Upper Eyelid Surgery/Blepharoplasty

Quick Links to Upper Eyelid Surgery

Overview Upper Face Rejuvenation Are you a good candidate? What do you want to change Benefits Dr. Cruise's philosophy regarding Upper Eyelid Surgery Consultation / Physical Exam Prior to surgery Anesthesia After the procedure Recovery time Possible complications Upper Eyelid Surgery Before and Afters

Overview of Upper Blepharoplasty

Aging affects the entire face. Aging around the eyes, however, is usually the first area that is noticed. The aging process can be simplified by thinking of it in terms of the three most important components of the face. These components are the skin, the underlying muscle, and the fat. Most people do not think of aging as involving the latter two structures but, in reality, these are probably the most important ones. Have you ever looked at a baby's cheek? It is full and fatty. Look at a model’s cheek. It is not as full as a baby's cheek but still it has significant volume due to the underlying fat.

Before & After

There is a substantial amount of fat situated around the eye region. As we age, the fat will either descend downward on the face or may go away completely. When this happens, it exposes the underlying facial skeleton resulting in the familiar gaunty appearance that we recognize as aging. Also, the fat and underlying muscles act as a filler creating the volume seen in the cheeks of youth. When this filler descends or goes away, we see wrinkling. This process is similar to a grape which turns into a raisin when the water is removed.

The importance of the underlying fat and muscle has been revolutionary in the field of plastic surgery over the last 10 years. It is no longer acceptable to think of eyelid rejuvenation as merely a procedure to tighten the skin. This is why Dr. Cruise feels it is so important to correct the problem itself and not just the effects of the problem.

When evaluating the upper eyelid there are three important components of the upper eye region that must be considered. The eyebrow, the upper lid itself, and the lateral canthus. Typically, these three areas sag at different rates and, therefore, each patient must be assessed individually.

Most patients need removal of fat and skin to create an elegant upper eyelid crease.

Descent and laxity of the lateral canthus is a major contributing factor to the appearance of old age within the eye region. This sagging gives a depressed, tired appearance. The upper eyelid of youth has a bright, open appearance. Of particular note is the fact that the lateral canthus should be higher than the medial canthus. Dr. Cruise feels that it is important to address this issue to create the best look possible. Often, he will elevate the lateral canthus in conjunction with the upper blepharoplasty to re-create that youthful, almond-shape appearance. See above.

Others need correction of all three elements comprising the upper eye: The eyebrow, the eyelid, and the lateral canthus.

Often, Dr. Cruise will perform a Temporal Brow Lift instead of a conventional brow lift when he does upper blepharoplasty. This is much less invasive, yet, still effective. The Temporal Brow Lift only addresses the temporal area but this is usually what needs elevation the most. The decision as to what is best for you can only be determined during consulation.

There is a fourth potential problem area when addressing the upper eyelid that is not talked about much and often goes unaddressed. This is eyelid ptosis, also know as, descent of the upper eyelid. See example below.

Example of 26-year-old female six weeks before her wedding. She complains that her left eye(right side of picture) was lower than her left. Notice in the BEFORE, how the left upper eyelid touches the pupil, whereas, the left eye is wide open and bright. Also notice difference in eyelid height. After shows both lids at the same level and similar eyelid height.

Eyelid ptosis becomes quite common as we age. The muscle that elevates the upper lid simply breaks off and the lid lowers. It may be one side or both. It gives the appearance of a chronic tired eye. Correction opens the eye and gives a brighter, more awake appearance.

The take home point to all this information is that there are several elements of the upper eyelid region that must be evaluated during and upper blepharoplasty exam.

It is important to understand the limitations of upper blepharoplasty. An upper blepharoplasty alone will not correct crow's feet. It will help but often a concurrent brow lift or temperal brow lift is necessary. Often, Botox® may also be helpful.

It is often very useful to perform fat transplantation, as well as either chemical peeling or laser skin resurfacing, in addition to eyelid surgery. This allows Dr. Cruise to address all the components associated with aging around the eye. Remember, the aging eyelid is a result of problems within the skin, muscle, and fat.