Upper Eyelid Surgery

Upper eyelid surgery is the third most common cosmetic surgery done in the U.S. The eyelids have the thinnest skin in the body. They blink, squint, and squeeze and are more susceptible to sun exposure over time than any part of our body and thus are the first part of your face that shows age. Genetics can also play a role in this. The change in your eye shape may show tiredness, aging, and lack of vigor and can affect how you see yourself.  

Prior to an initial consultation with a physician, careful scrutiny of the face and eyelids in a mirror and in recent photographs will lead many patients toward a more concrete idea about what exactly they do not like about their eyes. Being able to pinpoint a problem area enables the surgeon to address your needs and helps to avoid misunderstanding about desired post-operative appearances. 

The initial evaluation with a physician that performs eyelid aesthetic and reconstructive surgery is centered around three questions: 1) What feature of the eyelids is perceived as being abnormal? 2) Are any other areas of the face contributing to the eyelid abnormality or under consideration for cosmetic rejuvenation? and 3) Are any underlying eye or health abnormalities present that could compromise the anticipated procedures or its results? 

There are two types of upper eyelid surgery. The causes of each condition are quite different but they both cause obstruction of vision and aesthetic changes. The procedure to treat excess upper lid skin and the removal of bulging fat is called Upper Lid Blepharoplasty. Taking the extra skin off and restoring the natural, youthful and functional anatomy allows more light to reach the retina thus seeing better in low light situations. Driving at night can create issues seeing signs, as less light is available from hooding of the upper lid. The procedure also helps with sports like golf or tennis where the upper field of your vision can be obscured by extra lid skin.

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Another type of common Upper eyelid surgery is called Ptosis of the eyelids. Ptosis literally means “to fall or droop,” so drooping upper lids. What is the difference between the condition of extra upper lid skin and Ptosis?

With Ptosis, the tendon that lifts the eyelid is usually stretched or loose. Typically one upper eyelid is lower than the other.  The most common causes are aging and genetics. Trauma to the eyelid itself or just protracted swelling of the eyelids can cause tears and stretching of the tendon, as well. Surgery, rubbing our eyes, allergies that cause swelling of the eyelids, squinting and squeezing our eyes and if one wear contacts, pulling our eyelids open to insert the contact lens can lead to Ptosis over time.  If the upper lid margin is so low, some people unconsciously adopt a chin-up position to see better which can cause neck aches and some lift the upper eyelid by raising their eyebrows to try to get the lid out of their field of vision.

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Ptosis can severely affect vision especially when the lid lowers so much that it covers the pupil of the eye. People first start to lose the superior part of the vision as the lid comes down, but over the time the entire pupil may be covered affecting vision dramatically. Aesthetically the eye looks smaller and the contour of the upper lid itself can change especially when only in one eye compared to the other.

The procedure tightens, repairs, or shortens the tendon and/or muscle restoring vision, function and aesthetics. Excess skin or fat can also be removed if desired.

In addition to upper lid blepharoplasty, lower lid blepharoplasty to remove fat, excess skin and bags and/or tighten lower lids can also be done at the same time. 

Eyelid procedures are typically performed under local anesthesia on an outpatient basis. The eyes are not bandaged shut and vision is quite normal enabling reading and other activities to be enjoyed during the convalescence. Perhaps the most surprising feature is the swelling and bruising after surgery. As thin as the eyelid skin is, it’s no wonder why it bruises easily. Most of this is gone within 5-7 days but can persist for up to 14 days in individuals that bruise easily. This has practically no effect on the surgical outcome but is usually obvious even to the most casual observer. It is not uncommon to take a week away from your normal activities to wait until the eyelid appearance returns to normal.

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Oculoplastic surgeons are a natural choice for these procedures.    They usually have one to two years of fellowship training after Ophthalmology residency and their focus is only on the eyelids, the tear drainage system and the orbit of the eye (the bony space where the eye itself sits).  Thus, they are uniquely qualified to ascertain how aging or pathology of the eyelids affects vision, comfort of the eyes, and the appearance.  

Dr. Kathleen Albrecht sees many patients needing upper eyelid surgery for both cosmetic and functional problems. If testing shows that visually you have lost part of your world secondary to overhanging skin on your upper lids, the procedure may be covered by insurance. 

Dr. Albrecht’s specialized experience in eyelid surgery helps patients achieve their goals of improving vision, restoring function, and looking more open and rested like their younger selves. Dr. Albrecht also performs elevation of the midface and eyebrow and rejuvenation of the face and eye area using Botox and different facial fillers such as Restylane.

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