Increasing upper eye lid sagging can result in so-called hooded eyes. The excess tissue can cause a tired, older facial expression; on the other hand, in pronounced cases, it can also produce a sensation of pressure on the patient's eye lids, restrict their field of sight and give them headaches.
The operation is usually carried out under a local anaesthesia; a full anaesthesia is however available on request. Prior to the procedure the excess tissue to be removed is marked to ensure that neither too much nor too litttle skin is removed. During the operation skin is removed from the upper eye lid and also the fatty tissue underneath is partially removed. Following the operation the patient's eyes must be cooled continuously. The stitches are removed after 8 days; after 10-14 days the swelling and bruising has generally subsided to such an extent that the patient can go out in public.
The healing process for upper lid lifting is usually very uncomplicated and also virtually pain-free for the patient. In some cases the patient may experience an initial slight burning sensation but this subsides after a few hours.
When the skin on the lower eyelids sags, lacrimal or tear sacs are formed as well as excess skin on the lower lids which often leads to a tired or sad appearance. Very often this is hereditary, the patients report that their mother or father also has deep rims below the eyes. But this tired expression can also be intensified by too much stress, too little sleep and in particular excesses of nicotine and alcohol.
To achieve a lower eyelid lift, a part of the fat deposit is removed or redistributed with a local anaesthesia or under general anaesthetic via an incision immediately below the lower edge of the eyelashes, and the lower eyelid muscle is reaffixed to the outer corner of the eye, the excess skin is removed sparingly. After the operation the eyes must be cooled, bruising of the skin and a swelling of the lower lids are usual. Occasionally the patient experiences inflammation of the eye, but this usually subsides after a few days or with the help of eye drops. The stitches are removed after 10-12 days and after two to three weeks the swelling and bruises have usually disappeared.
As far as the healing process is concerned, a lifting of the lower eyelid takes slightly longer than the upper lid, as here the edge of the lid and therefore the conjunctiva is more irritated.
Many patients have their upper and lower eyelids treated in one operation but in this case a general anaesthetic is recommended.
Hyaluronic acid (or hyaluronan) on the lower eyelid
In many cases tired-looking lower lids can also be improved by injecting with hyaluronic acid or the patient's own fat tissue under the skin as a filler, without an operation. An operation is the more suitable method to remove excess skin. A considerable improvement can also be achieved by filling hyaluronic acid by injection to smooth out a deep lacrimal groove.