Preserving or Enhancing Upper Eyelid Volume
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Photo Essay
 Actual surgery photos
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Age-related upper eyelid bagginess in a middle-aged woman.
Note the concavity between the crease and brow.
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Lids elevated manually to reveal preexisting but camouflaged
upper orbital fat hollowness
(Surgery series shows patient's right eye)
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Skin to be removed is outlined and incised. The adherent underlying orbicularis muscle is not cut.
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Dissection is slow and careful to preserve all muscle, some of which typically comes off with the skin or is intentionally removed during standard blepharoplasty.
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Skin has been removed with full preservation of muscle. In selected cases, a tiny incision can be made to allow removal of some fat nearest the nose, but the middle fat pad extending across the lid is never violated. In this patient, no nasal fat was removed.
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The first suture reapproximates skin edges. The "excess" orbicularis muscle below is folded into a roll of padding that adds slight bulk and fullness.
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| As suturing progresses, preexisting hollowness above the incision line is diminished.
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Suturing complete. Despite substantial skin removal, brow position is preserved and deep volume appears increased.
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Same patient (still healing)
Despite significant skin removal, brow position has been preserved and fullness above the crease has been enhanced. The appearance is both natural and more youthful.
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(Surgery by Dr. Frank Meronk)
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