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Archive for the ‘blepharoplasty’ Category

Case Study – Double Hole Lateral Canthoplasty for Ectropion Repair

Saturday, October 3rd, 2015


Background: The position of the lower eyelid against the eyeball (globe) is of critical importance. To maintain good lubrication of the globe and to prevent the eye from drying out, the lower eyelid must be tight up against it. Like a clothesline spanning between two poles, the lower eyelid must have no slack in it and be relatively taut. Unlike the upper eyelid which opens and closes, the lower eyelid is fairly still.

The position of the lower eyelid is well known to be adversely affected by surgery due to the creation of scar and loss of lateral support. This can create a downward pulling of the lower eyelid known as ectropion. Lower eyelid ectropion deformities cause a downward and outward roll of the eyelid making it lose contact with the eyeball. When this happens the eye develops dryness ad irrigation due to exposure. Also the natural gutter effect of the eyelid position is ‘reversed’ and tears may run out the side of the eye as opposed to being directed towards the inner lacrimal drain. (punctum)

lateral canthoplastyCorrection of lower eyelid ectropion can be challenging and a variety of techniques exist to do it. All are based on using the lateral canthal tendon, or some remnant of it, to create outer support to the eyelid by attaching/resuspending it to the lateral orbital bony rim. Techniques differ based on whether it is attached to the inner or outer aspect of the lateral orbital rim. Accompanying techniques with the lateral canthoplasty are also often used including cheek lifts and in more extreme cases even skin and mucosal grafting.

Case Study: This 50 year old female developed ectropion of the right eye from prior lower blepharoplasty and other procedures. She has persistent dryness and itchiness of the eye and chronic tearing. She had failed two prior lower eyelid resuspension/elevation procedures.

Under general anesthesia she had a double hole lateral canthoplasty procedure. Above the desired point where the outer corner of the eye was desired to be, two transosseous burr holes were placed. A suture was passed from the outside in, attached to the lateral canthal tendon and then brought back out the other bone hole. The suture was then tied down pulling the outer corner of the eye upward and inside the lateral orbital rim.. Resuspension of the orbicularis muscle was done to complete her ectropion repair.

Lower Eyelid Ectropion Repair front view Dr Barry Eppley IndianapolisLower Ectropion Repair oblique view Dr Barry Eppley IndianapolisLower Eyelid Ectropion Repair side view Dr Barry Eppley IndianapolisAt six months after surgery, her ectropion remained repaired with complete resolution of all of her eye symptoms.

The double hole lateral canthoplasty procedure is as very effective procedure that solves the attachment problem. Besides a point of fixation one of its other best attributes is that it brings the attachment of the tendon inside the lateral orbital rim where it naturally is located. In moderate to severe ectropion this is my go to technique.


1) Lower eyelid retraction due to scar contracture is known as ectropion.

2) Manipulation of the lateral canthal tendon is a key element in lower eyelid ectropion repair.

3) Using bone holes place in the lateral orbital rim, a place of firm fixation for lateral canthal tendon repositioning is assured.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Upper Eyelid Lifts under Local Anesthesia

Tuesday, August 25th, 2015


Background: Upper blepharoplasty surgery, more commonly known as an eyelid lift, is the most common cosmetic eyelid surgery. It is tremendously effective and is associated with a very low risk of complications. While eyelid tissue is very thin and swells significantly after surgical manipulation, the recovery is fairly quick. The results of blepharoplasty surgery is sustained for years although its results are not permanent.

Blepharoplasty surgery is commonly done as part of other aesthetic facial surgeries such as facelifts and browlifts. As a result the swelling and bruising is seen as significant in the context of the overall face and the recovery is comparatively prolonged. But this composite facial rejuvenative surgery belies the otherwise relative ‘simplicity’ of the upper blepharoplasty procedure.

The upper blepharoplasty procedure relies on skin and some orbicularis muscle removal to create its effect. There is a debate as to whether any muscle should be removed along with the skin removal and its effect is primarily believed to help redefine the upper eyelid crease. Proper marking and not excessive tissue removal are the keys to an uncomplicated and satisfactory upper eyelid lift.

