The need to look beautiful has existed since existence of human history. Today, especially with the rise of social media people’s desire to see and show themselves as more perfect reached a peak. While in the past years, appearance was something mostly women paid attention to, nowadays men started pay close attention to this too. Our face is like a window to the outside world. In our relationship and communication to others our face, mimics and facial expressions are quite important. Especially our eyes and the area surrounding them stand out. Because of this, the changes in these areas with aging affect people and they feel the need to fix the changes they don’t like that happen in these areas.
As an ophthalmologist I want to inform you on what kind of changes affect these areas over time, what should one do and what are some of the common mistakes. Because the subject matter is too broad, I will continue talking about it in a number of articles. In this article, I would like to give you some information on upper eye lid surgery.
Upper eye lid: anatomy, function and changes that come with age…
When we look at the anatomy of upper eye lid, we see these forms respectively.
Skin structure: It is the thinnest skin in our bodies. In this area, there is no subcutaneous fatty tissue. Eye lid skin is jointed with a muscle called orbicular muscle which is right under the eyelid.
Muscle form: There is a muscle called orbicular muscle which surrounds our eyelids. This muscle jointed with the skin right beneath it. Orbicular muscle helps us close our eyes and it is also a mimic muscle. When we think about how we open and close our eyes thousands time a day, we can see how dynamic this muscle is. When we think how this dynamic characteristic of the orbicular muscle also moves the skin around it, it can be seen how the skin around this area is as dynamic as it. Because of this, with aging loosening around the skin, loss of elasticity and wrinkles are unavoidable.
Septum: It is a structure that has the role of a surrounding barrier and lies under the orbicular muscle.
Fat Packages: They lie right under the emptiness beneath the tunicle called septum and protect our eyes against damages. There are two fat packages inside and on the middle, on our upper eyelids. With the loosening of septum, there is a loss of elasticity and these fat packages sag forward. This causes baggy eyes and a hydropic appearance.
Levator Muscle: This muscle has important duties in terms of its valve function. Functionally, its most important job is to open up the eyelid. It also plays an important role on eyelid anatomy. Levator muscle comes behind the eyes and joins the gristly tissue called tars which makes up the anatomical skeleton of the lid. This muscle joins the lid with three-headed tendons called aponeuroses. One part of these tendons joins the upper parts of the tars, another to the front and another to the eyelid skin. The tendons that join the skin causes the fold on our eyelids. The distance between this fold and free eyelid side is 8-10 mm in women while it is shorter for men. The innate or later erasure of this fold causes low lids and bulgy eyes. The innate or later weakening of levator muscle leads to low lids or ptosis. Defects of breaking or adhesion on the tendons that joins skin are called as false ptosis and this causes the erasure of the fold on the eyelid skin.
Eyebrows: Right at the point where our eyelids stop, our eyebrows lie. While eyebrows take a crescent shape on women, they take a straighter shape on men. Eyebrow skin is thicker than the eyelid skin and there are more fat tissues here.
What is dermatochalasis?
With aging, there is a loss of elasticity and tonus, and loosening on all these tissues I mentioned below. Again, on the people who use their facial expressions too much prolapses and wrinkles take shape. Dermatochalasis is in short the loosening and prolapsing of the eyelid skin.
What is blepharoplasty? What are some of the precautions one should take before the surgery?
Blepharoplasty is fixing dermatochalasis with cosmetic surgery. Before the surgery there are a few precautions you should take. Let’s talk about them.
- Not all low lids are dermatochalasis. The muscle that opens up the lid needs to be checked. If there are changes on the function of this muscle, even with lid surgery the result may not be satisfactory.
- Dermatochalasis may not always occur on its own. Here, another aspect that should be paid attention is low eyebrows. If someone has low eyebrows, even with the blepharoplasty surgery the result may not be satisfactory. In fact, things can get even worse. Because blepharoplasty surgery might shorten the distance between eyebrows and lids with the skin taken off from the eyelid in the procedure.
- If there is no fold on the upper eyelid or if the fold asymmetry between the two eyes is not fixed the result again may not be satisfactory. I have talked about the eyelid anatomy in detail above. With only blepharoplasty the fold asymmetry cannot be fixed.
- Another thing that should be considered is the position and the prolapse of the fat packages on the upper eyelid. If too much of these are taken in the surgery, it can result in cavitation on the upper eyelid.
Before you decide on eyelid surgery, it is highly important for you to get examined by an ophthalmologist and get all these points that were mentioned checked. It is wise to remember that eyelids have many important functions. The most important one of these functions is that it covers an organ as important as eye like a blanket and protects it from any kind of harm that could come from the outside world.
In the end, we all want more beautiful and fresher gaze and we recommend these procedures to our patients who need it. With the condition of not damaging the function of eyelids which is a structure that is always dynamic.
There are a lot of things to be written or said on eye surgery and I will touch on these on my next articles. I will finish this one by saying that “First see beautifully, then be seen beautifully too.”
