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There have been serious changes in our approach to eyelids in recent years. Many insufficiencies and problems were realized in the standard surgery techniques which were practiced in the last 30 years. Recently, necessity of interventions such as “removing the adipose bags” is up to discussion. Our expectations passed beyond forming “eyelids without bags” and we prefer to evaluate the face as a whole.

Findings of advanced age affecting periphery of eyes:

The aging is most strikingly manifested by and noticed in eyelids. Aging-related wrinkles are almost inevitable in eyelids that are moving vigorously due to its structure and that have a very thin skin. Drooping and loss of elasticity around eyes poses negative influences on eyelids.

1- Forehead descends with age. Forehead region starts descending over eyelids together with eyebrows. Eyelids with no strength to hold such weight also move downwards.

  1. There is a membrane which surrounds eyeball and separates the adipose bags which provide support from the eyeball. This elastic membrane acts as a barrier. This membrane looseness with advancing age and becomes unable to carry the weight of adipose bags. As a result, adipose tissues overflow towards exterior aspect and we see them as “under-eye bags”.
  2. Eyelids are the thinnest skin part in our body. Moreover, they are adherent to the overly mobile muscles located beneath them. There so, skin of the eyelids form more wrinkles and sag more with every eye movement. Wrinkles called “crowfoot” which form at the eye margins are an example for this.
  3. A deep hollow area develops at the superior margin of cheeks, under the eyes. This occasion is caused by the sagging of cheeks.

On standard eyelid surgeries; excessive eyelid skin, thin muscle tissue under the skin and fat tissues filling the “under-eye bags” are removed. While this is a frequently performed surgery, it generally causes disappointment on patients. The reason of this disappointment is that the above-written basic problems actually originate from other adjacent structures such as cheeks and forehead, not the operated tissues. For example; accumulation over eyelids is mostly caused by sagging eyebrows.

What is the ideal treatment?

What is ideal is to approach eyelids as a part of the facial region. These should be corrected step by step:

  1. If there is a hollow area descending from beneath your eye towards your cheek, this area must be filled. Standard eye-lid surgeries do not correct this problem; they can even make it worse. This hollow area should be corrected by spreading the fat tissue forming under-eye bags towards lower parts and uplifting cheeks. This way a smooth and flat surface extending from cheekbones to lower eyelids is formed. This is an absolute must to have a young and sharp appearance.
  2. If there is an excessive sagging in cheeks, this must be corrected. This can be performed by uplifting cheeks with the assistance of endoscopic techniques or uplifting mid-facial features during lower eyelid surgery.
  3. Forehead must be evaluated for upper eyelids. If your forehead and eyebrows appear accumulated over your eyes; this condition must be corrected and eyebrows must be placed to their normal location with temporal lifting. Next, if there is still sagging left in upper eyelid, this should be corrected. Crowfeet also occur because of the sagging of temples and they near-totally disappear with temporal lifting procedure.

Simply removing the excessive muscle and skin after correcting the above-mentioned problems of both eyelids will be sufficient.

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