There exists a rare inherited disorder in children, called Blepharochalasis, which results in baggy upper eyelids. Children develop repetitive episodes of eyelid swelling that eventually stretches out all the tissues of the eyelid including, the skin, muscle, and structurally supporting tendons. These children often need a more complex reconstructive upper eyelid surgery. ?

What does upper eyelid surgery involve?

The upper eyelid procedure incorporates eliminating excess skin and conservative removal of protruding eyelid fat. Amount of upper eyelid skin removed is dependent on the degree of skin laxity. While waiting in the preoperative area and while the client is awake, the amount of redundant skin can be marked so that over resection of skin is avoided. Recent studies on aging have revealed a propensity for loss of overall fat volume in the face and eyes. These studies have prompted surgeons to be more conservative with removal of protruding eyelid fat. Many older clients who had more aggressive removal of fat are now returning to surgeon’s offices with a hollowed out appearance of their upper eyelid, termed the “gaunt” look. Fat pads in the upper eyelid are found in the central(middle) and medial(next to the nose) compartment. Today, conservative removal of fat is advocated and usually involves the medial fat pad only. ?

How long do I have to take off of work for upper eyelid surgery?

The traditional upper eyelid involves removal of upper eyelid skin and minimal fat pad and is considered minimally invasive. Subsequently recovery is considered short and most patients are able to return to work within two to three days. Patients may elect to avoid important social engagements as small, clear sutures are removed at one week following surgery. ?

If I am planning facelift surgery can I be considered for an upper eyelid surgery?

Patients undergoing facelift surgery will realize a more youthful facial and neck contour. If the upper eyelids demonstrate signs of aging, then patients may find a discontinuity of their youthful face and neck following facelift surgery when compared to their aged upper eyelid contour. Patients are encouraged to consider upper eyelid surgery at the time of their facelift surgery if upper eyelid aging signs are present. ?

How does a forehead lift effect the upper eyelid contour?

Patients considering upper eyelid surgery should have a thorough evaluation of their brows. A lowered brow position will increase the degree of upper eyelid skin present. In contrast, surgery to lift the eyebrows, i.e. forehead lift, results in reducing the redundant upper eyelid skin. As a result, patients who undergo forehead and eyelid surgery synchronously, will have their eyebrows lifted prior to their upper eyelid surgery. This will then result in more conservative resection of the upper eyelid skin. ?

Will I have difficulty closing my eyes following upper eyelid surgery?

Temporary tightness of the upper eyelid skin is not uncommon. If patients experience tightness they will notice relaxation of their upper eyelid skins and complete closure within one week. In the early period, it may be prudent to place eye lubrication into the eyes in order to prevent scleral abrasions. ?

Where is my upper eyelid incision made?

Upper eyelid surgery requires excision of redundant upper eyelid skin. Excision lines are placed strategically so that the final surgical incision line will fall in the natural upper eyelid crease (termed the supratarsal crease). This allows for improvement of upper eyelid contour using a nearly invisible surgical incision line. ?

If I have thyroid disease can I still be considered for lower eyelid surgery?

Patients who have thyroid disease often present with enlarged eyeballs, medically termed proptosis. Patients with enlarged eyeballs have to be examined thoroughly preoperatively as they have an increased risk of developing an undesirable “pulled look” of their lower eyelid following lower eyelid surgery (termed ectropion). These patients may require a lower lid tacking procedure to supplement the routine lower eyelid surgery. Consultation with a board certified plastic surgeon is necessary to determined what maneuvers will be required intraoperatively to ensure an aesthetically optimum result. ?

If I am planning to have a facelift surgery can I be considered for a lower eyelid surgery?

If you are planning to undergo facelift surgery, you should be considered for having your lower eyelid surgery performed at the same time. Although facelift surgery utilizing the extended “high” SMAS facelift technique will result in removal of some lower eyelid hollow, often a lower eyelid surgery is also beneficial to remove redundant skin that may become even more apparent following facelift surgery. ?

Will I have any numbness following lower eyelid surgery?

Numbness of the lower eyelid skin following lower eyelid surgery is uncommon and usually temporary. Numbness immediately following surgery is secondary to postoperative swelling that is expected and which will resolve over the first several weeks.