Because the upper eyelid is a small structure with thin tissues it can be fairly easily anesthetized by local anesthesia injections. Since the surgery can be done with the surgeon standing above or to the side of the patient and with the upper eyelid closed, the surgery can be performed out of the patient’s field of vision. This further promotes patient comfort.

Case Study: This 42 year old female felt her upper eyes were getting tired and heavy. She felt she had developed some hooding of skin that no amount of eyelid creams or Botox injections around the eyelids could solve.

Upper Blepharoplasty (Eyelid Lifts) under Local Anesthesia Dr Barry Eppley IndianapolisUnder local anesthesia injections into the upper eyelids, a tapering 7mm crescent of skin and muscle was removed along presurgical markings made with a caliper. The tissue segments were removed by scissors which minimized any bleeding. Small dissolveable sutures were used to close.

Upper Blepharoplasty (Eyelid Lifts) under Local Anesthesia oblique view Dr Barry Eppley IndianapolisUpper Blepharoplasty (Eyelid Lifts) under Local Anesthesia side view Dr Barry Eppley IndianapolisWithin one week after surgery she looked essentially no-surgical and had no bruising. Most of her upper eyelid swelling was gone by ten days after surgery. She described the experience as relatively painless and had no discomfort during the procedure and even afterwards.

An isolated upper blepharoplasty can be comfortably and safely performed under local anesthesia in the office. Its effects are immediate and the recovery is very short. Such an office procedure provides the most economic approach to having an upper eyelid lift done.


1) The upper blepharoplasties (eyelid lift) improves upper eyelid shape by removing hooding and redefining the upper eyelid crease.

2) An isolated upper blepharoplasty can be safely and comfortably performed under local anesthesia as an office procedure.

3) An upper blepharoplasty has a quick recovery with only moderate swelling and bruising.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Asian Love Band Surgery

Sunday, August 2nd, 2015


The Asian eyelid is very different from that of Caucasians both in anatomy and in aesthetic appearance. For the upper eyelid the ‘double eyelid’ blepharoplasty procedure is well known to create a crease which does not naturally exist. But for the lower eyelid aesthetic enhancements are less well known or requested.

Asian love band surgery indianapolisOne newer lower blepharoplasty aesthetic enhancement procedure is that known as Asian Love Band surgery. In this procedure a fullness is added to the lower eyelid just below the lashes. This is intended to enhance the underlying orbicularis muscle which in youth is fuller and more developed. (orbicularis roll) With aging the orbicularis muscle stretched and thins losing its fullness. To illustrate cultural differences in facial aesthetics,   an orbicularis roll in Caucasians would be considered undesireable and often requested to be removed. The Love Band operation is also perceived to make the eye look larger and more open, an optical illusion created by dividing the lower eyelid into two visible parts which is similar to what  “double eyelid” surgery does for the upper eyelids.

The Love Band lower eyelid surgery is done by placing small strips of grafts or implants under the skin through two small incisions at the inner and outer edges of the lid just below the lash line. Traditional materials used include allogeneic dermis (Alloderm) or Gore-Tex. The procedure can also be done non-surgically (albeit temporarily) by using hyaluronic-based injectable fillers.

Lower Eyelid Love Bands Surgical Technique 1 Dr Barry Eppley IndianapolisLower Eyelid Love Bands Surgical Technique 2 Dr Barry Eppley IndianapolisLower Eyelid Love Bands Surgical Technique 3 Dr Barry Eppley IndianapolisThe surgical technique that I have developed for Asian Love Band surgery uses temporalis fascia. This is a natural material that is harvested from small incisions in the temporal area. (although Alloderm can also be used) A small fat injection cannula is passed from one side of the eyelid to the other. The strips of temporalis fascia have a suture pass through them of which the ends are passed into the length of the cannula. The cannula is then removed leaving the suture on the other side of the eyelid. The suture is then used to pull the fascial graft through the lower eyelid tunnel, trimmed and closed with a tiny dissolveable suture.

