The Ten Minute Eyelift

The Ten Minute Eyelift
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By Nelson Lee Novick, M.D., FAAD, FAACS

Some degree of redundacy and laxity of the eyelids and underlying muscles can be considered a normal part the aging process. When severe, doctors refer to the condition as dermatochalasis, which is simply an excess of skin in the upper or lower eyelids that makes them appear droopy or “hooded.” It most frequently begins in people over 50 and is quite common in the elderly. Genetics may predispose to its development, and frequent allergies, and occasionally prior pregnancy may also contribute.

While we know how the problem develops, we currently have no way of preventing it. From the moment we are born, every blink of our eyes causes the tiniest stretch of the elastic fibers within the eyelid skin and the muscle fibers responsible for elevating the lids (the levator muscles). By the time, we reach our late forties and fifties, the tissues around the eyes have become increasingly stretched, loose and movable. Subject to the unrelenting downward pull of gravity, the lids eventually lengthen and droop. Women are more apt to notice the overhanging skin earlier on, when they begin having difficulty applying makeup to their upper lids.

Sagging eyelids are not just a cosmetic problem, however. When there is an excessive amount of upper eyelid skin, the skin may hang over the eyelashes and cause a loss of peripheral vision. The upper and outer parts of the visual fields are most commonly affected, and the problem may become severe enough to interfere with activities such as reading or driving.

Dermatochalasis, whether for functional reasons to improve peripheral vision or for strictly cosmetic considerations, has been traditionally treated with surgical blepharoplasty (eyelift surgery), and more recently with ablative laser surgery or tissue heating using radiowaves to promote shrinkage.

Blepharoplasty is by no means a no-downtime lunchtime procedure. It is true surgery requiring stitches and often intravenous sedation. The surgery involves reshaping the upper or lower eyelid by the removal and/or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. It is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid.

Following a “bleph,” there is often considerable initial swelling and bruising that may take as much as two weeks to resolve. Moreover, it usually takes at least several months until the final results of the surgery can be fully appreciated. Depending upon individual needs, the operation requires one to three hours to complete. Fees range from $2500 to $7500.

Laser ablation, in which the lids are abraded with laser light, is also not a quick fix. It, too, frequently requires intravenous sedation and a prolonged postoperative course. Persistent redness and permanent loss of pigment are potential complications. Fees range from $2500-$3000.

Although radiowave heating, which spares the epidermis (the skin’s topmost layer), may be performed quickly, and has little downtime, a series of treatments at periodic intervals are typically necessary. The procedure can be uncomfortable enough to require local anesthesia and intravenous sedation. The degree of skin tightening achieved is often only subtle to minimal. Fees average around $1500-$2000/session.

Several years ago, I developed what I dubbed the Ten Minute Eyelift for treating significant upper eyelid hooding. The technique is quite simple. With the patient seated upright, I first mark off the entire length of the lower third of the “underbelly” of the hooded portion of the lids on each side. Next, I numb these areas with a small amount of local anesthetic. Finally, I pass a cautery probe, which imparts an intense amount of heat energy, along the marked stretch of each lid.

Almost immediately, the skin contracts vigorously in response to the probe, drawing the hooded portion of the lid backwards over the surface of the underlying normal lid. As it does so, the underlying eyelid is exposed and restored. Each wound is then covered with only a small amount of antibiotic ointment and left to heal spontaneously.

The entire technique takes about five minutes per side. Healing is usually complete in seven to ten days. Slight bruising and mild swelling are common afterward and may take about a week before becoming less noticeable. Cold compresses can be used in the first 48 hours to minimize the bruising and swelling. This may be supplemented by the oral use of bromelain for three days. Bromelain, an enzyme, is a pineapple derivative that has demonstrated usefulness in preventing bruises and speeding their resolution. Pain medications are seldom necessary, but for some people who experience mild discomfort, acetominophen (Tylenol) is ordinarily adequate. Most people can return to work the following day.

One treatment is ordinarily all that is required. The results are permanent and can be fully appreciated in just two weeks. When fully healed, a faint, narrow, linear ivory or off-white line is often all that can be seen at the treatment site.

The accompanying “before” picture demonstrates how the “hood” of the upper eyelid covers the entire upper lid up until the lid margin (where the lashes begin). In the “after” photo, which was taken two weeks following a Ten Minute Eyelift, you can see how the hood no longer entirely covers the upper lid and has healed into a more youthful, more natural appearance. Fees range from $1000-$1500, depending upon the extent of the problem.

Q. I have droopy bags under my eyes. Can these be treated with The Ten Minute Eyelift?

A. In general, the technique is best reserved for a heavily hooded upper eyelid where the resulting whitish, linear scar will be concealed under the remnant of the hood. However, when there is sufficient redundancy and sagging of the lower lid to cause bags and folding of the tissue, this method may be used cautiously there, as well.

Q. I have heard that there is a limit to the number of times that blepharoplasty may be performed. Does this apply to the Ten Minute Eyelift?

A. While the result of a Ten Minute Eyelift is technically permanent, age-related changes to the delicate tissues surrounding the eyes may eventually result once again in significant hooding. Fortunately, the Ten Minute Eyelift may be repeated as often as necessry. Whenever possible, retreatment is performed directly over the previous scar so that no additional scar tissue is created.