Upper Eyelid Blepharoplasty
Zinaria Y. Williams, MD
DISEASE DESCRIPTION
The purpose of upper eyelid blepharoplasty is to remove redundant skin and fat prolapse that result from changes to the aging face. This is done both for aesthetic reasons and to address the functional deficits in vision that occur as a result of the mechanical ptosis caused by upper lid dermatochalasis. A variety of functional and cosmetic surgical interventions can be offered to address these changes of the upper face (Figure 6.1).
 FIGURE 6.1. Pre- and postoperative photos of a patient undergoing bilateral upper lid blepharoplasty. Note the improvement in marginal reflex distance and increase in pretarsal show following surgery. |
PREOPERATIVE CONSIDERATIONS
Aging face considerations
Eyelid and facial tissues lose volume and tone.
Collagen attenuation and dermal atrophy lead to skin laxity and reduced elasticity.
Environmental factors, including sun exposure and smoking, accelerate the skin changes that contribute to the aging process.
Retaining ligaments and other supportive fascial layers stretch, causing fat and muscles of the upper face to droop.
Brow ptosis and loss of lateral brow support cause additional excess skin to drape across the upper eyelid, often manifested as temporal hooding.
The orbital septum weakens, which can lead to fat and lacrimal gland prolapse.
Coexisting conditions — the primary task in evaluating for blepharoplasty is to determine whether the patient requires correction of other involutional facial changes at the same time.
Brow ptosis
Blepharoplasty in the presence of a significantly ptotic brow will result in further depression of the brow.
In a combined case, the brow lift should be performed before the blepharoplasty because elevation of the brow will change the amount of eyelid skin that will need to be removed.
Orbital fat prolapse
Determine in advance whether fat removal is indicated. The presence of excessive nasal fat is an aging aesthetic and is usually treated concurrently.
Conversely, aggressive resection of preaponeurotic fat can result in hollowing of the superior sulcus, which contributes to an aged aesthetic. Therefore, removal of preaponeurotic fat is rarely performed and, when undertaken, is done conservatively.
Blepharoptosis
Concurrent myogenic ptosis is commonly seen with upper lid dermatochalasis. Preoperative assessment to determine the presence of blepharoptosis is done by manually lifting the skin of the upper lid without placing any traction on the eyelid itself. This allows for a true assessment of the upper lid position without the weight of the lid and brow tissues causing a mechanical ptosis.
If the marginal-reflex distance remains low when this technique is performed, the patient will require a ptosis procedure at the same time as the blepharoplasty to adequately address the upper lid position.
Low tear production and dry eye
The resultant increase in palpebral fissure surface area following blepharoplasty can increase the evaporative rate of tears, and so a conservative approach is recommended in dry eye patients.
Lacrimal gland prolapse
Prolapse of the gland from within the lacrimal gland fossa may cause fullness in the lateral lid and can contribute to the mechanical ptosis seen in dermatochalasis.
This can be addressed by performing a lacrimal gland pexy at the same time as the blepharoplasty.
INDICATIONS FOR SURGERY
Dermatochalasis that obscures the superior and temporal visual field (Figure 6.2)
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
