Why Upper Eyelid Blepharoplasty Fails: Improving upper eyelid aesthetics

The upper eyelid is a common area showing premature facial aging including thin, hanging skin and bulging fat pockets. The upper eyelid is a focus of cosmetic correction through an upper eyelid blepharoplasty, which can remove excess skin and fat through an upper eyelid incision.

The upper eyelid can be an easy point of cosmetic focus, but often does not deliver an effective result as a “stand alone” procedure, especially when done as a “stand alone” procedure in the female patient. This is mainly do to unaddressed brow dynamics in the upper face.

Common Complaints After Upper Eyelid Blepharoplasty:

  • Long upper eyelid incisions, which are a sign of excess outer skin attempted to be removed through an eyelid incision rather than performing a combination brow lift.
  • Recurrent skin excess, which is common after the brow relaxes after just an upper eyelid blepharoplasty
  • Inability to close the eyes secondary to too much skin being removed to try an correct a droopy eyelid
  • Patients with the same or worse upper eyelid aesthetics after the upper eyelid procedure because no brow lift was performed

Upper eyelid blepharoplasty can have increased satisfaction in a male patient because of the acceptance of a lower brow position. A browpexy procedure can be performed to help secure the outer brow position through the upper eyelid in the male patient.

  • The reasons why an upper eyelid blepharoplasty can fail in the female patient is that typically there are two other issues at hand: either laxity and descent of the brow (pseudo-ptosis) or a droopy upper eyelid (ptosis).

The upper eyelid excess skin can obstruct vision and the body’s natural reflex is to lift the brow to help get the excess skin out of the way.

  • The compensatory brow elevation signified by deep forehead creases, relaxes after the obstructing upper eyelid skin has been removed.
  • This triggers a compensatory descent and relaxation of the brow with worsening of the upper eyelid and brow aesthetics.
  • This can be alleviated in a male through a brow pexy or sulcoplasty because browlifts in men often feminize the upper face.
  • In women, a brow lift at the time of the upper eyelid blepharoplasty can help to secure the brow position and reshape the brow.

Upper eyelid ptosis or a droopy eyelid may also go undetected at the time of upper eyelid evaluation and if not corrected can be a cause of post-operative drooping and dissatisfaction. Correction of upper eyelid ptosis can be performed at the time of an upper eyelid blepharoplasty and can help to improve the upper eyelid position giving a more awake and open eye shape.

The incision placement for an upper eyelid blepharoplasty is generally in the natural upper eyelid crease. The skin and fat can be removed through this naturally hidden incision and the droopy eyelid repositioned and tightened with internal sutures. There are numerous brow lift procedures which vary depending on hair thickness and hairline

Recovery from any upper eyelid blepharoplasty procedure is approximately 1 to 2 weeks. A brow lift and/or ptosis repair does not significantly prolong this period. Sutures are removed at the four day point. Eye care, with hydrating drops are recommended for 2 weeks. Bruising and swelling may be persistent for over one week,

Andrew P. Trussler MD is an experienced plastic surgeon in Austin Texas with advanced training in facial aesthetics including eyelid surgery including secondary correction of upper eyelid malposition, including brow lifts and ptosis repairs.

Dr. Trussler’s Austin plastic surgery office can help guide you in correcting commonly seen upper eyelid aging complaints. An upper eyelid blepharoplasty with a brow lift can help your eyelids not only look better, but function better.

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