Inevitably, with ageing, the periocular tissues change in appearance and texture; actually, they age earlier than other areas on the face. Factors such as sun exposure, smoking, lifestyle and genetic predisposition contribute for the early ageing.
The periocular area is composed by four distinct anatomic structures that, when in harmony, give the smooth, fresher gaze. These include the forehead, the eyebrows, and the upper and lower eyelids.
Aiming to preserve or regain a lively and revitalized appearance, many individuals seek cosmetic procedures that can subtly yet significantly enhance their natural features. Among these, blepharoplasty (eyelid surgery) stands out as a highly-effective solution for rejuvenating this area. Besides, more than addressing the visible signs of ageing, blepharoplasty offers an extraordinary opportunity to sculpt the eyes to achieve beauty standards, including the “feminine gaze”. This can be reached when tailoring the surgery by respecting the patient’s natural features and the harmony of the structures of the area to achieve an alert, softer, more open, and distinctly feminine eye aesthetic (image 1).
Ageing of the periocular area varies in severity and symmetry. The eyebrows can have a lower displacement (ptosis); excessive skin on the upper eyelid (hooded eyelids) causes a sad and tired appearance and restricts women from wearing make-up; the fat prolapse and laxity of lower eyelids cause sagginess and eye bags, fine wrinkles and dark circles, giving a tired and sad appearance.
When performing a blepharoplasty, the consultant surgeon assesses the area as a whole. The surgery is personalised; some patients need to treat the four eyelids plus the eyebrows (image 2). Other patients need correction only on the upper eyelids, whose improvement goes beyond aesthetic enhancement such as reforming the natural eyelid crease but also improving the patient’s visual field. Patients with lower lid bags benefit from lower eyelid blepharoplasty, which can be performed internally or externally, depending on the case.
Equally, men can also benefit from surgery, applying an appropriated approach by respecting male features.
Blepharoplasty can enhance the area but cannot stop ageing or create a completely different appearance. It can, however, be used in association with other tools such as laser resurfacing, chemical peels, platelet-rich plasma (PRP) injections, Botox injections and others, achieving better results, called “blepharoplasty plus”.
Patients’ wishes cannot be undervalued. Therefore, there is no strict age limit for blepharoplasty, which can be performed once the patient shows signs of ageing, causing dissatisfaction.Therefore, surgery is not only performed to restore but also to preserve the youthful gaze.
Oculoplastic surgery requires not only a deep knowledge of the delicate anatomy of the periocular area and surgical skills but also knowledge of beauty standards, perception of harmony, respect for the individual’s features and substantive surgical experience. The outcome impacts the patient’s self-perception, increasing their self-esteem and confidence.
Lastly, a thorough consultation with a board-certified oculoplastic surgeon is paramount. During consultation, the surgeon will assess the patient’s features, perform a dynamic assessment of eyelids and eyebrows, discuss patient expectations and the most realistic possible achievements, and determine the most appropriate surgical approach, ensuring the patient is well-informed and emotionally prepared for the procedure.
Dr Fabiola Murta is an Ophthalmologist and Oculoplastic Surgeon at IHPA.
Full member of ESOPRS and SPME; international member of ASOPRS and BOPSS. Former consultant at Moorfields Eye Hospital – London/UK
