What is Dermatochalasis?
Dermatochalasis describes the presence of loose and redundant eyelid skin. It is a common sign of aging and is seen in middle-aged and elderly people. It is often described as a “tired look” or “bags” and is most often seen in the upper eyelids but can also affect the lower lids. Studies show that the following play a role in the development of dermatochalasis: an increase in the diameter and number of lymphatic vessels, a reduction in elastic fibers that are essential for the structure and function of lymphatic system, disarrangement in collagen fibers, stromal edema, and increased number of macrophages.
- Dermatochalasis refers to loose, redundant eyelid skin.
- It is most often caused by aging.
- Blepharoplasty, a surgery used to correct dermatochalasis, improves functional vision and cosmetic concerns.
Dermatochalasis is a normal anatomical change with age. While dermatochalasis can affect an individual’s vision, often the concern is cosmetic. Dermatochalasis can have the appearance of being tired or cause a dull look to the face. Dermatochalasis may lead to corneal exposure and dry eye. Patients with dermatochalasis often have symptoms similar to keratoconjunctivitis sicca (dry cornea and conjunctiva) including mattering, burning, itching, redness, epiphora, foreign-body sensation, and photophobia. After blepharoplasty surgery, 86.8% of patients note an improvement in their dry eye symptoms.
Risk Factors for Dermatochalasis
Aging leads to weakening of the connective tissue and a loss of skin elasticity. Orbital septum weakening and fat herniation cause the bulging appearance. The skin is also weighed down due to gravity. Genetics is the strongest predisposing factor for dermatochalasis. Higher body mass index, male sex, lighter skin color, and current smoking are additional risk factors. Prior facial trauma or surgery, nerve palsies, and rare connective tissue disorders or tumors may cause the condition to appear worse. Lifestyle choices like sun exposure, high salt intake, lack of sleep, increased stress, and dehydration can also increase the risk of dermatochalasis.
The symptoms of dermatochalasis include:
- Decreased peripheral vision
- Drooping eyelids
- Heavy, tired feeling around eyes
- Brow ache
- Shadow in the upper or side vision
- Dry eye symptoms
A physical exam by an eye doctor is required to rule out other eye diseases. Special attention will be paid to the brow position and brow contour to differentiate between true and pseudo dermatochalasis. The doctor will measure the redundant eyelid skin, levator muscle excursion, and orbital fat. Photography and visual field testing will be performed with and without the eyelid taped to determine the effects of dermatochalasis on vision.
An upper lid blepharoplasty is surgery performed to correct dermatochalasis for cosmetic or functional purposes. The surgeon will first outline the tissue to be excised, beginning at the upper eyelid crease. They will ensure enough skin remains for eyelid closure. Sometimes, they will remove portions of the preseptal orbicularis with the skin. If there is significant fat herniation, the orbital septum may be opened, and the fat may be trimmed creating a more even upper eyelid contour. Incisions are well hidden within the upper eyelid crease.
A lower eyelid blepharoplasty may be performed for fat herniation and excess tissue around the lower eyelids. This is considered cosmetic and performed to reduce the appearance of “bags” under the eyes. Blepharoplasty is managed with oral analgesia and cold compresses in the early post-operative period. Some ophthalmic plastic surgeons add peri-operative intravenous and post-operative oral and/or topical antibiotics to minimize the small risk of infection. Patients should expect bruising for 1-2 weeks after surgery, and swelling is common for the first several weeks.