Eyelid’s Aging Process
Asian eyelids tend to undergo the aging process more rapidly than non-Asian eyelids. This is mainly due to differences in skin thickness and eyelid tissue mass. The skin on Asian eyelids is comparatively thick and heavy, and therefore descends faster with age. Many Asians also either lack the double eyelid fold altogether, or have an infold crease that is barely noticeable, which also contributes to faster eyelid aging. With a substantial fold, the progressive descent of eyelid skin is less conspicuous due to an increased eyelid surface dimension and an indirect attachment of skin to the underlying deep structure. The higher the fold is situated, the greater distance is needed for the skin to descend beyond the upper edge of the eye opening.
As tissue atrophies with age, skin and underlying soft tissue begins to stretch and sag. There is also general loss of volume in the eyelid and orbital region. Some patients begin to notice their eyelid folds have become weaker with age due to the loosening of connections between the eyelid skin and the eye elevating muscles. Furthermore, as the underlying soft tissue atrophies, the space separating the skin from the eye elevating muscle narrows. With the loss in soft tissue volume, the skin begins to indent, forming multiple late-onset pseudo folds. Such folds lack the crispness and sharp dynamicity portrayed in youth, causing one to appear older than their actual age. These late-onset eyelid folds are also transient and can fluctuate depending on the state of underlying soft tissue – weeping, pregnancy, and other factors could cause enough swelling to overpower the loose connections, preventing any fold formation.
The eyelid’s deeper muscle structures undergo aging processes as well. The levator aponeurosis, a connective tissue which connects eyelid cartilage (tarsus) to the levator muscle and aids in eyelid elevation, begins to detach from the eyelid tarsus. The Müller’s muscle, which is located beneath the levator aponeurosis, also undergoes muscle degeneration becoming partially replaced with fat cell depositions and thereby losing muscle functionality. Muscle degenerations can make double eyelid surgery and ptosis repair more challenging. In all upper eyelid procedures, there must be sufficient amount of collagen for the sutures to fasten to, in order to form a secure connection among individual structures. In cases of muscle degeneration, there is a high rate of lid contour deformity and lid asymmetry. Thus, more advancement is needed in ptosis repair and double eyelid surgery to overcome the degeneration of the Müller’s muscle.
The lower eyelid undergoes aging processes as the upper eyelid. Generally, for Asian lower eyelid, aging can decrease the fullness of the “aegyo-sal” (See Youthful Lower Eyelid Fullness) due to muscle hypotrophy in the superficial muscle of the lower eyelid.
Another manifestation of aging in the lower eyelid region is fat protrusion (i.e., eye bags). Contrary to its appearance, the cause is not due to increase in fat formation but herniation or loosening of the septum (the layer that covers the fat) along with weakening of the superficial eye muscle. The superficial muscle also descends and loosens the surrounding skin. In addition to the appearance of eye bags, with age, loss in soft tissue mass occurs and there could be convexity and/or concavity in the lower eye/facial region that was not present at a younger age. These issues that occur with age can be effectively corrected by undergoing Youthful Lower Eyelid Fullness Procedure and/or Lower Blepharoplasty.