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Posts Tagged ‘upper blepharoplasty’

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

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: Upper Blepharoplasty and Browlift For Vision Obstruction

Thursday, November 3rd, 2011

Background:  Aging is a lifelong process that is both relentless and progressive. In the face, the earliest signs of aging occur around the eyes. Beginning with wrinkles and eventually ending up with sagging eyelid skin and brows, the eyes and its surrounding structures (periorbital region)  show the range of manifestations that occur with the aging process. Because the eyes are the most visible area seen in every human interaction, their appearance has an influence on the perception of how one is perceived by others. But aging can also affect the main function of the eyes which is to see clearly.

In the latter stages of periorbital aging, usually ages 60 and beyond, the issue of aging goes beyond merely that of wrinkles. Upper eyelid skin becomes so excessive that skin hangs down on the eyelashes, creating not only a heaviness but impinging on one’s upper visual field. Without even knowing it, one loses how much light enters the eyes and the world becomes ‘darker’  and smaller in scope. and  The amount of upper eyelid skin rolling over onto the lashes is made even greater if the eyebrows have also dropped. Sagging eyebrows push the upper eyelid skin lower, dragging the level of the upper eyelid down creating a pseudoptosis appearance.

Case Study: This 69 year-old female presented with heavy eyes and an almost squinting appearance. She felt she looked tired and had a constant feeling of skin on her eyelashes. She regularly pulled up on her brows and eyelids to lift up the overhanging skin. Her eyelashes were completely covered by upper eyelid skin and were not visible. Her eyebrows were slightly below the brow bones. Visual field testing showed that almost all of her upper fields were obscured.

Under general anesthesia, an upper periorbital rejuvenation surgery was done. The first step in her procedure was to do a browlift. Because of her already long forehead, an open browlift was done using a hairline or pretrichial approach. Approximately one centimeter of skin was removed in the midline tapering out into the temporal areas. After the browlift, an upper blepharoplasty was done removing a large amount of skin and a small amount of orbicularis muscle. Her total procedure time was 90 minutes and she was discharged to home a few hours later.

Her frontal hairline and upper eyelid sutures were removed one week after surgery. Her swelling at that point was still discernible with some small amount of bruising. When seen just three weeks after surgery, she looked completely ‘non-surgical’. Her biggest comments were in how everyone told her how much more refreshed she looked and that she could see so much better. She noted how much brighter everything looked with some much more light being seen. She has to start wearing sunglasses again when outside because of the brightness.

Case Highlights:

1) Opening up the aging periorbital region through upper eyelid tucks and a browlift can make a dramatic difference in one’s appearance and how it is perceived.

2) When considering an upper blepharoplasty (eyelid tuck), consideration must be given to the position of the eyebrow and the possible need of a browlift.

3) A good periorbital rejuvenation result makes one look refreshed and less tired but does not make one look like a different person.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Upper Blepharoplasty (Eyelid Tuck) – Less is More

Wednesday, January 27th, 2010

Aging of the eyelids and periorbital area is one of the earliest signs of facial aging. This makes blepharoplasty (eyelid tuck), and an upper blepharoplasty in particular, a workhorse procedure in the arsenal of facial rejuvenation procedures. Many patients fear, however, that such an eyelid procedure will change their appearance somehow rather than making it more youthful or rejuvenated.

When considering an upper eyelid procedure, one has to take into account the position of the eyebrow. A low or descended  eyebrow can make it appear that more extra skin is in the upper eyelid than really exists. But what defines if an eyebrow is too low or ptotic? That would depend on where one’s brow was in youth. I would submit that most people do not remember where it was in their youth in most cases. This leaves it up to the plastic surgeon to provide an assessment which often leads to an excessive amount of browlift procedures being performed. The benefits of a browlift should be looked at very carefully as they often do not achieve as much rejuvenation as one would think.

Traditional upper blepharoplasty procedures involve the removal of excessive skin and a strip of orbicularis muscle. Often times fat is also removed from the upper eyelid compartments. These eyelid maneuvers often leave the upper eyelid area hollowed with an eyelid crease that sits too high. As the new eyelid crease sits up too high, the upper eyelid sulci become too deep and creates an unyouthful volume-depleted appearance.

Today’s blepharoplasty techniques make several changes to avoid the aforementioned negative effects. First, the upper eyelid crease incision is made lower than a traditional approach. This keeps it from becoming retracted too high after surgery. Secondly, no orbicularis muscle is removed. There is no benefit to disrupting this muscle support system of the upper eyelid and introducing more scar. Skin only is removed . This also plicates or rolls the underlying muscle onto itself adding some fullness. Third, there is little if any need to remove fat from the upper eyelid. This will avoid the potential for creating a volume-depleted look. Last, the use of browlifts are used only when the brow has severe ptosis where it is positioned below the brow bone. When browlifts are done, there is more focus on lateral brow elevation rather than the inner part of the brow.

Patients fear undergoing eyelid surgery because it may make them look different. More likely with traditional upper eyelid methods, they may not look as rejuvenated or youthful as they would like. A more ‘conservative’ upper blepharoplasty with emphasis on fat and muscle preservation can lead to a more natural looking result that does not alter one’s appearance. Browlifting should be done with caution avoiding an overelevated result.    

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Upper Blepharoplasty and Eyelid Scars

Monday, September 21st, 2009

Aging around the eye area is one of the first and often most significant signs of facial aging. The areas around the eye that change are the brow and both upper and lower eyelids. All the above sag due to not only loose skin but redundant (extra) skin as well. Most patients have a clear idea of these issues when it comes to the upper eyelid. They can clearly see skin hanging down onto their lashes and loss of the youthful supratarsal crease or fold that previously existed between the brows and the eyelashes.

Correction of the aging upper eyelid, known as upper blepharoplasty, is one of the simplest and most successful of all facial plastic surgery procedures. While it does cause some temporary bruising and swelling, the removal of a strip of the extra eyelid skin helps create an immediate change. The upper eyelid is tightened and the supratarsal fold is immediately restored.

 One of the potential concerns that some patients may have about the procedure is the risk of visible or poor scarring. The good news is that is one issue which is a rare problem. The scarring is so good in this area, and the scar is always hidden when you are awake (with the eye open, the upper eyelid crease rolls back inward), that this is really a non-issue most of the time.

 There are several reasons for the almost always good scarring which occurs on the upper eyelid. First, the upper eyelid has the thinnest skin on the entire body. The thinner the skin (with less dermis), the less tissue there is to produce scarring. Scar formation comes from the skin’s dermis which is paper-thin. Quite frankly, the excellent eyelid scars we see is as much the result of its thin skin as it is surgical technique. Secondly, the scar line is sufficiently above the lashline of the upper eyelid that it is completely covered when one’s eyes are open. To find an upper eyelid scar, you would have to ask the patient to close their eyes and then look carefully up close. Lastly, most poor scarring comes from wounds that are closed under significant tension. As the eyelids spent a significant part of their time being open, the incision closure or scar line is not under much stretch or tension.

In my Indianapolis plastic surgery practice, I have observed that the upper blepharoplasty is a very effective and simple procedure to go through. Most patients report virtually no pain, no matter how it looks to the viewer. Scarring is a very rare issue with blepharoplasty or eyelid surgery.

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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