The Asian Love Band procedure requires a method to pass a graft or implant right under the lash line through the tiniest of incisions. This cannula passing method provides a simple and effective method to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Lateral Canthopexies for Changing The Corner Of The Eye

Thursday, March 5th, 2015


Background: The shape of the eye has a significant impact on both facial appearance and expression. Its inner and outer shape is largely created by the overlying eyelids and how they come together and attach to the inside and outside of the orbital bones. The union of the upper and lower eyelids forms the inner and outer corners and this union also creates the aperture or angle between eye corners. The outside corner of the eye is probably the more important half since it controls the horizontal orientation of how eye shape is perceived.

Eye Shape Dr Barry Eppley IndianapolisEye shape most commonly has a neutral axis or a completely horizontal orientation. This means that the inner and outer eye corners are at the same horizontal spot on the orbital rim bones which creates a straight line across the eye when drawn between the two. A downward eye tilt means that the outer corner is lower than the inner corner. Conversely, an upward tilt to eye shape means that the outer corner is higher than the inner.

A horizontal or upward tilt to the outer corner of the eye is seen as most desired. Some women even prefer a more exaggerated or exotic eye cant with the outer corner being much higher than the inner corner. A downward eye tilt, which some people have naturally, is seen as undesired and can also occur from loss of outer corner lid support from any type of lower eyelid surgery.

Case Study: This 22 year-old female wanted to change the outer corner of her eyes slightly to fix their asymmetry and eliminate excessive scleral show. This was her natural eye shape and eyelid position.

Lateral Canthopexy results Dr Barry Eppley IndianapolisBecause she was having numerous other cosmetic procedures, her surgery was done under general anesthesia. Through a 7mm skin incision in the outer skin crease, lateral canthopexies were performed. The outer corners of the eye were sutured up higher on the outer aspect of the lateral orbital rims with small permanent sutures. The skin incisions were closed with very small resorbable sutures. Her six month after surgery pictures show the sustained improvement in her lower eyelid outer corner repositioning.

Lateral Canthiopexy result oblique view Dr Barry Eppley IndianapolisLateral Canthopexy results side view Dr Barry Eppley IndianapolisLateral canthopexies can elevate the outer corner of the eye and can do so without creating a bowstring or tightening effect across the entire lower eyelid. Because it stays on the outside of the bone (rather than inside like a lateral canthoplasty) it does not shorten the horizontal length of the lower eyelid. In addition, it helps to correct prevent rounding of eye shape which is more associated with that of an aging look.

Case Highlights:

1) Improving the upward tilt  of the corners of the eyes can be done by either lateral canthopexy or lateral canthoplasty techniques.

2) Lateral canthopexy vs. canthoplasty have different impacts of eye shape.

3) A lateral canthopexy technique is less likely to round out the eye shape and shorten the horizontal length of the lower eyelid.

Dr. Barry Eppley

Indianapolis, Indiana

Lateral Canthopexy vs Canthoplasty – Implications for Eye Shape

Friday, February 27th, 2015


Changing the outer corner of the eye is done for a lot of different aesthetic and reconstructive purposes. The two main reasons are to help correct a lower lid sag from prior surgery (reconstructive) or to create more of an uplifted corner of the eye to change its appearance. (aesthetic) The procedures used to do so are either a lateral canthopexy or a lateral canthoplasty

Lateral Canthopexy Dr Barry Eppley IndianapolisThe changes that occur between a canthopexy and canthoplasty is often subtle but how they are performed, their indications and the effects that result from their use is very specifically different. Understanding these eye corner manipulations requires an appreciation of eye shape.

The shape of the eye is really determined by how the upper and lower eyelids join at the corner.  This is much more so at the outer corner of the eye than the inner. (at least for Caucasians) A youthful eye is associated with a space between the upper and lower eyelids that is narrow and more drawn out to the side. In some ways it is a tight ‘bowstring’ look provided that the bony anatomy of orbit and cheek is normally developed around it. As one ages the shape of the eye changes as the lower eyelid droops. This creates an eye shape that is now rounder and horizontally shorter. In effect the bowstring effect is weakened.

