When Tissue-Sparing Upper Blepharoplasty May Be The Better Choice

In years past, it was common practice for surgeons to excise fat and muscle aggressively during upper and lower blepharoplasty. Even today, blepharoplasty is still referred to as "a procedure to remove fat--usually along with excess skin and muscle" (source: top plastic surgery information resource website).

Tissue-sparing upper blepharoplasty is a modification to the standard technique that pays more respect to the interaction of eyelid and orbital anatomy. Despite the name, not all eyelid layers are spared. Skin is still but removed but in a modified (although not particularly conservative) manner.

The big difference is that the lid's closing muscle (orbicularis muscle) and the orbital fat are left alone.

Such an approach is not for everyone, especially if the main concern is too much orbital fat causing upper eyelid bulging. The best candidates are those whose eyelids show certain characteristics.

• Upper Eyelids Are Sagging But Not Bulging

If eyelid volume appears satisfactory but the overlying skin has lost its elasticity and become stretched, removing more than the offending tissue is not just unnecessary but counterproductive.

• Upper Eyelids Appear Slightly Hollowed

If the eyelids are already short on volume (a not uncommon state past the age of forty), there is no good reason to add to the deficiency.

• Eyebrows Sit Naturally Low

Orbital fat helps support the brows from below, much like a foundation holds up the building. When a person's brows sit naturally low, often this is because there is not much natural fat present to prop them up. Excising what little there is may drop the brow even further as it collapses into the void.

• Eyebrows Have Been Surgically Elevated

If a forehead lift raises the brows noticeably, debulking the upper eyelids may yield an almost cavernous hollow that is a sure sign of either aging or overdone surgery.

• Seeking the Most Youthful Appearance

Adequate facial fullness suggests youth. Hollowing an upper eyelid serves little purpose other than to expose a large platform of skin above the lashes, a feature not often seen naturally in young people and not the least bit now in vogue.

• Family History of Upper Hollowness with Age

Heredity is hard to fight. Many groups show a genetic predisposition to hollow significantly with age (for instance -- and these are merely two examples-- those of eastern European background and those of eastern Asian lineage). Fat removed during upper blepharoplasty may later come to be viewed as an irreplaceable commodity that was squandered.

• Younger Patients

Those in their twenties or thirties seeking cosmetic surgery are wise to stay conservative. Future (and sometimes unpredictable) changes will occur over time. Being aggressive during the early years may be viewed with regret, especially if such actions result in functional or aesthetic changes that can't be reversed.

Conclusion

As with all cosmetic operations, surgery is best tailored to the preexisting anatomic limitations of each individual patient. When this is done with upper blepharoplasty, it is surprising how many people appear to be good candidates for this more prudent variation.

Best Place to Learn More

Tissue-sparing upper blepharoplasty: When less is more (video)