Plastic surgery

Upper Eyelid Blepharoplasty: pictures, recovery time, history

Mary Bell - plastic surgeon
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Medically reviewed: 29, November 2023

Read Time:5 Minute

What is the upper eyelid surgery

Upper blepharoplasty (upper eyelid blepharoplasty) involves the removal of excess overhanging skin and adipose tissue in the region of the upper eyelids. Indications for the upper blepharoplasty are:

  • age-related changes in the eyelids (the so-called aging eyelids),
  • overhanging eyelids,
  • congenital features of the upper eyelids,
  • increased eye fatigue due to excess upper eyelid skin,
  • narrowing of the visual fields,
  • wrinkled skin folds and subcutaneous fatty hernia,
  • the desire to change the incision of the eyes.

Technique of upper blepharoplasty

Before carrying out the upper blepharoplasty, the surgeon determines skin excesses in the upper eyelid area, and the appropriate marking is made on the palpebral fold. In the course of the operation, the excess contour of skin, and then of fatty tissue (“fatty hernia”), creating protrusions in the inner corners of the eyes, is excised.

Sometimes during the upper blepharoplasty, the fat tissue is not removed, but simply redistributed throughout the eyelid. Cutaneous incisions on the upper eyelids are located along the natural folds, from the inner corner of the eyelid to the outer one, which makes them subsequently virtually invisible.

At the end of the upper blepharoplasty, a neat cosmetic suture is applied, which is covered with narrow strips of aseptic patch of corporal color from above. The suture is removed on the third day, its healing is accompanied by the formation of a thin cosmetic hem, hidden in the natural fold of the eyelid.

Usually patients tolerate upper blepharoplasty easily. An extract from the clinic is made on the day of the operation or the next day. As a rule, pain, vision impairment or lacrimation after upper blepharoplasty are absent, the rehabilitation period is from 7 to 14 days.

If the problem of the upper eyelids is caused by ptosis, the lowering of the eyebrows and forehead, the upper blepharoplasty, as a rule, is combined with the endoscopic forehead lift. Performing combined blepharoplasty can smooth out the forehead skin, raise eyebrows and eliminate sagging of the eyelids.

For blepharoplasty plastic surgery uses one of two methods: percutaneous and transconjunctival.

Possible complications after upper eyelid surgery

With upper blepharoplasty, excision of fatty hernias and excess skin is performed.

The most frequent aesthetic complication of upper blepharoplasty is a slight change in the shape of the eye – its rounding.

Removing an excessive amount of skin during blepharoplasty can lead to contouring the edge of the orbit or even the uncoil of the eyelids in the patient during sleep, which in turn is fraught with the drying of the cornea. In addition, in this situation, the probability of omission of the eyebrow tissues is high.

With excessive removal of fatty tissue, there may be a so-called “sunken” or “corpse” eye, which is characterized by empty eyelids.

Percutaneous blepharoplasty of the upper eyelid

Traditional upper blepharoplasty is performed using percutaneous access. This is one of the most frequently performed operations on the upper eyelids.

For anesthesia during top blepharoplasty, plastic surgery applies general anesthesia or local infiltration anesthesia. The duration of the operation takes an average of 30-40 minutes. Immediately before the beginning of the operation, the surgeon, using a special marker, outlines the contours of future incisions in the upper eyelid and determines the amount of skin that is supposed to be removed.

The operating field is processed according to the accepted procedure, anesthesia is performed, then a cutaneous incision and removal of the skin strip is performed using the scalpel (laser or radio-knife) along the planned lines. If necessary, the underlying circular muscle of the eye is removed. If there is a fat bulge in the inner corner of the eye, the ophthalmic septa is opened and the internal portion of the intraorbital fat is removed. ‘

If the tissue of the upper eyelid is observed, the intraorbital fat is evenly redistributed or added to this area, but not removed. Removing the central portion of fat is extremely rare.

In the presence of indications, the surgeon forms a fold of the upper eyelid by sewing the lower line of the cut of the skin to the upper eyelid that lifts the muscle.

Ptosis (descent) of the lacrimal gland is eliminated by fixation. When ptosis of the external part of the eyebrow (tail) is simultaneously performed its lifting and periosteal fixation above the edge of the orbit by 10-15 mm. With the same access, it is possible to eliminate the ptosis of the upper eyelid and destroy the muscles in the zone of the nadper, thereby eliminating the deep wrinkles of this area.

The operation is completed by applying a neat intradermal suture, which is sealed with thin strips of the patch and covered with an aseptic bandage. The bandage is usually removed after 4-6 hours after the top blepharoplasty with percutaneous access.

Transconjunctival blepharoplasty of upper eyelids

Conduction of the upper blepharoplasty by transconjunctival access is indicated for patients who have excess intraorbital fat in the absence of excess skin in the upper eyelid. These can be patients who had not had blepharoplasty before, or who had undergone blepharoplasty before, but who needed a second operation to remove the internal portion of intraorbital fat.

While the lower blepharoplasty is performed by transconjunctival access for a long time, its use for top blepharoplasty plastic surgery began to be used much later.

The history of transconjunctival blepharoplasty

The possibility of using transconjunctival access in the lower eyelids was described back in 1928, and its wide application was introduced after 1980, which significantly reduced the likelihood of delaying the lower eyelid downward compared with the traditional method of blepharoplasty. In the upper blepharoplasty, transconjunctival access has only been used since 1999.

Due to its short duration and limited indications, the upper blepharoplasty by transconjunctival access can be performed under local anesthesia. The healing and repair of tissues after surgery is rapid, complications are extremely rare.

The average duration of the intervention is 20-30 minutes. After the processing of the operative section, the upper eyelid is removed by a special crochet and a cut about 5 mm long is made on its conjunctiva (inner shell). Then, removal of intraorbital fat is performed without subsequent suturing of the incision.

If there are appropriate indications, transconjunctival access with upper blepharoplasty allows to achieve good aesthetic results and, in a technically literate implementation, does not cause complications.

          
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