Ageing Eyelids

The frame surrounding a painting can be chosen such that it enhances the beauty of the painting. When it comes to the eyes, the eyelids can frame its beauty and your appearance. The eyes are a unique part of the face in that they age variably from the other areas such as the cheeks, jowls and neck. I regularly see patients in their 20’s and 30’s as well as patients in their 70’s and 80’s with eyelid concerns. Common complaints include excess skin, protruding bags and lines around the eyes.

The eyelids are divided into the upper eyelids (sitting above the eyes) and the lower eyelids (below the eyes). The surrounding areas that can further affect the eye appearance include the forehead, brows and the cheek areas.

Upper eyelid ageing is primarily an issue of excess skin. The skin stretches from repeated eye movements, such as blinking and the laxity that comes from normal ageing with loss of skin elasticity and collagen. Besides making the eyes appear sleepy, it can make it difficult to apply makeup, hide your eyelashes or affect vision. Rarely is there a problem with excess fat protrusion that frequently occurs with the lower eyelids.

In the old days when patients used to get upper eyelid surgery performed, removing part of the underlying muscle and fat was performed automatically. This led to hollowed appearing eyes as the patients continued to age. As our understanding of youthful eyelids continued to evolve, a shift to maintain fullness in the upper eyelid vs hollowing out the eyes is the present norm.

Look at any glossy magazine, the models all have young eyes with full brows and minimal hollowness in the upper eyelid area. When you compare your younger looking eyes to older ones- the main difference is the excess skin. – As a result of this the procedure has been tailored in such a way as to try to achieve this aesthetic. Skin is treated primarily while the fat and underlying muscles are treated only in indicated cases.

The lower eyes can age in a variety of ways, all of them tend to make you appear tired. Extra lines and skin forms which can get crepey and wrinkly, hollowness in the under eye area can make you appear tired, as well as ‘fat bags’ that protrude also make you look tired (we can’t win). Each of these can occur independently or in combination.

Further compounding these changes are the ageing that occurs in the areas surrounding he eyes. Brow droopiness can occur in some people, causing heaviness, especially in the lateral (outer) brow and cheek hollowness making the fat bags appear heavier.

Here are some pictures showing the different cases of ageing eyelids in patients of different ages and genders.

Facial Analysis:

In the first picture- we have a female in her 40’s: she has nice brow fullness but her eyes appear heavy and tired. This is due to excess upper eyelid skin, that is sitting on her eyelashes. She also has hollowness in the lower eyelid area with some excess and crepey skin- she underwent an upper eyelid blepharoplasty – to contour and remove excess skin while maintaining youthful brow fullness. She also underwent a lower eyelid laser resurfacing to tighten the skin and soften the creapy skin, and fat transfer to augment the hollowness in the under eye areas. No surgery was performed to the lower eyelids. She has a much more rested and balanced appearance after.

Here we have a patient in her 60’s with a thin face. She does not have any upper eyelid concerns. She does have lower eyelid fat herniation (fat bags) and excess skin that has stretched from the fat bags and ageing. She underwent a subciliary lower blepharoplasty to remove excesss fat and skin. Her under eye area appears smoother, softer and less tired.

Here we have a patient in his mid 50’s who has a combination of excess upper eyelid skin, excess skin in the lower eyelids, fat bags protruding in the lower eyelids and volume loss in the cheeks and under eye area. He underwent an upper eyelid blepharoplasty, along with subciliary approach to the lower eyelids to remove excess skin and fat- he also underwent a fat transfer to the cheeks to give him a more youthful cheek appearance. You can see in his after pictures that he has a much more balanced appearance.

So here are multiple examples of the different ways the eyes can age. Each person will have individual variations and a thorough understanding of the ageing process along with treatment options will lead to the best, most natural and balanced outcomes.