Lower Blepharoplasty without lateral Canthopexy Dr Barry Eppley IndianapolisThe very frequently performed aesthetic lower blepharoplasty procedure has a high incidence of changing the outer corner of the eye. Careful inspection of many before and after surgery pictures of lower blepharoplasties will show some dropping of the lid margin, even some increased scleral show and an eye that appears slightly rounder. The changes that lie below it can show dramatic improvement with elimination of protruding fat and loose skin but the trade-off in some patients can be a slightly rounder eye and lower lid margin. This phenomenon is well recognized and accounts for today’s trending towards more tissue preservation of the lower lid and the addition of orbicularis muscle suspension support at closing.

Lower Blepharoplasty with lateral Canthopexy Dr Barry Eppley IndianapolisThe role of lateral canthopexy is greatest in lower blepharoplasty surgery for prevention of eye shape change or to restore a rounded corner afterwards. In a cnanthopexy, the point of union of where the upper and lower eyelid meet is changed and fixed to the outer aspect of the lateral orbital rim. in essence the corner is ‘pexed’ outward creating a longer and more narrowed eye shape. This is done with small sutures to the periosteum on the bone.

Conversely, a lateral canthoplasty is more invasive and requires fixing deeper tissues of the lower eyelid (tarsus or muscle) to the inner aspect of the lateral orbital rim. This is usually most effectively done by placing drill holes in the lateral orbital rim where a transosseous suture can be passed to ensure that the new canthal attachment is ‘high and tight’ inside the orbital rim.

While effectively restoring the bowstring effect of the lower eyelid against the eyeball, it does so at the expense of shortening the lower eyelid and giving it a rounder shape. For this reason lateral canthoplasties are primarily used as a reconstructive procedure for significant lower lild retraction. It restores lower lid competence but not necessarily a more youthful looking eye shape.

Dr. Barry Eppley

Indianapolis, Indiana

Cooling Gel Masks After Blepharoplasty (Eyelid) Surgery

Friday, January 30th, 2015


The eyelids are very thin tissues that are well known to swell and bruise easily. Because one’s eyes are so visible, every upper eyelid surgery patient would like their bruising and swelling to go away as soon as possible. For this reason, it is standard practice to do several after surgery strategies including cold compresses, head elevation and the oral intake of Arnica. While no one after surgery strategy is known to be universally effective, it is commonly believed that cooling or cold would be the most important.

Eye Masks for Blepharoplasty Surgery Dr Barry Eppley IndianapolisThe use of eye cooling has led to a wide variety of gel compresses for the eyes for blepharoplasty patients. Most are composed of a gel material that retains cold for a period of time after being removed from the refrigerator or freezer. The historic cooling regime was frozen vegetables (such as peas or corn) but gel pads are lighter and easier to use

In the February 2015 issue of the journal Plastic and Reconstructive Surgery, a paper entitled ‘The Effect of Eyelid Cooling on Pain, Edema, Erythema, and Hematoma after Upper Blepharoplasty: A Randomized, Controlled, Observer-Blinded Evaluation Study’ was published. In 38 consecutive patients who had upper blepharoplasties performed, one side was cooled with an ice pack and the other eyelid was left uncooled. Evaluations were done on the degree of pain, edema, erythema, and occurrence of hematoma one hour, one day, one week, and two months after surgery. Light photography was used one week after surgery to determine the degree of bruising.

The results showed showed no difference in pain between the cooled and uncooled eyelids on the day of surgery. Pain in the cooled eyelids was significantly lower one day after surgery. No differences were seen in swelling, bruising or occurrence of hematoma between the cooled and uncooled eyelids at any time point in the study. The authors conclude that because the majority of patients had no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty is not necessary.

