The problem

The eyes are the most attractive and the most expressive parts of the face. Aging changes in this area can falsely project an appearance of tiredness, sadness, anger, or lack of interest. The upper eyelids in particular consist of extremely thin skin. In fact, they have the thinnest skin in the body. As the upper eyelid skin stretches, it may show the first signs of aging on the face. Droopy upper eyelid skin can become so severe that it interferes with vision by obscuring the passage of light into the optical system of the eye.

Why upper eyelids sag

Aging of the upper eyelids may be accelerated by several factors, including tobacco use, excessive sun exposure, a history of allergies, repetitive eyelid rubbing, and other environmental influences. It may also have hereditary components.

Before an upper eyelid lift

Before undergoing a corrective eyelid procedure, a medical history is performed. Dry eyes and previous laser vision correction are issues that must be discussed. Any history of allergies is also considered. An examination is an important part of the evaluation, including a measurement of visual acuity, an examination of the brow position, the position of the eyelids, and the eyelid characteristics. Photos are taken, and in some cases, a visual field examination is performed to evaluate the peripheral vision.

There are common medications and supplements that can promote bleeding. These are to be discontinued for a prescribed period of time before surgery, as directed by your physician. Lists are available which detail the types of substances that are associated with increased bleeding.

The procedure

An upper eyelid lift, or upper blepharoplasty, rejuvenates the upper eyelids. It is a surgical procedure that removes an ellipse of excess skin from the upper eyelids. Incisions are performed with a laser, a radiofrequency device, an electrocautery device, or a scalpel. The incision is most often placed in the location of the natural eyelid crease. The amount and shape of skin removed is based on the amount of redundancy and the technical and artistic skill and experience of the surgeon. Fat removal may be performed in cases where bulging fat pads are present. This is most commonly done for the bulging fat at the inner corner of the upper eyelid. Removal of fat in the central upper eyelid is often avoided, as it creates a hollowness which can be associated with an aged appearance. The incision is closed with an extremely thin suture that is removed a week later.

Upper Eyelid Blepharoplasty

Extra procedures

When the lacrimal gland, which is partially responsible for tear production is protruding at the outer corner of the upper eyelid, this is lifted back into place to improve the upper eyelid contour. Eyelid crease fixation is sometimes performed to stabilize the incision on the natural crease and to emphasize the crease itself. If the brow is sunken or the position of the upper eyelid is low (blepharoptosis), this can be corrected at the same time with a brow lift or a ptosis repair. Other procedures may also be performed with upper blepharoplasty, such as laser skin resurfacing, fillers, botox, etc. to create facial harmony and restore youthfulness. Fat preservation or the addition of facial volume is emphasized to maintain a natural look. For patients who desire thicker and longer eyelashes, a prescription medication (Latisse) may be prescribed for this purpose.

Often, lower eyelids are addressed at the same time as the upper eyelids to correct sagging lower eyelid skin, bags, and/or dark circles.

After the procedure

A topical antibiotic ointment which is safe for use around the eyes is applied to the incision area. Cold compresses are used for 48 hours after surgery to prevent swelling. It is advisable to avoid strenuous activity for the first week, but light activities and showering are permitted. A follow-up appointment is scheduled for suture removal.

Complications

Bleeding or infection are serious complications of any surgical procedure, but are extremely rare with upper blepharoplasty. Other rare complications are visible scars, dryness of the eyes requiring eye drops, and drooping of the upper eyelids. These conditions are treatable with scar therapies, dry eye therapies, and/or other procedures. Hollowing can occur if too much fat is removed. Too much or too little eyelid skin removal can require further corrective procedures. These risks can be minimized by having your procedure performed by a trained oculoplastic surgeon.