Tired eyes? Here’s the surgery that fixes it [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before meets After.

Eva Sheie (00:03):
What is eyelid surgery and how do you think about eyelids?

Dr. O'Brien (00:10):
Eyelid surgery usually involves removing some heaviness around the eyes, whether it's heaviness resting down on the upper eyelashes or feeling puffy underneath the eyelids. And the term for it is blepharoplasty. Most people refer to it as an eyelid lift and they are really great procedures. Patients love them. The recovery is pretty minimal as far as being back in action and feeling like you're presentable. And they're a lot of fun to do.

Eva Sheie (00:45):
What are the most common reasons that people have eyelid surgery?

Dr. O'Brien (00:50):
For the upper eyelids, I would say it's just things feel heavy. Women feel like they can't get their makeup in where they want it to be or it rubs or it blends or they'll say, "I don't even know why I bother trying to put makeup on because you can't see it. " Sometimes the eyes feel tired by the end of the day because they're really are getting heavy or they're using their eyebrows to kind of pull the eyelids up a little bit. For the lower eyelids, I would say most people notice puffiness. Sometimes it's a little wrinkly, crinkly or crepiness to the skin, but most people come in when they start seeing what are almost always called bags under their eyes.

Eva Sheie (01:29):
What about dark circles?

Dr. O'Brien (01:31):
Dark circles under the eyes can be related to an eyelid lift. Usually in that circumstance, it's where the fat pockets under the lower eyelids start to bulge forward. And then the light comes down from above and highlights the top and then highlights the cheek. And then the area between the top of the bag and the cheek is in the shadow. And when that's the case, they have dark circles under their eyes. And so if you remove that fat or you restore a smoother eyelid contour, their dark circles go away. Some people have dark circles under their eyes, either from allergies, inflammation. Sometimes it's just natural skin tones that make the skin itself look darker, and that's not really going to be changed by surgery.

Eva Sheie (02:23):
What's the treatment for dark circles when it's not surgery?

Dr. O'Brien (02:27):
It depends a little bit on what is causing the dark circles. If it's that they have some hypervascularity, maybe some laser treatments or something like that. If it's because they rub their eyes, because they have allergies, it's treating the allergies so that they're not having that inflammation or maybe microbruising. If it's a hyperpigmentation, again, you may come back to something to kind of blend the skin tones, whether it's a topical cream or something along those lines, or again, going toward a laser treatment. There are treatments for it, but they are a little bit more limited.

Eva Sheie (03:06):
Is there a certain age that people really start considering eyelid surgery?

Dr. O'Brien (03:13):
As far as the age for eyelid surgery, the most popular ages are probably 40s to 60s when people come in and are really talking about having eyelid surgery. But I definitely see younger patients more commonly for the lower eyelids because there are folks who have bags under their eyes literally from the time they're children. And it has to do with sort of the insertion of a septum that supports the fat. And if that septum for whatever reason is not fully intact or not attached appropriately, they can have bulging under their eyes even at very young ages. And so every now and then I'll have somebody who comes in, not as a teenager, but in their 20s or 30s who have complained about this issue since they were very young and they're finally ready to do something about it, in which case addressing that fat pocket or that septum may be appropriate.

Eva Sheie (04:08):
Is there an easy way to tell if you need more than just eyelid surgery? For example, if you may also benefit from having a facelift or a brow lift at the same time as eyelid surgery.

Dr. O'Brien (04:22):
Sometimes people do come in talking about their eyelids and sometimes it's truly the, it's not just the eyes that have aged or if they address the eyes, it may be what they're seeing, but in reality, the most aging feature may not be their eyes, but it is what they themselves have been seeing or worrying about. And so maybe I do bring in the conversation about a brow lift if the brow has dropped down and is now looking really heavy and it's making the space between the eyes and the eyebrow small. So maybe that's what's crowding. Maybe it's not that they have a lot of extra skin, but maybe the brow has aged or in regards to the lower eyelid, sometimes it's the fact that the cheek has aged, that they have maybe some eyelid changes, but it may be that they've lost fat in their cheeks or their skin has really changed in the cheek area.

Dr. O'Brien (05:16):
And so that lid cheek junction, which is where creatively the eyelid meets the cheek is now aged because the cheek may be more than because of the eyelid, in which case we talk about maybe more facial procedures, either instead of the eyelid or in addition to the eyelid.

Eva Sheie (05:34):
In the procedure statistics that come out every year, eyelid surgery is always at the very top of the list of what's most popular. Why do you think eyelid surgery is so popular?

Dr. O'Brien (05:46):
I think eyelid surgery is popular because it gives a boost. People can see the difference. They see that difference in a relatively quick fashion, although the healing process does take a few months to finalize, but very quickly people can see that their eyes look bigger, brighter, they're more open, and they're feeling well. It doesn't take a long time to recover. And so it just gives that boost very early.

Eva Sheie (06:16):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.