Excess skin of the lower eyelids
Excess skin of the lower eyelids (dermatochalasis) occurs in most people with age. It is due to a combination of factors, including loss of elasticity and thinning of the outer layer of the skin.
Excess skin may hang in unsightly folds and is often accompanied by bulges of fat which are the
“bags” that develop in the inner, central and outer part of the lower eyelids.
Excess skin in the lower eyelids is mostly a cosmetic issue, with patients feeling that it makes them look tired or older. It does not cause visual problems or discomfort.
These bags or swellings in the lower eyelids are due to prolapse of internal fat in the eyelid. This fatty bulge is always there, but may look worse in the morning after a night of lying flat, and improve as the day progresses.
Blepharoplasty is the name of the surgery which removes this excess skin from the eyelids.
This surgery aims to improve the appearance of the lower eyelids. The overall effect will also help to rejuvenate the whole face, often giving a marked improvement in the youthful appearance of the face.
Please click here for more information on Lower lid blepharoplasty surgery.
Fat reduction or removal is usually done at the same time as removal of the excess skin.
During surgery, the excess fat is identified, isolated with a surgical clamp and carefully removed. This procedure requires expertise and care as there is often significant bleeding associated with fat removal which rarely can threaten the vision of the eye if not controlled properly. It is also important not to remove too much fat, which leaves the eyelid looking hollow and unnatural.
Sometimes, the fat is also repositioned within the eyelid to cover any hollows that form with age. Dr Then will discuss this additional technique with each patient if suitable.
Unfortunately, non-surgical treatments (such as creams, “freezing” cryotherapy, laser) are not very effective and do not produce a lasting suppression of the fat.
All blepharoplasty surgery performed for excess skin and fat removal in the lower eyelids is classed as cosmetic as it does not affect the vision. This means that the costs of surgery must be completely covered by the patient. Medicare and Private Health Insurance funds will not cover these costs.
Occasionally, you will require another procedure to be performed in addition to the blepharoplasty surgery, such as tightening of the lower eyelid. This may be classified as a functional procedure and therefore attract a Medicare rebate. If any additional procedures are required, this will be discussed with you during your consultation.
The cost of lower eyelid blepharoplasty surgery will vary between patients depending on the complexity of the procedure required, and will be discussed with you prior to any booking.
Ectropion of the lower eyelids
An ectropion is an abnormal outward turning of the margin of the eyelid (where the eyelashes are). This usually refers to the LOWER eyelid. Occasionally it can be seen in the upper eyelid.
In most cases, an ectropion is seen in the older adult and is due to aging of the tissues of the eyelid that support and hold it in place. These supporting structures include the tendons at the inner and outer corner of the eyelids and the internal muscles of the eyelid. Stretching or detachment of these supporting structures results in the eyelid either turning outward (ectropion) or inward (entropion).
Please click here for more information on Lower lid ENTROPION (inward turned lid)
Less commonly, an ectropion may develop from scarring of the outer skin of the eyelid from previous trauma or surgery, or from the weight of an eyelid tumour or lump.
An ectropion usually causes one or more of the following symptoms:
- Watery eye
- Excess mucous/sticky discharge in the eye
- Irritated eye
- Red eye, or reddened lower eyelid margin
In many cases an ectropion will continue to worsen and may cause complications in the eye itself. These include exposure and drying of the eye, which can then lead to persistent infections or scarring of the eye.
Dr Then will diagnose the presence and cause of your ectropion with a thorough examination of your eyes and eyelids.
An ectropion will not spontaneously correct itself and is best managed with surgery.
In situations where surgery is not possible (for example, if the patient is not medically fit for surgery) or not desired by the patient, there are some non-surgical methods. These include the use of cautery or radiofrequency to reposition the eyelid. However, these measures are often temporary, and the ectropion is more likely to recur than after surgery.
Entropion of the lower eyelids
An entropion is an abnormal inward turning of the margin of the eyelid (where the eyelashes are). This can result in rubbing of the eyelashes onto the conjunctiva (white part of eye) and cornea (clear window of the eye in front of the iris). It most commonly affects the LOWER eyelid, but can occasionally affect the upper eyelid.
In most cases, an entropion is seen in the older adult, and is due to aging of the tissues of the eyelid that support and hold it in place. These supporting structures include the tendons at the inner and outer corner of the eyelids and the internal muscles of the eyelid. Stretching or detachment of these supporting structures results in the eyelid either turning outward (ectropion) or inward (entropion).
Less commonly, an entropion may develop from scarring of the inner surface of the eyelid from previous trauma, infection or inflammation in the eye.
An entropion usually causes one or more of the following symptoms:
- Irritated painful eye (foreign-body, gritty sensation)
- Watery eye
- Red eye or reddened eyelid margin
- Excess mucous discharge from the eye
These symptoms usually result from the rubbing of the inward turning eyelashes onto the surface of the eye.
In many cases, it will continue to worsen, and may cause complications of the eye itself. In particular, traumatic rubbing of the cornea by the eyelashes can result in sight-threatening infections or scarring of the eye.
Dr Then will diagnose the presence and cause of your entropion with a thorough examination of your eyelids and eyes. An entropion will not spontaneously correct itself and is best managed with surgery.
In situations where surgery is not possible (for example, if the patient is not medically fit for surgery) or not desired by the patient, there are some non-surgical treatment methods. These include the use of cautery or radiofrequency to reposition the eyelid. However, these measures are often temporary, and the recurrence rate of entropion is higher than after surgery.
Lower lid blepharoplasty Surgery
Blepharoplasty surgery aims to remove the excess skin in your lower eyelids to improve the appearance of the eyelids. The overall effect will help to rejuvenate the whole face, often giving a marked improvement in the youthful appearance of the face.
