifying glasses using finest suturing. The stitches are removed about 5 – 7 days after surgery. Right after surgery, the patients rest for about an hour in the surgery recovery room. During this time the operated lids are cooled prophylactically in order to prevent or minimize swelling.
Also worth mentioning is the fact that a “bagged eye” may be a consequence of a sagged eyebrow, which if true should be surgically corrected. It is often necessary to lift especially the external part of the involved eyebrow. Either way, this requires a small incision hidden in the eyebrow hair region to separate and lift an inner layer that is connected to the brow (Brow lifting). With this elegant procedure brows may be lifted several millimeters without leaving a visible scar.
Lower Eyelid Tightening – Lacrimal Sacs
Also the correction of lacrimal bags is done on an ambulatory basis in the day clinic of the surgery. Often it is necessary to remove prominent fat deposits and also some skin. The ocular ring muscle is responsible for skin wrinkles and also tissue bags; it needs being tightened correspondingly. If the patient has a tendency to “sunken eyelids” fat deposits may not be removed. In this case, lower lid fat deposits are mobilized and transferred to above the lower lid bone with proper fixation to the bone. This technique also straightens the lower lid because the lower lid contour becomes smoother by the fat transfer. At the end, incisions are closed with fine sutures and covered with bandages. The lower lid correction may be done in one procedure with upper lid tightening, however, with the risk of an increased local lymphedema.