The main focus of upper eyelid surgery is to remove excess skin between the natural crease of the lid and the eyebrow. When there is a marked amount of redundant skin, it can hang over the lashes and eyelid margin like a hood; obscuring the vision and blocking the lateral portion of the eye. When a large amount of skin is removed during eyelid surgery, the eyes can appear more open than they were prior to surgery. In this instance, the actual shape of the eye does not change as the surgery does not change the position of the eyelid margin, but it may appear to be more open since the hood of skin blocking the eye has been removed.
In order to actually raise the upper eyelid margin during eyelid surgery, a procedure must be done to the muscle that raises the upper lid or it’s attachment to the eyelid itself. This is sometimes done when the muscle (levator palpebrae) has lost its connection with the eyelid allowing the upper lid margin to rest too low on the eye, obscuring much of the upper iris or even the pupil. This is a not uncommon cause of a droopy eyelid in adults and the correction may be covered by insurance. This procedure will open the eyes more and give them a little more of a rounded appearance.
Lower eyelid surgery generally concentrates on the fat in the eyelid to remove or reduce bulging pockets or dark circles. If the lower eyelid has lost strength and tone, it can sag down too far or even turn outwards, which is known as an ectropion. In this case, too much of the white part of the eye shows which can be corrected during lower eyelid surgery by tightening the eyelid margin. When this is done, the eye may appear to change shape a little; becoming more almond shaped than round. This surgery may require a repositioning of the support structures of the eyelid margins along the outer orbital bone to a higher level.
Tightening the supporting structures of the lateral lower lid can also result in a slight upward tilt to the outer eye aperture, which is typically considered a more youthful appearance to the eyes.
Fat is often removed from the medial fat pocket of the upper eyelids next to the nose when there is a bulge caused by either excess fat or a loose cover to the pocket. There are three fat pockets that are usually manipulated or reduced during a lower eyelid procedure to treat lower lid bags or dark circles. There is no noticeable change in the shape of the eyes with fat removal from either the upper or lower eyelids.
Loss of supporting structures of the lower eyelid can result in drooping and an outward rotation of the lower eyelid known as an ectropion. This gives a rounder appearance to the eyes along with excessive show of the white part of the eye (sclera). This can appear after lower eyelid surgery and is why the lid may be supported with a tightening procedure to prevent its occurrence; especially in older patients.