Upper Blepharoplasty Eyelid Surgery
Ventura, Los Angeles, California
The ellipse of extra skin to be removed from the upper eyelid is marked out after the patient is lying down, thus allowing for the scalp to pull back and exert any lifting effect.
The bottom edge of the ellipse follows the line of the natural eyelid crease and extends from the area just above the tear duct medially to the outer edge of the eyelid opening temporally, where it then angles slightly up and outward into an existing laugh line.
The skin above the incision is gently pinched while the eyes are closed to determine the maximum amount of skin that can safely be removed without pulling up on the upper eyelid margin or down on the brow. To avoid a stark outcome, the actual amount of skin that is removed is always much less.
Upper eyelid skin is removed using a scalpel and fine scissors and forceps (the laser is not used, as the final scar may be compromised). Only if the underlying orbicularis muscle is overdeveloped or stretched are its fibers trimmed conservatively.
If orbital fat is clearly bulging, a structural layer known as the orbital septum is opened. One or both fat pads are thinned conservatively to avoid hollowing.
The upper eyelid's opening muscle (levator muscle complex) located below the fat is identified and avoided during surgery. Bleeding is meticulously controlled with electrical and thermal cautery.
The skin incision is closed using a combination of interrupted and continuous (baseball) non-dissolving stitches.
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If fat is not bulging, the orbital septum is left intact and no fat is removed from the middle pocket. In our practice, "tissue-sparing upper blepharoplasty" has become the rule rather than the exception.
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