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Upper blepharoplasty or eyelid surgery is the surgery that seeks cosmetic improvement of the upper eyelid.
This surgical technique allows us to eliminate the excess skin of the upper eyelids, managing to clear the look, to give us a rejuvenated and more rested aspect.
Besides, when the excess of skin in the eyelids is significant, it can cause visual fatigue and a feeling of heaviness, and with the surgery an immediate improvement is achieved in that aspect too, in the form of less visual fatigue.
The most frequent candidates for an eyelid operation or upper blepharoplasty are usually women and men over 40 years of age in good general health.
Some patients, due to their individual features, present an apparent excess of skin from earlier ages.
In these cases it is usually more of an Asian type eyelid configuration, with the palpebral fold lower, and that gives an appearance of excess skin.
It is important to detect those patients who have droopy or low eyebrows, since in these cases the blepharoplasty alone does not manage to clear the eyelid sufficiently and it may be necessary to add a brow lift to achieve an appreciable result over the look.
Like any cosmetic surgery intervention, for an eyelid operation or blepharoplasty it is important to have reasonable expectations. In other words, this surgery will enhance your appearance and may make you feel better about yourself, but it cannot achieve dramatic changes in your looks and its effect is limited to the upper eyelid.
Any preexisting medical problems should be controlled prior to such surgery, especially hypertension and diabetes, as well as discontinuing anticoagulant medications.
There is no medical problem that prevents this surgery, as long as it is well controlled.
The upper blepharoplasty or upper eyelid operation is considered by many surgeons as a simple act of “removing skin, muscle and fat”. But this simplification means that there may be many patients who are dissatisfied with the surgery, since the changes that occur in the eye region with age are complex and are not simply an excess of tissue, such as: the state of the eyelid fold, the position of the eyebrow, or the loss of fatty tissue.
The analysis of each patient and the selection of the appropriate surgery for each one is the key to success in a superior blepharoplasty.
The objective is to rejuvenate while preserving our own features; that is, to look like our photographs from years ago.
Too aggressive surgery on the skin, muscle and fat of the upper eyelid results in “hollow” eyelids, sunken eyes, a sad look and in the worst case difficulty in closing the eyes.
Upper blepharoplasty is performed by making an incision on the natural crease of the upper eyelid, so it follows the natural tension lines of the skin and is also hidden in the upper orbital crease.
The use of electric scalpel or laser to make the cut avoids bleeding and shortens recovery. Through these incisions we can work the excess skin and/or fat, while the orbicularis muscle remains intact.
Some patients with a low or sagging palpebral fold may need to have it reshaped, otherwise the surgery may not achieve the desired effect.
If the patient requires a correction of palperal ptosis (see drooping eyelid), this can be done through the same blepharoplasty incision. On the other hand, when the eyebrow is very low (especially the tail of the eyebrow), it may be necessary to lift it in the same act (see eyebrow lift).
Special mention is required for the use of lipofilling in upper eyelid rejuvenation.
Some patients show with age a clear loss of volume in the upper arch, which causes the upper eyelid to have a “deflated” look, amplifying the sensation of excess skin.
In these cases, if we remove all the apparent excess skin without treating the loss of volume, we provoke in the patient a deep furrow that the patient had never had before and it can look different. In addition, it should be noted that the deep grooves in the orbits age.
Restoring lost volume in these patients is possible thanks to advances in lipofilling techniques: We use small particles of fat (Micro-fat), extracted from the abdomen by means of liposuction, which integrate perfectly without problems of irregularities. This way along with the upper blepharoplasty these patients can have a more youthful appearance with a fuller eyelid.
Dr. Nieto is a reference in oculoplastic surgery. He combines his activity in reconstructive surgery in public medicine with his private reconstructive and cosmetic activity at the Clínica Corachán in Barcelonaand the Instituto Oftalmólogico Gabriel Simón in Madrid.
Clínica Corachán 2, bajos. Plaza Manuel Corachán 4, Despacho 8 Barcelona 08017
Instituto Oftalmológico Gabriel Simón Fuencarral, 7 28004-Madrid
