When you look in the mirror, do your eyes look heavier, smaller, or more tired than you feel?
Take a look at the photo above. This patient is dealing with significant upper eyelid hooding, clinically known as dermatochalasis. For the majority of our patients, the key component to an upper blepharoplasty (eyelid lift) is simply removing this redundant, heavy skin that has developed over time due to gravity, loss of elasticity, and genetics.
However, a truly successful eyelid lift is never a one-size-fits-all skin trim. Here is a look at the basics of an upper blepharoplasty, and why we sometimes go beyond the skin to get the best result.
The Basics: Precision, Measurement, and Safety
The foundation of an upper blepharoplasty is the safe, meticulous removal of excess skin. The skin on your upper eyelid is the thinnest on your entire body, and the margin for error is measured in millimeters.
- Careful Marking: Before we even begin, we take precise measurements of your eyelids. We mark the exact amount of skin to be removed taking account your natural facial proportions to ensure the highest degree of symmetry possible between the left and right eyes.
- Protecting the Anatomy: An upper blepharoplasty is an exercise in restraint. The goal is to remove the heavy, stretched skin without damaging the vital structures beneath it. We must carefully preserve the underlying levator muscle (which lifts and opens your eye) and the orbicularis oculi muscle (which allows you to blink and close your eye tightly).
When done correctly, the incision is hidden perfectly within the natural crease of your eyelid, leaving a crisp, youthful platform for makeup and a bright, rested appearance.
When the Problem Isn’t Just Skin
While removing skin is the core of the procedure, it doesn’t always solve the whole problem. During your consultation, we also evaluate two other major factors:
Excess Fat (“Pooching”) Sometimes, the heaviness isn’t just skin; it’s a small pocket of fat pushing forward, most commonly in the inner corner of the eye near the nose. During the blepharoplasty, we can gently sculpt or remove this specific fat pad to eliminate the “pooching” and create a smooth, clean contour.
Eyebrow Position If your eyebrow has dropped, it pushes the thick brow fat pad down onto your eyelid space. If we only remove eyelid skin without addressing a heavy brow, the outer corners of your eyes will still look hooded and heavy. Depending on your anatomy, we have two ways to fix this:
Endoscopic Brow Lift: For significant brow drooping, we use small incisions hidden behind the hairline. Using a few small entry points in the hair and sometimes a tiny camera (endoscope), we release the brow ligaments and lift the entire weight of the brow off the forehead and eyes.
Browpexy: If you only have mild drooping at the outer corners, we can perform a “browpexy.” The beauty of this technique is that it is done through the exact same incision as your upper blepharoplasty. We place an internal suture to lift and stabilize the outer brow fat pad, clearing the hooding on the outside of the eye without needing any extra incisions in your hairline.
The Bottom Line
An upper blepharoplasty is a highly tailored procedure. By taking exact measurements, respecting the underlying muscles, and addressing any underlying fat or brow heaviness, we can safely restore a naturally bright, awake look to your eyes.
Disclaimer: This blog does not constitute medical advice and no doctor-patient relationship is formed by reading it. Prior results do not guarantee a similar outcome. Additional facts or future developments may affect subjects contained within this blog post. Before acting or relying upon any information within this newsletter, seek the advice of a medical doctor.