Upper Eyelid Surgery

Upper Eyelid Blepharoplasty

Upper eyelid blepharoplasty (also known as an eyelid lift or tuck) is an operation that removes excess skin and puffiness from the upper eyelids.  In this procedure, an incision is made in the patients pre-existing upper eyelid crease so that no knew line is created.  Through this incision, excess skin is removed and the area may be gently sculpted to enhance the contour between the eyelid and the eyebrow.  This procedure results in a more youthful and rested look.  It can improve peripheral vision and can lessen the feelings of fatigue and eye strain.  Medical insurance may cover a portion of the procedure if the excess eyelid tissue covers a part of the pupil and blocks the peripheral vision.

This woman had a small incision brow lift as well as upper eyelid blepharoplasty and lower eyelid fat repositioning
This Boot Camp instructor wanted her face to match her youthful body. She had an upper eyelid blepharoplasty to remove excess upper eyelid skin, and lower eyelid fractionated CO2 laser plus lateral canthoplasties
This man was bothered by excess skin weighing down on his outer upper eye lashes. This problem was solved with an upper eyelid blepharoplasty. He also had a very light CO2 laser treatment on the lower eyelid skin.
This man only wanted what was needed to see better, so he only had an upper eyelid blepharoplasty.

Ptosis Repair

Ptosis, or droopy upper eyelids, results from inadequate muscle function.  This can occur because the muscle that raises the eyelid thins or slips.  The result is that the eyelid margin (the part the eyelashes are attached to) drops down to cover the top portion of the eye and sometimes even the pupil.  This can be seen in children who are born with eyelid muscle that contracts poorly.

Eyelid ptosis is repaired by shortening the muscle or by reattaching the slipped muscle to raise the eyelid.  There are two muscles in the eyelid:  the major muscle, the levator palpebrae, which is just under the eyelid skin, and a smaller Mueller’s muscle which is posterior near the back surface of the eyelid.  Either or both of these muscles may be operated on.

Ptosis Repair: Adult Posterior

In this surgery the smaller posterior muscle, or Mueller’s muscle, is shortened.  The posterior ptosis repair is the shorter surgical procedure in time than the anterior levator advancement.  A test can be performed in the office before surgery that will show the doctor and the patient what results can be expected from the procedure.  The incision is made on the back surface of the eyelid so there is no skin incision.

This procedure can be performed in combination with an upper eyelid blepharoplasty so that the eye is opened wider and excess skin is removed.

A right upper eyelid posterior ptosis repair and bilateral upper eyelid blepharoplasty made her eyes match better.
This man had bilateral upper eyelid posterior ptosis repair which helped him keep his eyes open to read and see better.
After having a small incision brow lift to elevate the brows and upper eyelid skin, plus a posterior ptosis repair to open his eyes wider, this man’s field vision was much increased. He also looked and felt more awake.

Ptosis Repair: Adult Anterior

In this procedure, an incision is made to the patients pre-existing upper eyelid crease.  While in the operating room, using sedation and local anesthesia, the patient will be asked to open and close his or her eyes.  The stitches that shorten this eyelid muscle are adjusted so the eyelids can match each other in height and so there is a desirable and matched arch and contour to the eyelid margin.  Excess skin can be removed, using a blepharoplasty procedure, through the same incision site that is used to shorten the muscle.

This Asian woman had such severe ptosis that she could only see by tilting her head back and chin up to see under her drooping eyelids. She needed anterior levator advancement ptosis repair. She also had lower eyelid fat repositioning to partially fill in the hollows under her lower eyelids.

Ptosis Repair: Childhood Ptosis

Some children are born with levator palpebrae muscles that do not work well.  The movement of the eyelid from down-gaze to up-gaze is decreased.  Although the surgery cannot increase the range of motion, a drooping eyelid can be raised to open the eye wider.  This procedure generally requires a larger amount of shortening of the levator palpebrae muscle than in adults.  In children there is a greater chance of needing a second operation to get the levels just right.

This 4 year old child was born with bilateral congenital upper eyelid ptosis with minimal movement of the levator palpebrae muscle. The eyelid muscle function was so poor that the eyelid was connected to eyebrow using a buried frontalis“sling”; he could then raise his eyebrows to open his eyes.