The Upper eyelid is one of the first sites where age-related changes are noticed. The skin of the upper eyelid is the most thin of all skin in the body, and has a fatty layer. Additionally, periorbital muscles are used daily, which also contributes to aging of the upper eyelid. With this change deepened fold and wrinkle as well as visual disturbance and trichiasis often develop.
Upper blepharoplasty corrects sagging of upper eyelid and bulging of fatty tissue. An incision is made along the natural eyelid fold, and skin, muscle, and fat is removed as needed.
Refined diagnosis is necessary because the clinical manifestations show great variations between individuals. The patient may have sagging eyelids caused by drooping skin, muscles, or excessive fatty tissue. If the sagging of the upper eyelid is caused by the ptosis, correction of ptosis should be performed together. Most of the surgery is conducted under the local anesthesia and stitch out is planned around the postoperative 4th day. After 1 week, daily activity and social life can be resumed. Preoperative counseling is necessary if the patient takes anticoagulant agent or has high blood pressure because the convalescent period may be longer in this case.
As one grows old, skin of lower eyelid thins, tension of the muscle is decreased, orbital septum becomes weaker, and orbital fat is protruded so that the bulging of fat in the lower eyelid is prominent. Over time, predisposed individuals develop attenuation of the orbicularis oculi muscle and laxity of the attachments between the orbicularis and the deep fascia. The orbicularis progressively sags until folds of muscle are suspended across the lid, emulating gathered bunting. Some patients cite a history of familial occurrence of these folds. This phenomenon can affect any part of the upper or lower eyelid. However, the unmodified word festoon, without anatomic specification, has come to refer most often to sagging of the orbital and malar segments of the orbicularis oculi muscle of the lower eyelid.
Commonly, protruding intraorbital fat and septum accompany festoons; however, occasionally, festoons are composed solely of muscle and skin. Corrective surgical steps are directed at tightening the slack muscle and skin.
Through blepharoplasty, partial removal of protruded orbital fat and redistribution can be achieved and laxity of orbital septum is tightened and skin and muscle sagging is corrected.
If there is only the festoon without skin laxity or muscle sagging, transconjunctival incision without external skin incision is preferred. On the contrary, too much depressed eyelid can be helped with fat graft to be rejuvenated.
In most of the cases, postoperative pain can be handled with analgesics. Head elevation for 2 to 3 days after the surgery with ice massage is recommended. The patient had better be told that they should avoid watching TV on lying position or reading a book for a long time. Stitch out can be completed within 4 to 5 days after the surgery. One day after stitch out, the patient can make up. The patient can go back to their daily life in 1 week though the periorbital swelling and bruise may last for 2 to 3 weeks. Temporary tearing and dazzling may occur, which is spontaneously resolved.
Before & After Photographs
The above doctor’s cases are for reference only. Results may vary per individual.