Background: The desire for wider or more open eyes to improve one’s expression is not uncommon. Most of the people who seek such eye surgery have an abnormal eye appearance known as ptosis. This is where the upper eyelid hangs down lower than normal and covers up some of the iris or the colored part of the eye. The position often gets lower later on in the day as the eyelid muscles get more tired. Technically the upper eyelid margin should fall no lower on the iris than about 1mm. Anything lower gives the eye a tired or sleepy appearance.
Surgical repair of eyelid ptosis is well known and the exact surgical treatment depends on how much ptosis exists and its cause. Surgical techniques include levator resection, muller muscle resection and a frontalis sling procedure.
But a few select patients do not have true eyelid ptosis or it is very minor but still want a more open eye appearance. This raises the question of whether a ptosis like upper eyelid procedure can be performed on a normal eyelid without ptosis. Technically the procedure is the same even if the eyelid has a normal position. The more relevant question is whether by raising up a normal upper eyelid margin if this will have any negative effect on lid competency and adequate globe lubrication. (incomplete lid closure can create eye dryness)
Case Study: This 21 year-old female felt her eyes were not open enough. She felt her upper eyelids were too low and wanted them more wide open. She did have about 2mms of ptosis and a long upper eyelid vertical skin distance.
Under general anesthesia she had an ptosis repair blepharoplasty procedure done through an upper eyelid skin crease. Five levator-tarsal sutures were placed to raise the upper eyelid margin. Under general anesthesia this was more challenging as no dynamic eyelid motion could be done.
Her after surgery results showed better elevation of the central part of her upper eyelid with increased iris exposure. She had no eye dryness issues.
Creating more wide open eyes usually involves the treatment of ptosis whether the patient recognizes they have this eyelid condition or not. As long as the upper eyelid margin does not create a scleral gap as a result of the ptosis repair there is no risk of eye dryness or creating an unusual eye appearance. (startled) Wider eye surgery involves increasing the vertical distance between the eyelids and is a form of ptosis repair to do so.
Highlights:
- Ptosis repair is generally reserved for use in patients that have actual upper eyelid ptosis.
- A wider open eye in the vertical dimension can be created using a ptosis repair blepharoplasty technique. (levator-tarsal suture fixation)
- The upper lid margin should sit no higher than the top of the iris.
Dr. Barry Eppley
Indianapolis, Indiana