Eyelid Rejuvenation and Blepharoplasty

The eyelid area is delicate and complex, with the brows, muscles, fat pads and skin all influencing how the eyes look. What seems like heavy eyelids may actually be brow descent, while dark circles may relate to hollowing, thin skin, pigmentation or visible veins. Some patients are best suited to blepharoplasty, while others may benefit more from non-surgical treatment.

A specialist assessment helps determine whether the concern is due to excess skin, volume loss, muscle activity, pigment or vascular change, whether surgery or non-surgical treatment is more appropriate, whether combination treatment is needed, and whether there may be a functional issue such as visual obstruction that could support insurance consideration. At Scars & Lasers, measurements such as MRD1 may be performed where appropriate when functional blepharoplasty is being assessed.

The Science Behind Eyelid Ageing

Ageing around the eyes occurs because several changes happen at the same time:

• The skin becomes thinner and loses collagen and elastin
• Repeated muscle movement causes crow’s feet and lower eyelid wrinkling
• The brow gradually descends
• Fat beneath the eyes can bulge or shift
• Volume loss develops in the tear trough and upper eyelid
• Pigment and visible veins become more noticeable through thin skin
• Sun damage accelerates collagen loss and skin laxity

These changes may lead to:

• Hooded upper eyelids
• Crow’s feet
• Crepey lower eyelid skin
• Dark circles
• Tear trough hollows
• Under-eye bags
• A heavy or tired appearance
• Reduced upper eyelid definition

Because these changes often occur together, effective rejuvenation usually requires a layered and individualised approach.

Surgical Eyelid Rejuvenation

Upper Eyelid Blepharoplasty

Upper eyelid blepharoplasty removes excess upper eyelid skin and, where appropriate, a small amount of underlying muscle or fat. It is often the most effective treatment for true upper eyelid hooding.

Upper blepharoplasty may help if you have:

• Excess upper eyelid skin
• Hooding touching or resting on the lashes
• Reduced upper eyelid definition
• Heaviness affecting daily activities
• Difficulty applying make-up
• Reduced peripheral vision due to overhanging skin

Benefits may include:

• A more open, refreshed appearance
• Improved upper eyelid definition
• Reduced heaviness
• Improved visual field where appropriate

In some patients, brow descent contributes significantly to upper eyelid heaviness. In these situations, surgery to the eyelids alone may not provide the best result and brow support may also need to be addressed.

Lower Eyelid Blepharoplasty

Lower eyelid surgery may be appropriate for patients with:

• Prominent under-eye bags
• Protruding fat pads
• Excess lower eyelid skin
• Lower eyelid laxity

Lower blepharoplasty may sometimes be combined with resurfacing or tightening treatments to improve the quality of the lower eyelid skin.

Non-Surgical Eyelid Rejuvenation

Wrinkle-Relaxing Injections

Wrinkle-relaxing injections can soften the muscles around the eyes and brow to create a fresher, more open appearance.

These treatments may be used for:

• Crow’s feet
• Fine lower eyelid wrinkling
• A subtle brow lift
• Downturned outer brows
• Bunny lines
• Excessive squinting contributing to creasing

Treatment is performed using Botulinum toxin.

Dermal Fillers for Tear Troughs and Volume Loss

Dermal filler may help restore lost support beneath the eyes or around the brow and upper eyelid.

Filler may improve:

• Tear trough hollows
• Under-eye shadowing
• Mild upper eyelid hollowing
• Volume loss around the outer eye and temple

However, not all dark circles are due to volume loss. Patients with significant bags, poor lymphatic drainage or very thin skin may not be suitable for filler alone.

Regenerative Injectable Treatments

Some patients benefit more from improving the quality of the skin beneath the eyes than from adding volume.

Rejuran® and particularly Rejuran® Eye are regenerative injectable treatments designed to repair, thicken and rejuvenate the delicate skin around the eyes.

Rejuran® Eye acts as a non-surgical skin booster by stimulating collagen production, improving skin quality and making the under-eye area appear smoother, thicker and less translucent.

These treatments may be particularly useful for:

• Thin, crepey lower eyelid skin
• Fine lines
• Mild dark circles related to translucent skin
• Early lower eyelid ageing
• Patients who are not ideal candidates for filler

Laser and Energy-Based Eyelid Rejuvenation

Laser and energy-based treatments are often the best non-surgical option for crepey eyelid skin, fine wrinkles, pigmentation and mild laxity.

Fractional laser resurfacing with UltraClear® or Alma Hybrid™ stimulates collagen and tightens the skin. It can improve crepey eyelid skin, fine lines, mild laxity, sun damage, early hooding and uneven texture.

UltraClear® with laser coring offers a stronger non-surgical tightening option for selected patients with mild to moderate hooding or localised skin excess. By removing microscopic columns of tissue, it can improve hooding, crepey lower eyelids, fine wrinkles and mild laxity. It does not replace surgery where there is significant excess skin, but it may delay blepharoplasty or complement it.

Pigmentation and dark circles may be caused by pigment, visible veins, thin translucent skin, tear trough hollowing or under-eye bags. PicoWay® may help brown pigmentation, while VBeam® Perfecta or Excel® V+ may help vascular shadowing and visible veins. Rejuran® and especially Rejuran® Eye can also help repair, thicken and rejuvenate thin lower eyelid skin, making it less translucent and less shadowed. Patients with more significant dark circles often benefit from combination treatment using filler, Rejuran® Eye, laser and resurfacing.

Skin tightening treatments such as Ultraformer MPT, Tixel-type resurfacing and fractional non-ablative tightening may help mild upper eyelid heaviness, crepey lower eyelid skin and early laxity.