Rejuvenation of the Upper Eyelid

s. co m The eyes are the most captivating feature of the face. Furthermore, attractive eyes are an important feature of the youthful face. Although attention is drawn to the eyes, the surrounding structures that frame the eye are key contributors to facial beauty. The frame of the eye extends down to the lower eyelid-cheek junction and up to the upper eyelid–brow unit. Thus, the periocular region is a complex that should be broadly defined to include the eyebrow and midface. It is a surgeon’s job to carefully analyze the underlying anatomy to determine the surgical approach to achieve the best aesthetic result. The youthful upper eyelid is full, not hollow or overskeletonized. There is a crisp upper lid crease with elastic support of the underlying soft tissue, creating a smooth, taut pretarsal and preseptal upper eyelid. The eyebrow is often addressed in conjunction with the upper eyelid in upper face rejuvenation. This article focuses solely on surgical rejuvenation of the upper eyelid. The goal of rejuvenation of the upper eyelid should be a more youthful but natural-appearing result. Upper eyelid surgery is the most requested and performed facial rejuvenation surgery in the United States. The excision of the eyelids dates back 2000 years. The cauterization of excess eyelid skin to reduce drooping is described in the Sanskrit document, the Sushruta. American surgeons began to write about cosmetic surgery in 1907, with Conrad Miller’s Cosmetic Surgery and the Correction of Feature Imperfections. Over the subsequent decades, surgeons advocated the removal of herniated fat pads and orbicularis oculi muscle excision. Over the past 20 years, the emphasis on technique has shifted to conservation of fat, skin and muscle excision