Upper Blepharoplasty

Cristen Olds, MD¹; Sam P. Most, MD¹

Author Affiliations Article Information

JAMA. 2019;321(13):1320. doi:10.1001/jama.2019.1957

Upper blepharoplasty is a procedure that involves resection of redundant skin and/or musculature of the upper eyelid.

Aging of the Upper Eyelid/Brow Complex

With aging, a patient may notice the upper lids feel “heavy.” This can be caused by the eyebrow descending, upper eyelid skin excess, or both. Upper blepharoplasty, or eyelid lift, is distinct from a brow lift, which elevates the eyebrow. These procedures may sometimes be done together.

Reasons for undergoing an upper blepharoplasty may be purely cosmetic (to reduce the appearance of aging), functional (to reduce obstruction of vision by overhanging skin), or both. Functional upper blepharoplasty involves reduction of the upper eyelid to improve visual obstruction caused by redundant lid tissue. Patients may seek cosmetic upper blepharoplasty with aesthetic concerns regarding overhanging skin, which may cause a less youthful appearance. Clinical evaluation and management of both functional and cosmetic concerns is important. In addition, any ptosis of the upper eyelid (meaning that the margin of the eyelid sits too low and covers the pupil) should be noted. This is caused by poor function of the muscles of the eyelid and is treated differently (ptosis repair).

Patients with eye disease such as glaucoma or dry eye are not candidates for eyelid surgery except in special circumstances.

Basics of Upper Blepharoplasty

The procedure may be done with local or general anesthesia. Technically, the procedure involves identifying the upper eyelid crease on each eyelid and designing a skin excision that removes enough skin to alleviate the issue and preserves enough to allow normal eyelid closure. In some cases, a small amount of the orbicularis oculi (the muscle that closes the eyelid) is removed. Fat is typically preserved over the middle of the eyelid, but some removal may help with aesthetic contour in cosmetic eyelid surgery. When the procedure is complete, the eyelid is closed with sutures. The incision should lie in the eyelid crease, making it less visible after healing.

Recovery

Typically, patients may have mild bruising or swelling around the eyes for 10 to 14 days. Some surgeons may recommend avoidance of makeup for 2 to 3 weeks. Glasses may be worn immediately, but patients may be instructed to avoid contact lenses for a few weeks, depending on surgeons’ preferences.

Complications of blepharoplasty are relatively rare. The primary issue to consider is removal of too much upper eyelid skin, resulting in difficulty closing the eye. This in turn may cause chronic dry eye issues and pose a risk of injury to the cornea. For this reason, conservative skin excision is recommended. Other complications include ptosis of the eyelid (due to injury of the levator muscles), asymmetry of the eyelids, or blindness, which is exceedingly rare.

For More Information

• Mayo Clinic
  www.mayoclinic.org/tests-procedures/blepharoplasty/about/pac-20385174
• American Society of Plastic Surgeons
  www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Weissman JD, Most SP. Upper lid blepharoplasty. Facial Plast Surg. 2013;29(1):16-21. doi:10.1055/s-0033-1333833