Eyelid surgery

In the upper eyelids the main problem is looseness of skin with some prominence of fatty tissue from within the eye socket. To correct this an ellipse of skin is removed with a strip of underlying muscle. Prominent fat if present is also removed and the wound closed with a single stitch running along the length of the wound and secured at either end with tape. This stitch is removed after seven days following surgery.

In the lower lids typical bags are formed by prominence of fatty tissue from within the eye socket becoming more visible as the retaining structures of this fatty tissue weaken with age. The prominence of the bags is exacerbated by descent of the cheek fat pad which allows a dip to develop known as the tear trough. In the past prominent fatty tissue has been removed which has left some patients with a very empty appearance to the eyes.

In the majority of cases the treatment of choice is now to reposition and re-contour the lower lid and cheek. The prominent fatty tissue is spread and positioned deep to the cheek fat and the cheek fat pad is elevated. This obliterates the tear trough and gives a smoother transition of contour  from the lower lid to the cheek.

The surgery is done through an incision which runs along the margin of the lower lid just below the eye lashes. The wound is closed with a single stitch which is removed after seven to ten days following surgery. As part of this rejuvenating procedure the lower eyelid needs good support to prevent retraction or downward drooping. This is done either by tightening the ligamentous attachment of the lower lid known as a lateral canthopexy or providing a sling of muscle to support the lower lid structures.