a more wide-awake
look with less sagging and puffiness around the eyes. The surgeon should
describe for the patient not only what can be improved by surgery but also
what can not, and where improvements are likely to be only marginal – bags
below the eyes that are down on the cheeks, for example. The limit of the
lower eyelid is the bone beneath the eye, and if there is puffiness below
that, out over the cheekbone, it is usually not improved by a conventional
lower eyelid operation. Patients with a recurring tendency to puffiness
around the eyes may still have the problem after their surgery. A tendency
to swell can not be surgically removed, of course, but if excess fat and
skin are removed the amount of tissue that swells will be considerably reduced.
This usually constitutes a major improvement from the patient’s point of
view.
The surgeon should
make note of the position of the eyebrows, and point it out to the patient
if this is a major reason for the extra skin in the upper eyelid. It is
easy to illustrate by lifting the eyebrows with the fingers, as described
in the section on forehead lifts. For some patients who seek help because
of their tired-looking eyes the problem is not only too much skin or fat:
the muscle that lifts the upper eyelid may also be poor. An upper eyelid
that hangs so far down that it partly obscures the iris or even the pupil
of the eye can contribute to a tired look. The patient must be told that
this condition is not improved at all by a conventional eyelid lift. If
the eyelid hangs this much, however, there are several surgical methods
to correct the problem that can be combined with an upper eyelid lift.
Occasionally children are born with eyelids that droop down over their pupils.
This congenital defect, called ptosis, is often corrected in childhood with
methods similar to those used to shorten and lift the upper eyelids of older
patients.
The small, fine wrinkles in the skin around the eyes of some patients can
not be stretched away. They have to be removed by other
methods, usually peeling. The newest and most effective method is laser
peeling. Some patients have brownish pigmentation around their eyes, and
this is not helped by surgery either. The skin must be bleached with special
skin creams or lotions. Another difficult condition to treat is a deep crease
leading down from the inner corner of the eye in the angle between the eyelid
and the nose. This problem is usually not remedied by conventional eyelid
surgery: special measures are required.
It is also important at the consultation to review any eye problems the
patient may have had. Eyes that are easily irritated or tired, for example,
sometimes have insufficient tear production. The doctor may conduct a simple
test for this with a small bit of filter paper, which is left to soak up
tears
