Once upon a time, upper eyelid surgery consisted of removing the excess skin on the upper eyelid in an "ellipse" shape and then sewing it back together nicely. Even in its simplest form, where and how much skin will be removed was a very sensitive issue that needed to be carefully planned for each patient.
With the experience accumulated over the years by the plastic surgery branch, today this surgery covers all layers of the eyelid when necessary, even the eye. The eyelid has gained a more comprehensive (expanded) form in which its immediate neighborhood can be accessed and intervened through the eyelid incision.
Look what is happening in and around the aging upper eyelid.
Eye There is a relative excess of skin around it. This excess skin is relative because we don't actually produce new skin as we age. Many structures under the skin, from muscle to connective tissue, from fatty tissue to bone, lose volume and shrink. As a result, the skin remains relatively loose compared to the underlying structures. You can think of it as losing weight and your old clothes becoming too big for you. Removing this relative excess in the skin is still a valid strategy because it is not yet possible to return the subcutaneous tissues to their youthful volumes. So, we will send the dress to the tailor, but we also need to take care of what is inside the dress. Extended upper eyelid plastic surgery is about everything that is under the dress.
As we get older, the muscle called "orbicularis oculi", which is adjacent to the skin under the eyelid and serves to close the lid like a curtain, also becomes abundant. When necessary, removing this muscle will relieve the accumulation on the upper eyelid. In cases where the muscle is abundant but not removed, the muscle will fold on itself and form a roll on the upper eyelid crease. As you can imagine, you will not like this roller very much.
As we get older, the connective tissue layer that separates the superficial and deep layers of the eyelid, which we call the orbital septum, also becomes loose. The looseness in this layer causes the upper eyelid fat pads to become prominent forward from the eyelid, like a hernia. It leads. Loosening of the septum can be evaluated and tightened surgically if necessary.
Under the septum is the deep layer of the eyelid. We can say that it is. There are fat pads here that form the upper eyelid bags. We shape these fat pads differently in each patient. Sometimes we remove the fat, sometimes we push it behind the eye, sometimes we transfer it from one bag to another.
The most important structure in the deep layer is the "Levator" muscle, which helps to open (lift) the eyelid. This muscle has a curtain that extends from its body to the cartilaginous structure on the lash border of the eyelid. Micro tears occur in this curtain as a result of wear and tear over the years. This wear and tear is more noticeable in patients who have had drooping eyebrows for a long time and who try to keep their eyelids open against the load of the eyebrow. Repair of this curtain structure is also an element of modern upper eyelid surgery.
Another important structure in the deep layer is our tear-producing gland. This gland may sag in some patients, and if it is not noticed before surgery and supported during surgery, it may manifest itself as an annoying swelling on the outer part of the upper eyelid after surgery.
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Stay beautiful.
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