| The Problem : A Tug
of War |
|
Throughout one’s lifetime, the four muscles
that contribute to eyelid closure tighten and relax millions
of times due to actions as slight as blinking to as strong
as squinting in the sun. These four muscles are opposed by
only one muscle that raises the eyebrows. In time, this constant
“tug of war” between the opposing forces that pull
the eyebrows up and down leads to drooping of the brows and
wrinkles across the forehead.
The first damaging effects of this “tug
of war” become apparent as early as the 3rd decade of
life, and gradually worsen over time. As the eyebrows droop,
the skin between the eyelashes and the eyebrow that was once
stretched smoothly across the eye begins to overlap. For women,
this is first noticed as difficulty in applying eyeshadow
because the “platform” on the upper lid begins to
disappear beneath overhanging skin.
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This phenomenon of the skin folding over the
eyelid crease (known as hooding) gives the appearance of having
too much fullness of the upper eyelids. Countless patients
have expressed concern with this apparent excess of eyelid
skin. Classically, they pinch their upper eyelid and say “Doctor,
my eyelids make me look tired. I want you to cut this skin
out.” In reality, few patients would benefit by having
the skin excised (cut out) since many do not truly have excess
skin. On careful examination when the eyebrows are raised
to their more youthful position, there is actually little
to no extra skin on the eyelid. In fact, removal of upper
eyelid skin may pull the eyebrow down even further, exaggerating
a tired appearance. (See article on the subject of eyebrow
position and facial expression.)
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In this case, a brow
lift is fundamental to achieving an aesthetically pleasing
result. This will not only return the eyebrows and eyelid
skin to a more youthful appearance, reduce forehead wrinkles,
and create a rested expression, but it will also anchor the
brow to minimize further descent of the eyebrows. If there
truly is excess eyelid skin after restoring the eyebrows to
their normal position, then a pinch of skin can be removed
to minimize eyelid fullness.
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It should be noted that a percentage of the population
would, in fact, benefit solely from removal of upper eyelid skin
without a brow lift. These people do not have significant
sagging of the brow and forehead and tend to fall into two categories.
They inherited upper eyelid fullness with excess skin, usually apparent
by the 20s or 30s. Or they are in the 60s, 70s, or older and the
skin has lost elasticity or has been stretched from rubbing the
eyelids.
Significant excessive upper eyelid skin can interfere
with vision. With appropriate documentation and approval, insurance
may cover the costs of a functional
blepharoplasty to restore vision. Eyelid surgery performed purely
for aesthetics or for a condition not severe enough to warrant insurance
coverage is considered cosmetic
blepharoplasty.
Dr. Jonathan Hoenig provides the most advanced and
innovative techniques in facial plastic surgery and facial rejuvenation
today. To learn more about facial plastic and reconstructive surgery,
visit us on the web at http://www.la-plastic-surgery.com,
email info@drhoenig.com,
or phone toll free 866-HOENIG9.
dr. hoenig
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