Will my lower eyelid hollow be improved following lower eyelid surgery?

Patients who present desiring lower eyelid surgery often complain of redundant skin, bulging of the upper aspect of the lower eyelid skin, and hollow of the lower aspect of the lower eyelid skin.

What lower eyelid changes can I expect to change with lower eyelid surgery?

Lower eyelid surgery will remove bagginess, fatty protrusions, upper face hollowness, lax hanging skin, and improve over all lower eyelid contour.

What is Blepharochalasis?

Blepharochalasis is a rare inherited disorder that appears in childhood; children will notice repetitive episodes of eyelid swelling that eventually leads to loosening of eyelid muscles that help lift the upper eyelid (levator muscle). Eventually, these children will notice drooping of their eyelids.

What is Dermatochalasis?

Dermatochalasis refers to the stretching and redundancy of eyelid skin associated with aging changes.

What is Steatoblepharon?

Steatoblepharon is the medical term for herniated eyelid fat that protrudes under the eyelid skin and results in puffiness of the lower eyelids.

What is eyelid ptosis?

Eyelid ptosis refers to the drooping of the upper eyelid margin that is caused by stretched out or weakened muscle of the eye which helps lift the eyelid (levator muscle). This condition must be detected by your plastic surgeon prior to surgery as it will require tightening of your muscles in addition to the removal of the redundant skin and protruding fat pad.

How many fat compartments exist in the eyelids?

There are two fat compartments in the upper eyelid and three in the lower lid. If performed by non-trained physicians, the lacrimal gland located over the lateral aspect of the outer aspect of the eyelid may be confused as a fat compartment. Inadvertent injury to the lacrimal gland will result in dry eye syndrome.

How can someone go blind during eyelid surgery?

Although this complication is rare and devistating, it is observed following bleeding into the orbital socket likely caused by bleeding from a blood vessel around the eyelid fat compartments. Bleeding in this compartment is termed retrobulbar hemorrhage and may lead to collapse of the vessels that feed the eye globe if sufficient pressure accumulates in this space. Risk factors include high blood pressure or poor blood clotting capacity. If caught early, then release of the eyelid incisions and possible release of the lateral aspect of the eyelid margin (cantholysis), and infusion of a diuretic are necessary to prevent permanent damage.

Are there different causes for upper eyelid droop (ptosis)?

Several causes for upper eyelid droop exist and have been characterized as:

Myogenic (dysmyogenic) ptosis: most common congenital type, due to faulty development of the eyelid muscle that pulls the eyelid up (levator muscle).
Neurogenic ptosis: results from faulty innervation of upper eyelid lid retractors; ptosis is profound with complete interruption of innervation to levator muscle.
Mechanical or traumatic ptosis: results from any traumatic injury that interferes with levator muscle or its innervation

What is postsurgical lagophthalmos?

This refers to the inability to close eyelids completely or to cover the globe adequately. It is common postoperatively due to swelling of the eyelid following surgery. If it does not resolve over the first several weeks it can be caused by over-resection of the upper eyelid redundant skin. Patients are provided artificial tears and/or lubricating eye ointment for routine surgical aftercare while this condition resolves.

What creates the natural upper eyelid crease?

The natural upper eyelid crease is called the supratarsal fold or crease. This crease occurs just above the upper border of a stiff structure called the tarsus. The tarsus provides structural integrity to the lower aspect of the upper eyelid so that it has stiffness and so that it does not flop around. This crease is created by the extension of the eyelid lifting muscle, called the levator, as it attaches to the skin.

What is the double eyelid operation?

This operation is often requested by patients of Asian ancestry who lack a supratarsal fold, the naturally occuring crease of the upper eyelid. This occurs because the eye lifting muscle, the levator, has either lost its attachments to the skin or the attachments are lower on the eyelid over the tarsus, the stiff portion of the lower aspect of the upper eyelid, thus not allowing for the naturally occuring crease to occur. . or do not have the fold bilaterally; When the fold then is present, this creates two aesthetically pleasing segments to the upper eyelid referred to as the double eyelid. which is considered aesthetically normal. The double eyelid operation uses standard upper eyelid surgery techniques with the addition of re-establishing the levator connection to the upper eyelid skin.

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