Contrary to common belief not all cosmetic eyelid surgery is performed in patients who are 40 years old plus i.e. for rejuvenation purposes.
Around 30% of the cosmetic eyelid surgery performed by Mr Cheung is for patients aged 18-35 ( Mr Cheung does not offer cosmetic surgery to patients under 18 years old).
As with all blepharoplasty surgery, success is often often dependent on careful surgical consultation, planning and meticulous surgery e.g. to create a skin crease which is harmonious with the patient’s facial features, ethnicity and cosmetic wishes.
Although Mr Cheung is happy to consider cosmetic blepharoplasty in patients from the age of 18 years old onwards; as with any cosmetic type procedure, it is vital that the patient is mature enough to consider the potential psychological/ emotional implications as well as the potential risks of any planned surgery.
For this reason, Mr Cheung would therefore normally recommend that patients only consider cosmetic surgery from the age of 25 onwards.
There are various reasons for young patients attending Mr Cheung’s cosmetic clinics but the most common reasons include:
• Young patients wanting greater exposure of their upper eyelids often to enable them to wear eye makeup or to make their upper eyelids look more symmetrical.
• Young patients unhappy with their lower eyelids looking fatty and bulging.
• Young patients feeling that their lower eyelids look tired and hollow.
This sort of cosmetic surgery is therefore designed to alter features which the patient was born with.
This sort of surgery is usually only performed by oculoplastic surgeons and involves creating newer, often higher, skin creases to increase the upper lid show (ULS) a.k.a. pretarsal lid show.
• This may involve surgery to both upper eyelids to increase the upper lid show on both sides.
• Whilst for other patients this involves performing surgery to one upper eyelid only to try to improve its symmetry with the eyelid on the other side.
The normal skin crease is formed due to the presence of an attachment between the skin and the fibres of the levator aponeurosis (main tendon responsible for elevating the upper eyelid). An anchor blepharoplasty is a specialised type of blepharoplasty which involves creating a new higher skin crease by making a incision where you want the new skin crease to be, carefully exposing the levator aponeurosis and then creating a new attachment between the skin and the levator aponeurosis by suturing the skin to the levator aponeurosis with so called anchor sutures (hence name).
Unlike older patients, young patients often do not have much excess skin to remove within the eyelid fold as one would normally do for a conventional upper eyelid blepharoplasty. Therefore to increase upper lid show safely, one cannot simply just remove skin as doing so would cause closure problems of the eyelid leading potentially to a dry eye syndrome.
By elevating the skin crease however, one can therefore increase the upper lid show safely. This sort of surgery evolved Mr Cheung’s work from incisional Oriental blepharoplasty where that sort of surgery in essence is all to do ablation of unwanted skin creases and then formation of new skin creases to the patient’s request.
For most young patients attending Mr Cheung's clinics for their lower lids, their main complaint is typically of them looking either too bulging (lower lid fat bags) or slightly too hollow (tear trough deformity).
For most young patients though with hollow looking lower eyelids, surgery is NOT required. Instead these patients often do very well without surgery using tear trough filler injections of restylane
Tear trough deformity in a 30 year old lady. She complained that she looked tired.
Notice that she has some hollowing under her eyes (tear trough deformity) and a mild bulging of a fat bag
She complained that she had looked tired even in her teens and that this had worsened as she got older.
Immediately following injection of Restylane. Only a tiny volume was necessary on each side
Notice the single injection points when using a microcannula technique
There was minimal bruising and the patient can return to work the following day
Two weeks Restylane injection for tear trough deformity.
All the bruising has disappeared. The Restylane filler not only fills up the under eye hollowing but also helps disguise the mild bulging from the small fat bag
Before treatment again
After treatment again
Advice Leaflets for Blepharoplasty Patients
British Oculoplastic Society blepharoplasty advice
Primary rejuvenation upper blepharoplasty - Plastic, maxillofacial and aesthetic medicine news