By Dr. Jean E. Keamy
When we are in our twenties, our upper and lower eyelids look perfect. No one ever noticed droopy upper lids or puffy bags under our lids in our youth. Often by the time we are 45, the upper lids begin to have some excess skin and may appear to be droopy. The lids may make the lids look closed, resulting in a smaller looking eye. In some people, the fat pads in the upper eyelid prolapse slip or fall out of place. The paper-thin muscle, called the levator muscle, can also detach. This results in a droopy upper eyelid that may cover the pupil and affect vision.
In the lower lids, the malar cheek pad descends as we age. This causes a hollowing around the lower eyelids. Some people may experience “bags” or excess skin in the lower lids. This results from either a laxity in the skin or a prolapse of the fat pads in the lower lids.
The only way to correct droopy or heavy upper lids is through an upper eyelid blepharoplasty. It is usually considered a cosmetic procedure unless the heavy lids or detached levator muscle causes a decrease in the superior visual field. If the vision is affected, some insurance companies may consider the blepharoplasty functional.
With some local anesthetic, the upper eyelid incision is made along the eyelid crease so it is essentially invisible with the eyes open. The amount of skin and muscle to be removed is marked and excised. Sometimes upper eyelid fat pads are removed. If the levator muscle is detached, it is reattached to the tarsus muscle. Then the skin is usually closed with dissolving sutures. The whole procedure takes between 40 minutes to an hour.
Repair of the lower lids is called a lower lid blepharoplasty. Usually it is a cosmetic procedure. An incision is made along the crease near the eyelashes. Fat pads are removed. The excess skin is excised and closed with dissolving sutures. Sometimes the lid is very lax and may need to be tightened at the same time. The eyelid tightening is called a canthopexy. Surgery on the lower lids usually takes 60-90 minutes.
Dr. Jean Keamy is a board certified ophthalmologist specializing cataract surgery, refractive surgery, eyelid surgery and diseases of the eye. She owns Keamy Eye & Laser Centre on 24 Lyman St. in Westborough and can be reached at 508-836-8733. Learn more at www.seemedrkeamy.com.
