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Upper eyelid surgery

Overview of Upper Eyelid Surgery (Upper Blepharoplasty)

Eyes are the focal point of one’s face. They are the first thing people notice and are the key to facial expression. During the aging process, the region around your eyes shows the effects of aging much sooner than other areas. This is the main reason why so many people seek cosmetic eyelid surgery. We often hear complaints such as, “My eyes always look tired and old even when I feel wide awake.” This is very profound because if you look old and tired you will feel the same way. How many times have you dressed up and prepared to go out feeling good about yourself only to look in the mirror to see that your eyes look older than you feel?

Aging affects the entire face. Aging around the eyes, however, is usually the first area that is noticed. The aging of the face can be thought of in terms of its three most important components: the skin, the underlying muscle, and the fat. Most people do not think aging involves the latter two structures but, in reality, these are probably the most important ones. Have you ever looked at a baby’s cheek? It is full and fatty. Look at a model’s cheek. It is not as full as a baby’s cheek but still it has significant volume due to the underlying fat.

There is a substantial amount of fat situated around the eye region. As we age, the fat will either descend on the face or go away completely. When this happens, it exposes the underlying facial skeleton resulting in the familiar gaunt appearance that we recognize as aging. Also, the fat and underlying muscles act as a filler to create the volume seen in the cheeks of youth. When this filler descends or goes away, we see wrinkling. This process is similar to a grape which turns into a raisin when the water is removed.

The recognition of the importance of the underlying fat and muscle has been revolutionary to the field of plastic surgery over the last 10 years. It is no longer acceptable to think of eyelid rejuvenation as merely a procedure to tighten the skin. This is why your Dr feels it is so important to correct the problem itself and not just the effects of the problem.

When evaluating the upper eyelid there are three important components of the upper eye region that must be considered: the eyebrow, the upper lid itself, and the lateral canthus. Typically, these three areas sag at different rates and, therefore, each patient must be assessed individually. Most patients need removal of fat and skin to create an elegant upper eyelid crease.

Descent and laxity of the lateral canthus is a major contributing factor to the appearance of old age within the eye region. This sagging gives a depressed, tired appearance. The upper eyelid of youth has a bright, open appearance. Of particular note is the fact that the lateral canthus should be higher than the medial canthus. It is important to address this issue to create the best look possible, he often will elevate the lateral canthus in conjunction with the upper blepharoplasty to recreate that youthful, almond-shaped appearance. See above.

Others need correction of all three elements comprising the upper eye: the eyebrow, the eyelid, and the lateral canthus.

Often, your Dr will perform a temporal brow lift instead of a conventional brow lift when he does upper blepharoplasty. This is much less invasive, yet still effective. The temporal brow lift only addresses the temporal area, but this is usually what needs elevation the most. The decision as to what is best for you can only be determined during consultation.

There is a fourth potential problem area for the upper eyelid that is not always talked about and often is not addressed. This is eyelid ptosis, also know as descent of the upper eyelid.

Eyelid ptosis becomes quite common as we age and can affect one or both sides. The muscle that elevates the upper lid simply breaks off and the lid lowers. This gives the appearance of a chronic tired eye. Correction opens the eye and gives a brighter, more awake appearance.

The take home point to all this information is that there are several elements of the upper eyelid region that must be evaluated during an upper blepharoplasty exam.

It is important to understand the limitations of upper blepharoplasty. An upper blepharoplasty alone will not correct crow’s feet. It will help but often a concurrent brow lift or temporal brow lift is necessary. Often, BOTOX® can be helpful.

Benefits of Upper Eyelid Surgery

There are many benefits to eyelid rejuvenation surgery. The key is to precisely identify the problem.

Lower eyelid surgery benefits:

  • Tightens and smoothes out bags underneath the eyes.
  • Repositions lower eyelids into a more elegant, almond-shaped appearance.
  • Repositions underlying fat to get rid of the sunken, aged appearance.
  • Repositions skin and underlying muscles to smooth out wrinkles.
  • Markedly fills out the deep crease, known as the tear-trough, between the eye and nose.
  • Eliminates circles underneath the eyes.
  • Improves dark discoloration within the lower eyelid.
  • Improves fine wrinkles.

Upper eyelid surgery benefits

  • Removes excess fat and skin of the upper eyelid.
  • Creates a sculpted, more attractive upper eyelid.
  • Creates a double lid and removes excess eyelid fat in Asians.
  • Elevates the upper eyelid to give a more bright and youthful expression.
  • Repositions upper eyelid fat into a more youthful position.
  • A temporal brow lift or formal brow lift can can be performed at the same time.

Are You a Good Candidate for Upper Blepharoplasty?

Most people, as they age, can obtain improvement from upper eyelid surgery. Specifically, good candidates include people with the following problems around the eyes.

  • Excess skin and fat within the upper eyelid.
  • Sagging of lateral eye brow if temporal brow lift is also done.
  • Sad or tired appearance of upper eyes.
  • People who desire an elegant, well-defined upper eyelid crease.
  • Asians who desire a double eyelid.
  • Crow’s feet within the lateral eye area.
  • Sagging of the lateral canthus giving a “hound dog” appearance.
  • Ptotic eyelid that makes the upper lids appear tired.

Possible Complications of Upper Eyelid Surgery

The most common complications are inadequate correction of the problem or asymmetry. If this is the case, correction can usually be made with a minor additional procedure. One must understand that complete symmetry is not possible. Nobody is naturally perfectly symmetrical. Sometimes, the underlying bony structure is so different from one side to the other that symmetry cannot be achieved.

Complications that can occur with any surgery include infection, blood or fluid collection, and unfavorable scarring.

Recovery Time after Upper Eyelid Surgery

Usually, people are off work for about 1 to 2 weeks depending on how self-conscious a patient is about the swelling and bruising. Once again, patients who have had fat transplantation tend to take longer for the swelling to subside.