With age, the upper and lower eyelid tissues begin to relax. Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin can hang over the eyelashes and disrupt vision. These changes may be accelerated by sun exposure, allergies or recurrent swelling that result in stretching of the skin. In some individuals, this process may be hereditary. Visual difficulties related to drooping upper eyelid tissues are the major concern for older adults that can be corrected through eyelid surgery.
A functional blepharoplasty is performed for medical reasons. This eyelid surgery is intended to improve vision or promote normal function of the eye and visual process. The major functional benefit is that it can improve vision. With the removal of excess skin, the surgery can restore the peripheral vision obstructed by:
- Sagginess of the eyelids
- Bulging and bags around the eyes
- Wrinkles around the eyes
Ophthalmologists, oculoplastic surgeons, general plastic surgeons, ear, nose and throat surgeons, and oral and maxillofacial surgeons perform medically necessary eyelid surgery.
Common Eyelid Problems in the Elderly
- Ptosis: Ptosis or Blepharoptosis is the medical term for drooping eyelids. The condition may affect one or both eyes. This can be present since birth or may result from aging, trauma, cataract surgery, long-term contact lens wear, or genetics. The ptosis could be unilateral or bilateral and vary in severity. When the edge of the eyelid falls too low and covers part of the pupil, it can block the upper part of your vision. Eyelid surgery can raise the position of the upper eyelid margin by tightening the muscle and tendon that normally elevate it. Surgical correction of a drooping upper eyelid involves repairing the stretched tendon. In age-related or acquired ptosis, the levator may be reattached or slightly shortened to correct the lid position. If levator function is poor, the eyelid may be lifted.
- Dermatochalasis/baggy eyes: Lack of elasticity and progressive stretching of tissues cause baggy eyelids. With blepharoplasty, excess eyelid tissues can be removed. The lower eyelids may also appear baggy and surgery can be performed to enhance the aged appearance of the lower eyelids.
- Entropion and Ectropion: While Entropion is a condition in which the eyelid is turned inward, causing the eyelashes to rub against the eyeball, Ectropion is a condition in which the eyelid is turned outward so that its edge does not touch the eyeball. Both the conditions usually involve both lower eyelids and rarely affect the upper eyelids. Correction of these conditions usually involves tightening which enhances the form and function of the eyelids.
Blepharoplasty is usually performed as an outpatient procedure under local anesthesia. Most insurance companies will also pay for eyelid surgery performed for a functional visual impairment.