Upper Blepharoplasty (Upper Eyelid Lift)

The main reason for cosmetic blepharoplasty is the development of excess upper eyelid skin. Excess skin will result in a sleepy-eye look and communicates “I am tired” to the observer. If the condition is advanced, even the vision may become obstructed.

Dr. Frank P. Fechner performing an upper eyelid lift.

How is the Upper Eyelid Procedure Prepared?

This procedure can be performed using various methods of anesthesia. The plastic surgeon will plan the incision and skin removal. Commonly, exact amounts of excess skin are measured and the removal is planned so that afterwards, the resulting scar line will be well-hidden within the natural eyelid crease. Local anesthetic solution may be deposited under the lid skin. Then, the face is usually cleansed with sterilizing solution. Some cosmetic surgeons use special shields to protect the inside of the eyes.

How is the Blepharoplasty Performed?

Different surgeons may use their own variations of the eyelid procedure. The following are the usual steps. After making incisions as planned, the skin is removed. Often, also a small strip of the underlying lid muscle is trimmed. Commonly, excess eyelid fat is reduced. At the end, the incisions are sutured with stitches.

What are the most Important Aspects when Performing an Upper Blepharoplasty?

After ensuring the appropriate candidacy of the patient for this procedure, the planning is crucial for a successful procedure. Beforehand, the eyelid needs to be studied in order to determine, what will result in the best overall outcome. How much excess skin is present? May the patient require or request a browlift at a later time? Is there fat tissue that should be reduced and where is the fat? After a thorough planning phase, meticulous execution of the eyelid lift and avoidance of bleeding ensure a favorable outcome. Removing enough but not too much is an important guidelines when performing any type of cosmetic surgery of the face. The surgeon should be able to transform is plan into well-measured action. The suturing of the eyelid incision needs to be most accurate and exact ensuring a minimal scar line.

What kind of Stitches is used for Eyelid Lifts?

In general, there are two types of suture material used for blepharoplasty – absorbable and non-absorbable. Absorbable sutures melt away spontaneously over a period of times. The specific make of absorbable suture determines how long this will take. Non-absorbable sutures will have to be removed. This is usually a painless process usually done 4 to 8 days after surgery. Some plastic surgeons feel that sutures that require removal may lead to superior healing while others disagree. Some patients prefer if sutures do not require removal. It is probably a good idea, to let the surgeon decide on the suture type as he is usually guided by his experience.

What are Advanced Procedures of the Upper Eyelid?

There are two additional eyelid-related problems which are not addressed by a blepharoplasty as described:

  1. Low brow position. Usually, eyelid Lift surgery will not help with a brow that is too low. In rare situation, the brow may even appear lower as a result of upper lid skin removal. Considering one of the many options for brow elevation may be appropriate.
  2. Ptosis. Eyelid ptosis is clearly different from droopy excess upper lid skin. Here, the margin of the upper eyelid is too low and the whole eyelid needs to be repositioned to a slightly higher position – a procedure usually referred to as “ptosis repair”.

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