Patients will usually undergo lower lid blepharoplasty surgery to improve appearance and feel more comfortable.
Dr Then will carefully examine your eyelids and eyes and will then thoroughly discuss the best treatment options for you, to help you achieve the goals that you have in mind. It is important that expectations are realistic about what blepharoplasty surgery can achieve for your face. Age, skin type, structure of underlying bones and soft tissue, and any other associated problems, will all influence the results of your blepharoplasty surgery.
As with any surgery, knowing what you want to achieve, and whether these expectations can be met, are crucial.
Surgery is performed under general anaesthetic, and as a day case procedure, in-hospital. The general anaesthetic is administered by a specialist anaesthetist.
In the operating theatre, Dr Then will mark the surgical area to map out the degree and contour of excess skin to be removed. An incision is made into the natural crease of the eyelid, which will minimise the visibility of any future scarring. The marked area of excess skin is then removed. If necessary, any excess and bulging fat is also removed at this time. Finally, the wound is carefully closed with fine sutures, which will also minimise the risk of significant scarring in the natural skin crease.
After surgery, the eyes will be padded for a short time with cold compresses to minimise bruising and swelling. The eye pads are removed before you are discharged home.
Most patients do not experience significant complications with blepharoplasty surgery.
However, the risks of blepharoplasty surgery include:
- Bleeding and bruising
- Infection
- Over- or under-correction of skin removal
- Asymmetry of skin removal between the left and right eyelids
- Dry eye
- Poor eyelid closure
- Unsatisfactory scarring, or cysts/whiteheads along the suture line
- Temporary patches of numbness in the eyelid
- Persistent eyelid swelling
- Bleeding in the orbit of the eye, leading to loss of vision (only if fat removed)
- Many patients are concerned that they will be left with a “surprised” look after blepharoplasty surgery.
If performed properly, this is very unlikely, and Dr Then is careful to remove only as much skin as is required. The removal of too much skin will lead to an unsatisfactory appearance as well as the risk of not being able to close the eyes properly, which leads to dry and uncomfortable eyes.
Loss of vision is a very rare complication, and only occurs when orbital fat is removed at the time of blepharoplasty surgery. Every precaution is taken during surgery to minimise this rare risk.
Many patients will experience temporary dry eyes after the surgery, which can be easily treated with artificial tears. If you suffer with dry eyes prior to surgery, symptoms may worsen after surgery for a period of time. However, this is easily treated with regular application of artificial tear drops to the eyes.
Early bruising and swelling is very common. Bruising usually resolves within 7-10 days. Unsightly scarring of the eyelid is very uncommon. However, the eyelid wound will initially appear lumpy and pink for the first few months. Usually by 6 months, the wound has healed to a minimal line, which is hidden within the lash line of the lower eyelid.
Ectropion surgery
Ectropion surgery usually involves tightening and reattachment of the supporting tendons and retractor muscles, via incisions made in the outer corner and internal aspect of the eyelid. If the ectropion is due to external scarring, then skin grafts may be required.
The aim of surgery is to restore the normal position of the eyelid margin so that it looks normal and allows the eye to close comfortably. This can be performed as a day case and under local anaesthetic.
After surgery, all patients will have some bruising and swelling of the lower eyelids which may extend into the cheek or lower face and neck. This usually recovers over a few weeks after surgery.
The eyelid often feels and looks tight, and can take up to 6 weeks to soften and settle into its final position as healing progresses. The eye may feel gritty, irritated or watery in this period also, but also usually settles with time. Regular artificial tears can ease these symptoms.
There may be tenderness and lumpiness in the outer corner of the eyelid. This is due to scar tissue forming over the internal sutures used to tighten the outer eyelid, and usually settles within the first 3 months. Dr Then will review the eyelid one week after surgery, and then again after 3 months, to ensure that the patients has achieved a good result and is comfortable.
This surgery is confined to the eyelid tissues, and does not involve the eye itself. Therefore there is no risk of visual loss with this surgery.
The risks of surgery include (but are not limited to):
- Over-correction or under-correction
- Asymmetry of eyelid position
- Infection
- Suture granuloma over the scar tissue at the outer corner of the eyelid
- Recurrence of ectropion and need for further surgery
Entropion surgery
Entropion surgery usually involves tightening and reattachment of the supporting tendons and retractor muscles, via incisions made in the outer corner and internal aspect of the eyelid. If the entropion is due to internal scarring of the eyelid, then grafts of the mucous membrane may be required.
The aim of surgery is to restore the normal position of the eyelid margin so that the eyelashes no longer rub the eye, resulting in a comfortable and safe eye. This can be performed as a day case and under local anaesthetic.
After surgery, all patients will have some bruising and swelling of the lower eyelids which may extend into the cheek or lower face and neck. This usually recovers over a few weeks after surgery.
The eyelid often feels and looks tight, and can take up to 6 weeks to soften and settle into its final position as healing progresses. The eye may feel gritty, irritated or watery in this period also, but also usually settles with time. These symptoms can be relieved by using regular artificial tears.
There may be tenderness and lumpiness in the outer corner of the eyelid. This is due to scar tissue forming over the internal sutures used to tighten the outer eyelid, and usually settles within the first 3 months. .
Dr Then will review the eyelid one week after surgery, and then again after 3 months, to ensure that the patients has achieved a good result and is comfortable.
This surgery is confined to the eyelid tissues, and does not involve the eye itself. Therefore there is no risk of visual loss with this surgery.
The risks of surgery include (but are not limited to):
- Over-correction or under-correction
- Asymmetry of eyelid position
- Infection
- Suture granuloma over the scar tissue at the outer corner of the eyelid
- Recurrence of ectropion and need for further surgery
These risks are uncommon and can be successfully treated if they occur.
