Historically, removal of excess upper eyelid skin began as a result of older people having so much excess skin that it affected their vision, as well as the cosmetic appearance of making them look older than they felt. Some patients would actually present with Scotch tape holding up the skin enough to be able to see adequately.

What most do not realize is that excess upper eyelid skin can give even younger patients (as young as those in their 20s) a more tired, older-looking appearance. This excess skin can be attributed to genetics such as those of Asian ancestry having more excess skin than other nationalities.

Many younger patients come in for injections of Botox or Dysport to diminish deep forehead furrows. They don’t realize that they are subconsciously raising their brows because of excess, heavy eyelid skin resting on their lashes, which in turn creates the furrows in the forehead.

An upper lid blepharoplasty often eliminates these forehead creases completely, and at a minimum diminishes them.

In addition, younger patients with this problem are unable to wear eye shadow because of the creases caused by the heavy upper lids. As patients age, the extra skin might start resting on the lashes, turning them downwards. With age, the excess skin accumulates even more.

Blepharoplasties (eyelid lifts) are typically performed under local anesthesia, taking less than an hour to perform. The skin is carefully measured and excised. The incision is sutured, and the patient is instructed to use ice soaks to reduce swelling and bruising that can last for seven to 10 days.

Sutures are removed in four to five days, and the patient may resume wearing eye shadow. Once healed, the incision is barely perceptible, if at all.

Another issue for some patients is pockets of fat underneath the eyes (“bags”) that can result in dark circles. This also can make one look older and tired.

These fat pockets can be easily removed with an incision made inside the lower eyelids with no sutures required. If there is also excess lower skin as well, a skin incision is made just below the eyelashes of the lower lid, and the excess skin is removed.

The results of younger patients undergoing removal of upper and-or lower eyelid skin usually will last decades. Forehead furrows virtually disappear so Botox or Dysport will usually not be needed, and the patient truly looks younger and more rested.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com