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Aging of the eyes is often the first sign of facial aging. Its develops initially because the thin skin of the eyelids and their frequent movement creates excessive excessive and loss skin. The upper eyelid often suffers the worst because it actually is more active than the lower eyelid with a greater excursion of movement. Skin folds or hooding develops eventually in everyone and no one is immune to this occurrence.

For this reason upper blepharoplasty or an eyelid lift is one of the most common of all facial plastic surgeries. In this procedure the excessive upper eyelid skin is removed with or without a strip of orbicularius muscle. In some cases bulging orbital fat may also be removed but the cornerstone of the procedure’s success lies in the skin removal. This is unlike the lower eyelid where considerations of fat removal, management of tear troughs and laxity of the lower eyelids all play a significant role in the aesthetic outcome of the procedure.

While the tissue removal in upper blepharoplasty seems ‘simple’ it is still a precise operation that must be marked out carefully before surgery. The final location of the incisional closure is critical as the scar line needs to end up in a natural skin crease that is hidden when the eye is opened. It can not end up too high or too low and should be retracted back into the depth of the supratarsal crease as the eye opens for invisibility. The symmetry of its location in each eyelid must also be equally matched from each lid’s lash line.

There can be a debate about the merits of removing any orbicularis muscle with the upper eyelid skin removal. In doing so the depth of the supratarsal crease may be deepened for better eyelid crease definition and without any compromise of upper eyelid closure function.

Dr. Barry Eppley

Indianapolis, Indiana

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