Most people don’t like how their eyelids age. What causes the eyelids to change appearance over time? Often patients don’t like the sagging or drooping of the eyelids but often they are unaware of the components that are involved in the aging of the eyelids. There are several components that play a role. There are five primary components that contribute towards eyelid aging. As an oculoplastic surgeon in Denver who performs blepharoplasty commonly and recently wrote a guide to cosmetic eyelid surgery for patients, I think it is interesting to know what actually causes the eyelids to age. There are five components that all contribute together to cause eyelid aging. In each individual some of these five components contribute more in some patients than others. It is nice to know everything that causes eyelid aging so we can direct treatments against them:
Loss of collagen in the skin causing it to loosen and stretch
As the eyelids age, the skin in the eyelids lose collagen. As a result, they become weaker and stretch over time. This primarily causes
the upper eyelid to get baggy skin but also can cause the lower eyelids to get baggy skin. Smoking and sun exposure contribute to this and make it worse for sure. This is treated by removing the loose skin of the eyelid in the upper eyelids and lower eyelids.
Fat that pushes forward from the eye socket
Our eye socket contains fat that cushions the eye and the other structures in the eye socket. This fat over time pushes forward and causes “puffiness” of the eyelids. This puffiness is often worse in the morning when we lie flat while sleeping and it fills with water. Over the course of the day we stand upright and the fat shrinks as the water drains. Consuming high salt foods also makes this fat more noticeable. In a blepharoplasty, we remove the fat to sculpt the appearance. We also sometimes reposition the fat to areas that are more hollow in the hopes that it will soften the hollowness in the tear trough.
Weakening of the eyelid muscle that opens the eyes
There is a muscle in the eyelid that raises the eyelid or opens them. This muscle is called the levator muscle. When this muscle becomes weak or detaches from its original spot in the eyelid, the eyelid becomes droopy. The eyes may appear half shut or closed. By tightening the muscle we can raise the eyelid and open the eyes so they have a more “awake” appearance.
Loss of fat in the eyelid skin causing the eyelid to deflate
In the eyelid there is fat superficially meaning right behind the skin. It gives young patients that youthful appearance of the eyelid. We lose fat over time and volume in the upper eyelid. The only way to treat this is fat repositioning or filler in the upper eyelid.
Relaxing of the eyebrows causing them to droop and push the eyelid skin down
Most of the structures in the face descend with time. That is what gravity does! One of the parts of the face that contributes to the eyelid aging are the eyebrows. As they descend, they push down the eyelid skin and cause them to droop. This can contribute to eyelid skin drooping. The decision to raise the eyebrows is a personal one. In females eyebrow elevation can be helpful. In male patients often it feminizes their appearance so it is often avoided. Often I talk to patients whether the eyebrow should be raised or not. It is a personal decision that you should discuss with your doctor. There are many ways to raise the eyebrow from endoscopic approachs, temporal brow lifts, direct lifts and suture lifts.
As can be seen there are five complicated components that contribute to eyelid aging. In some patients the puffiness from fat can be worse. In others it can be loosening of skin in the upper eyelids. In others it can be both. As an eyelid surgeon, I have to evaluate which components contribute and how much to determine what is the best approach to give the patient to most youthful appearance. Long story short, its complicated and patients do best in hands of experts in eyelid surgeons such as oculoplastic surgeons who specialize in cosmetic eyelid surgery.
