While the anatomy of the upper and lower eyelids is nearly identical, and the aging process which they undergo obviously similar, freshening up the eyelids is different whether you are north or south. Compared to the lower eyelid, the upper eyelid offers a ‘simpler’ procedure that, quite frankly, has fewer risks or complications
In the lower eyelid, because it is suspended like a clothesline from one side of the eyebone to the other, too much skin removal or aggressive surgical handling, may make it pull down after surgery as it heals. This condition, known as ectropion, can cause a lot of eye irritation and tearing as the eyeball really wants the eyelid tucked up close against it. (this keeps it lubricated and allows the eyeball to be washed clean, so to speak, with each blink that we do) Even an infinitely small gap between the eyeball and the eyelid can cause this problem. In older patients, where the ‘clothesline’ is not as strong as in youth, the risk of ectropion is significant and some tightening of the tendon that attachs the eyelid to the bone is often done at the same time to prevent this potential complication.
The upper eyelid does not pose the same potential problems as the lower eyelid. There is no risk of the eyelid pulling away from the eyeball with skin removal and, as a result, much more skin can be taken. By comparison, it is usually possible to take three or four times as much skin from the upper eyelid as the lower eyelid. Difficulty with eyelid closure from too much skin removal on the upper eyelid, while possible, is rare. Since the movement of the upper eyelid is primarily responsible for most of eyelid closure (the lower eyelid is pretty passive), its continuous downward movement can also stretch out the eyelid fairly quickly should a tad too much skin be removed. The lower eyelid has no such capability.
The intricacies of upper eyelid surgery is all in the placement and design of the incisions and the cutout pattern of skin and muscle. Incisions on the upper eyelid which are placed too low may be visible, incisions placed too high may create an unnatural appearance after surgery. And, of equal importance, incision placements must be identical on both eyelids to make a good matched set.
As an Indianapolis blepharoplasty surgeon, I have learned that an upper blepharoplasty is tremendously effective, fairly simple to undergo, and has few complications. But the real bonus is that it is virtually painless! Yes there will be some mild swelling and bruising, but with a week or two, you will have a result that will last for many years.
Dr, Barry Eppley
Indianapolis, Indiana