Upper Eyelid Lift
The upper eyelids function both as aesthetic and functional parts of the face. It is nearly impossible to overlook the upper eyelids and it would be equally impossible to do without them. Technically, they form the lower border of the forehead, separated from it only by the eyebrows. Plastic surgeons who are evaluating patients to determine the proper approach for correcting upper eyelid problems need to consider the laxity of the eyebrows first. Function should also come before aesthetics when trying to determine which eye lift technique will most successfully address the presenting issues.
Evaluating the Patient
When the plastic surgeon evaluates the patient, he or she must consider the various layers that affect the upper eyelid: bone, skin, fat, and muscle. These layers play various roles in the development of aging issues associated with the eye.
The skin in the upper eyelid is quite thin, allowing it to stretch and droop over time. Though the droopiness may have an impact on the aesthetics of the eye, the most important consideration for the plastic surgeon is knowing precisely how much skin is needed in order for the eyelids to function properly. If the surgeon removes too much skin, the eyelid won’t be able to close properly, though it may have an aesthetically pleasing appearance when the lid is open.
An eye lift is not a technically challenging surgery in itself; however, it is often combined with other treatments such as the addition of volume, brow lifting or stabilizing, the creation of an upper eyelid crease, the repositioning of the lacrimal glands, and repair of droopiness around the eye. A highly qualified plastic surgeon will be able to determine what eye lift procedures are necessary to achieve optimal results.
An eye lift or upper blepharoplasty can easily be performed with local anesthesia. Using local anesthesia diminishes the risks associated with surgery considerably. Doctors will also give patients a sedative such as diazepam as necessary to help them relax during the procedure.
Marking Incision Points
It is important for the plastic surgeon to properly mark the eyelid prior to the surgery. These markings will guide the surgeon during the procedure when making incisions in the proper location to achieve the desired effects. The surgeon will first determine where the eyelid crease is located using light and a magnifying glass.
The plastic surgeon will note the position of the eyebrows before having the patient lie down. Then, once the patient is supine, the surgeon will move the eyebrow into the position it was in while the patient was seated or standing. Once the eyebrow is in position, the surgeon will determine how much excess skin is on the upper eyelid. This excess skin will be gently grasped between a set of forceps to check and make sure that the eyelids will close properly after the excess skin has been removed. The surgeon will grasp the skin that the line of the natural eyelid crease is under one side of the forceps and the lines where the skin should be cut to perform the remainder of the excision is beneath the other side of the forceps.
The markings on the eyelid will follow the natural line of the eyelid crease. The shape of the skin excision above the eye will depend on many factors. The surgeon will excise skin in such a way as to prevent ‘hooding’.
Differences between Men and Women
Eye lift surgery in men is different from that performed in women. One reason for this is the fact that women can easily cover up some of the scarring left from the procedure using make-up while men generally are not willing to wear make-up and more readily object to having a scar from the procedure.
The depth of the eyelid crease in men and women needs to be carefully considered by the plastic surgeon. The location of a deep eyelid crease can have a feminizing affect that is undesirable for most men. Rather, men tend to look better with a bit of skin redundancy in the upper eyelid and a lid crease that is only a few millimeters above the margin of the lid.
After an eye lift surgery, the patient should go home and take it easy for the remainder of the day. Doctors recommend that patients lie down with two pillows propping them up for support. An ophthalmic ointment should be applied several times throughout the day along with an ice compress. Acetaminophen is used to control the pain. Watching television and reading is usually not recommended for at least 24 hours following the surgery. Physical exercise is also not recommended.
Silk sutures should be removed within 24 hours after the surgery. Prolene sutures on the other hand can be removed four days after the procedure. Nylon should be removed within 3 days. In some instances, the plastic surgeon may decide to put in another set of sutures, usually to promote a more aesthetically pleasing outcome, though this isn’t always necessary. Sometimes doctors are able to simply use surgical tape or surgical glue to help provide the eyelid with the support it needs while the tissues are still healing.
Patients may return to mild physical activity within 10 days after their eye lift surgery and a more strenuous exercise routine can be worked toward by the fourth week after the procedure. Direct, prolonged exposure to sunlight is not recommended for at least 6 weeks after the surgery.