Upper Blepharoplasty Indianapolis Dr Barry EppleyThis study casts doubt on a very long-held and logical treatment after upper blepharoplasty surgery. It just seems so logical that cooling/cold therapy would be beneficial that it is hard to believe that it isn’t. Despite what this study shows I doubt few plastic surgeons will abandon it. Particularly since it is a very low cost treatment that at the least has psychological value for the patient.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Visual Obstruction Treated By Browlift And Blepharoplasties

Monday, December 8th, 2014


Background: Changes around the eyes are the earliest signs of facial aging. As a result, the ongoing aging effects often creates severe changes around the eyes as one enters their sixties. Besides the excess skin of the upper eyelids and the lower eyelid bags, the eyebrows often sag downward magnifying the hooding effect on the upper eyelids.

Visual Field testing Indianapolis Dr Barry EppleyHooding of upper eyelid skin and brow sagging do have functional effects. By weighing down the upper eyelids there is a loss of a portion of one’s visual fields. A portion or all of the upper visual field may be lost as the position of the upper eyelid acts like a blind over a window. Partial closure of the blind results in loss of one’s ability to see what lies above as one is looking straight forward. This is often confirmed by an historic test known as Goldman’s visual field examination which evaluates the entire range of peripheral vision. But automated perimetry testing today has replaced the traditional Goldman method in many ophthalmology/optometry practices.

To correct these severe eye aging effects and to improve one’s upper peripheral vision, multiple procedures need to be done. With brow sagging, an upper blepharoplasty alone (while helpful) may induce one to remove too much upper eyelid skin and severely shorten the distance between the eyebrow and the lashline. (in essence even pulling the eyebrow down further) A browlift combined with an upper blepharoplasty is needed to not only lift up the low brows but to also reduce the amount of upper eyelid skin that really needs to be removed. Together they create a periorbital effect that is better than a browlift or an upper blepharoplasty alone.

Case Study: This 62 year-old female was bothered by the way her eyes looked and how ‘old’ her appearance. She had such severe hooding that her upper eyelid skin hung below her lashlines. The weight of her upper eyelids, combined with some brow sagging, created a pseudo ptosis look as the level of her upper eyelids enchroached on the iros of the eye.

Visual Field Obstruction Blepharoplasties result front viewVisual Field Obstruction Browlift Blepharoplasties result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, an initial browlift was performed using a pretrichial incisional approach. An irregular zigzag incision was used along her frontal hairline. A total of 8mms of vertical upper forehead skin was removed for a moderate browlift effect. An upper blepharoplasty was then done using marks done before surgery based on pulling the brows upward. Lastly, lower blepharoplasties were performed with skin and fat removal, orbicularis muscle resuspension and lateral canthopexies.

Visual Field Obstruction Blepharoplasties result side viewHer results at six weeks after surgery showed a significant improvement in the appearance of her eyes but without an overdone look. Her lower eyelids had good contact with the globe and the position of the outer corner of her eyes was maintained. She did have some mild dry eye symptoms during the first month after surgery even though she had no ectropion or eyelid malpositioning problems. This is not rare when upper and lower blepharoplasties are combined with a browlift as this will slow the blink reflex for a period of time after surgery.

Case Highlights:

1) Severe aging around the eyes results in brow sagging and upper eyelid hooding which does impact one’s superior visual fields.

2) Optimal correction of visual field obstruction requires a combined brow lift and upper blepharoplasties.

3) Lower blepharoplasties are often done at the same time to enhance the overall periorbital aesthetic effect but do not provide an improvement in peripheral vision.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Natural Blepharoplasty Results

Saturday, September 13th, 2014


Background: Aging is an inevitable consequence of living and its most recognizable effects are on the face. The first place affected on the face by aging is around and on the eyes. The near constant motion of the eyelids and its thin overlying skin are a set up for wrinkles, loose skin and bags and puffiness caused by extruding fat from under the eye. Given that the eyes more than any other facial feature reveal one’s ‘character’ and are a reported ‘mirror of the soul’,  aging changes of them reflect what most would not want others to see.

