SURGICAL EYELID TREATMENTS
Upper eyelid surgery is often recommended for functional or cosmetic reasons or a combination of the two. Brow surgery may also be recommended, although this is far less commonly indicated. Most medical insurance companies will cover upper blepharoplasty surgery if the conditions for functional visual impairment are met.
Generally, surgery involves excision of some redundant skin, underlying muscle and if necessary, excess fat. The skin crease is an important structure in the upper lid as this determines the position of the fold which drapes the upper lid.
The skin crease is typically higher in women than men and lower or absent in most oriental races. Loss of the skin crease can contribute to the overhang of skin and often reformation of the crease is indicated during blepharoplasty surgery.
Upper blepharoplasty is the most common cosmetic surgical eyelid procedure performed. There is a very high satisfaction rate amongst patients and it should achieve a significant cosmetic improvement in the upper lids while still maintaining a natural appearance.
This surgery involves removal of skin and removal or redistribution of fat. There
has been a move away from skin excision in recent years as this is more likely to result in lower lid retraction or ectropion formation. Another trend has been towards reducing the removal of fat in the lower lid, as this can skeletonise the face, ultimately hastening the aging process.
A prominent hollowing (termed the “tear trough”) can occur at the junction of the lower lid and cheek, and this usually relates to a combination of loss of fat over the rim, fat prolapse above this and cheek descent. Fat may be redistributed into the tear trough to address this condition though more recently tissue fillers have been found to give very good improvement and now are often the treatment of choice.
The current approach to lower blepharoplasty is to assess whether to remove, reposition or replace tissue (refer below).