How Upper Eyelid Surgery is Performed

How Upper Eyelid Surgery Is Performed

Video transcript: Upper eyelid blepharoplasty is performed through a small incision that occurs in the upper eyelid. There’s a natural forming crease usually about 10 millimeters from the lash line that forms when we open our eyes. That crease is used as the inferior end of the skin incision. That skin is incised and the extra skin above that is removed. Now of course it’s important that some extra skin will be left behind, so patients can open and close the eyes comfortably even after the skin is removed. In addition to that, for patients that require it, a small amount of orbital fat is removed from behind the eyelid structures. A small incision is placed in a place called the orbital septum, and this allows for access to the fat and gentle removal. When this is completed, the skin and muscle layers are closed, the stitches – they generally need to stay in for about a week.

In this schematic diagram which you can see is that there is extra skin from above that crease line that is hanging down over the crease. That crease is called the super tarsal crease. When the skin hangs over the crease, it gives the impression that the eye is more closed or more heavy. In some cases it sags and hangs over so much, that it has a curtain effect on the eyes such that the patient can often have trouble seeing in the lateral and superior aspects of their visual fields; almost as though there is a curtain of skin that is folding down over their eye.

Here’s an example of a patient who I performed an upper blepharoplasty for. She had a little bit of extra skin, although it’s not severe, she does have some extra fat that sits behind the eye as well, and this fat although it is normal and not related to body weight, seems to bulge forward as we get older. The eyelid structure is not quite as tight as we age, so the fat that normally sits there in position starts to bulge forward with time. So in her case, I made a small incision in her supratarsal crease, again, about 10 millimenters from her lash line. I removed that extra skin that was above that incision line and I also accessed the retro orbital base to remove some of the additional fat that was bulging forward. Then I closed the stitches and the stitches were removed after a week, and this is how she looks about six weeks after the surgery.