Beginning in the late 30s and early 40s, the signs of periorbital (around the eye) aging begins. Botox and other neuromuscular modulator injections do a good job of slowing down this process by decreasing the formation of crow’s feet, but it can not prevent the development of loose skin on the eyelids and the herniation of fat on the lower eyelids. These aging eye effects can be quite variable with some people more genetically prone to developing them sooner and more extensively than others. But inevitably everyone will have more of these eye aging signs than they want.

Eyelid (blepharoplasty) surgery is well known and has been around for almost a century in various forms and techniques. Most patient’s biggest fear about blepharoplasty surgery is that they will look like a different person or will look unusual or very obvious that they have had plastic surgery. They can even point to numerous celebrity examples who show exactly what they fear. How is such a result avoided? Will everyone look like they have had surgery? After all, the eyes are seen by everyone and won’t all changes be seen?

Case Study: This 58 year-old female was tired of her tired looking eyes. She wanted to look less fatigued but was afraid that she might look ‘surgical’. She had a large amount of upper eyelid skin with significant hooding. (skin laying on or near the eyelashes) Her lower eyelids show multiple redundant skin rolls and bags. Here eyebrows were not especially ptotic or has any significant sagging.

Upper and Lower Blepharoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, upper blepharoplasties was performed removing 12mms of skin centrally and sparing the underlying orbicularis muscle. Medial fat pockets were also removed.  Lower blepharoplasties were done using a skin-muscle flap technique. A three pocket fat removal, 5mms of tapered skin removal at the lateral canthus and a lateral orbicularis muscle suspension was done.

Upper and Lower Blepharoplasty result oblique view Dr Barry Eppley IndianapolisHer recovery took about ten days to look ‘non-surgical’ and three weeks to fairly normal. Many blepharoplasties will look a little tight for a period of time but by six weeks after surgery this has usually passed. Her results at six months show significant improvement but a result that retained her natural look.

An overdone or unnatural result from periorbital rejuvenation surgery is caused by numerous factors including aggressive tissue removal and an over elevated or exaggerated browlift. It is the browlift that is often at fault for a perceived abnormal eye look after plastic surgery. The effects of aggressive tissue removal, particularly that of fat, are often not seen until much later when the eye may look skeletonized or more hollow. The key to a natural blepharoplasty result is to not try and work out every excess bit of tissue or get rid of all wrinkles. While patients want the best result possible, they also d not want an over operated look either.

Case Highlights:

1) Aging of the eyes is the first facial area affected and is commonly treated by blepharoplasty surgery.

2) Four lid blepharoplasty (upper and lower eyelid surgery) is the most effective method of partially reversing the effects of aging on the eyes.

3) Natural blepharoplasty results occur when the amount of skin and fat removal is not overdone and lid function is not affected.

Dr. Barry Eppley

Indianapolis, Indiana

The Effect of Upper Blepharoplasty on Eyebrow Position

Thursday, June 5th, 2014


One of the most facial aging surgeries is that of blepharoplasty or the removal of excessive eyelid skin. It is most common because everyone develops redundant skin of the eyelids with enough age and everyone has four eyelids. Even for those patients not driven by a desire for an aesthetic improvement, an upper blepharoplasty is more common than a lower blepharoplasty because it can cause functional symptoms. The weight and hanging of excessive upper eyelid skin can push down on the lash lines, making the upper eyelids heavy and causing upper visual field impairment.

Blepharoplasty (Eyelid Tuck) Dr Barry Eppley IndianapolisBecause skin is taken away from the upper eyelid, and sometimes very aggressively to really get rid of it, the question is often asked if by doing so the eyebrow will be pulled down. Since it is common with heavy eyelids that one use their forehead muscle to lift the eyebrow and help take the weight off of the eyelids (so one can see better), does eliminating the skin reduce this habit which could also cause a drop in eyebrow position? (unmasking the real eyebrow level)

In the May 2014 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery, an article was published entitled ‘The Effect of Upper Eyelid Blepharoplasty on Eyebrow Position’. In this paper, a total of 140 consecutive patients who had upper blepharoplasty due to superior visual field obstruction were studied with before and after measurements of their eyebrow position. In addition, horizontal forehead lines were classified by degree. Their results showed that there was an average very slightdrop in eyebrow position by measurement. (less than 1.5%)  This was not visibly detectable with the exception in some men. In men, one of of six displayed a significant lowering of the eyebrow position. The sample size of men was small (14) compared to that of women. (126) Before surgery lifting of the eyebrows by means of frontalis muscle activity did not influence the position of the eyebrows after surgery, although forehead horizontal lines did seem to diminish significantly afterwards.

