The number of eyelid surgeries performed in the last 10 years has declined by 50%, according to statements made at the Jules Stein Eye Institute's course on cosmetic eyelid surgery. The decline is not due to the fact that too few procedures are currently being performed. Rather it is that there have, in the past, been many "overoperated eyes", according to the speakers.
The concept of what constitutes attractive eyelids has changed. In the past it was said that a broad flat upper lid, on which a woman could easily apply makeup, was desirable. In a man, some overlapping skin has always been considered attractive. The problem with the female ideal was that, if you look closely at the eyelids of young attractive women, you will not see the eyelid that was previously described. Rather, most young women have full upper eyelids. Take a look at the eyelids on this page. Previously one of the goals of upper eyelid surgery was to remove excess fat. Now we realize that there is no excess fat. The fat that may be visible is the result of the loss of the normal tissue, some of which is fat, that lies beneath the upper lid. It is still appropriate to remove some excess skin in a woman with folds of skin on her upper lids (upper lid blepharoplasty), but the removal of fat should be very limited. The ideal solution would be to at least partially replace some of the missing tissue. Unfortunately the techniques for this are still being developed. Rejuvenation of the lower eyelid has advanced further than upper lid blepharoplasty, and the techniques for doing this will be discussed in the next post.
Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi CA