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The goal of upper blepharoplasty surgery should be to enhance and sharpen the crease without hollowing the eyelid or altering brow position. Aggressive tissue removal should be avoided.

upper eyelid surgery

 

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.

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.

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 fine stitches.

 

Upper Blepharoplasty Details - More on upper blepharoplasty options, pros, and cons

Upper Blepharoplasty
Treatment of Upper Blepharoplasty Complications

Eyelid Surgery QuickNotes - Advantages of upper lid tissue-sparing blepharoplasty

When Tissue-Sparing Blepharoplasty May Be The Better Choice

Eyelid Surgery Photos - Actual patients before and after upper blepharoplasty

Patient Photos

Video Case Studies - Two movies on upper blepharoplasty narrated by Dr. Meronk

Tissue-Sparing Upper Blepharoplasty: When Less is More
That Tiny Roll of Upper Lid Skin: It's Not What You Think

Operations Step-by-Step - Cosmetic upper eyelid surgery shown start to finish

Upper Eyelid Blepharoplasty
Tissue-Sparing Upper Blepharoplasty

Asian Eyelid Surgery - On plastic surgery to enhance the upper lid crease

Asian Double Eyelid Surgery

Hollowed Eyelid - Considerations to help avoid upper lid hollowness and other problems

The Most Common Surgical Missteps


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Author: Frank Meronk

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