Eyelid Surgery (Blepharoplasty) Maryland

The upper eyelid should exhibit a visible crease ( supratarsal fold) that compliments the eye without being too deep. The crease should extend the length of the upper eyelid. Fat pockets surround the eyeball, and frequently the fat bulges excessively. Only a small amount of fat should be removed. If too much is removed the eyes may develop a “sunken” eye appearance.

Patients most commonly complain of the “bags” and excess wrinkling of the lower eyelid skin. The usual and incorrect approach is to remove too much fat from the lower eyelid area resulting in a hollow appearance. In addition, the inexperienced surgeon may excise too much lower eyelid skin resulting in a lower eyelid that is positioned too low on the eyeball. These patients will have problems of dry eyes and incomplete closure especially when they are fatigued. The cosmetic appearance is always poor since the outer half of the lower eyelid sags below its proper anatomic position.

Steps to achieve the best cosmetic result when considering eyelid surgery:

1. Determine if the eyebrow is at the correct height.
    If yes——-→ consider upper lid Blepharoplasty
    If no——-→ perform brow lift first, then
       —————→ +/- upper lid Blepharoplasty
2. Perform lower lid Blepharoplasty with fat conservation with
    +/- Lower eyelid support

The systematic approach to aesthetic surgery of the area around the eyes is to first assure that the eyebrows are situated at the appropriate height. The characteristics of attractive eyes are associated with proper brow height and shape, the presence of a well defined fold in the upper eyelid and the absence of any form of swelling or puffiness about the eye. In the stock photos below, you will see that the maximum height of the eyebrow is just above the outer border of the iris. It arches gently without too much of a curve. If the brow is elevated too high, the patient will have a surprised or startled look.

As the distance between the eyebrow and upper eyelid lashes narrows, the patient will invariably look tired. This is demonstrated in the previous section regarding brow lifts. In many patients, the brow position is satisfactory, yet the patient’s eyes appear swollen, “puffy” upper and lower eyelids. This condition is called blepharochalasis and is the result of thin stretched out upper and lower eyelid skin combined with prominent fat pads which surround the eyeball.

An upper eyelid Blepharoplasty involves removing the excess skin in the upper eyelid, recreating a crease and removing excess peri-orbital fat thereby giving the patient a more youthful appearing eyelid. Some surgeons remove too much periorbital fat and the patient will develop a sunken eye appearance which is very unsightly and difficult to correct. If too much skin is removed, the patient can not close their eyes which is a very serious problem. Conservative eyelid surgery is preferable.

Lower Eyelid

Lower eyelid blepharochalasis is also a frequent cosmetic problem. Swollen “baggy ” lower eyelids are very distracting and give the patient a very tired appearance. Again, a conservative approach to improvement is advised. Remove and repostion selected areas of periorbital lower eyelid fat is very important. Excessive removal of lower eyelid skin results in the lower eyelid being pulled below the iris, a condition called lagophthalmus.

Patients:

Upper and Lower Eyelid Surgery

Upper Eyelid Surgery

Lower Eyelid Surgery