Male Blepharoplasty result front view Dr Barry Eppley IndianapolisTo some degree it us understandable why, in most cases, even an aggressive upper blepharoplasty does not pull the eyebrows down. Upper eyelid skin is very elastic and stretchy and allows for large resections of skin. It is not apparent at all during surgery that the position of the eyebrow moves down at all. However, it may have an eyebrow dropping effect in some men because men usually appear later for upper blepharoplasty surgery (they simply wait longer) and may have a strong and well established compensatory frontalis muscle compensation. Once their upper visual field is improved, the real natural position of their eyebrows becomes unmasked (lower) as the lifting effect of the frontalis muscle is no longer needed.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Eyelid Lifts (Blepharoplasty) in the Older Male

Monday, February 10th, 2014


Background: Aging begins around the eyes early in life and continues unabated up through one’s senior years. This periorbital aging is manifested by the creation of extra eyelid skin which is caused by the stretching of the thin eyelid skin due to frequent movement. As the redundant eyelid skin becomes excessive it weighs down the upper eyelid. Known as hooding it essentially creates folds of skin that lie on the eyelashes pushing the lid margin downward.

Older Male Eyelid hooding Dr Barry Eppley IndianapolisBetween of the weight of the eyelid skin and its folding over the lashline, an obstruction of the upper visual field results. This is often not even noticed by the individual because the visual field loss is so gradual. Getting lower and lower over the years, the loss of incoming light from a gradually smaller visual field is just credited to a naturally weakening vision with age.

With this upper eyelid hooding and visual field obstruction comes accompanying forehead wrinkles. While some of these horizontal forehead wrinkles are due to lifelong facial expressions, some of them are due to a constant holding of the eyebrows upward to lift some of the skin off of the eyelids, making one able to see better. Such browlifting is often inadvertent and unnoticed by the individual.

Case Study: This 76 year-old male wanted to improve the appearance of his eyes. He said he was frequently told he looked like he was squinting all the time. He felt he looked old and that some eyelid surgery may be beneficial. He wore glasses and had no symptoms of dry eyes.

Older Male Eyelid Lift Results front view Dr Barry Eppley IndianapolisUnder general anesthesia, a large excisional skin-only upper blepharoplasty was done. No orbicularis muscle was taken. The lower eyelids were treated by the raising of skin-muscle flaps, excision of protruding fat pockets, lateral canthopexies, conservative skin removal and orbicularis muscle suspension suturing.

Older Male Eyelid Lift results oblique view Dr Barry EppleyAfter surgery he had excellent improvement in appearance of both upper and lower eyelids. He felt he could ‘see’ better and that there was more light wherever he went. He did have a minor complication of some lower eyelid irritation and lower eyelid sag at the corners which took about two months after surgery to completely resolve.

Older Male Eyelid Lift results side view Dr Barry Eppley IndianapolisBlepharoplasty (eyelid lifts) in older patients can offer great improvement in appearance and even function. But the lower eyelid must be handled very carefully as it is at high risk for after surgery lid malpositioning. (ectropion) Even when handled well (limited skin removal, tendon tighening and muscle suspension), many older patients will experience  temporary period of lower eyelid lag symptoms.

Case Highlights:

1) Advanced aging around the eyes creates severe upper eyelid hooding, upper visual field obstruction and redundant lower eyelid skin with sagging.

2) When the amount of excessive eyelid skin is considerable, the eyes can look small and one can appear to be continuously ‘squinting’.

3) Upper and lower eyelid lifts (blepharoplasties) can create considerable improvement, opening up the eyes and making them feel less heavy.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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