Upper Blepharoplasty: Pearls for the Procedure

With careful preoperative evaluation and intraoperative technique, upper eyelid blepharoplasty can provide significant cosmetic and functional improvements. A fine-tip marker is used to mark the upper eyelid crease from the punctum to the lateral canthus. A “lazy S” configuration is used to compensate for the difference in the length of the upper and lower incision and to limit medial webbing. The amount of skin to be removed is determined using a pinch technique with the endpoint being minimal rotation of the lashes or leaving approximately 20 mm of eyelid skin. A skin incision is made, and the skin is subsequently removed using scissors or electrocautery. Underlying orbicularis can be removed to reduce upper eyelid fullness. Likewise, medial herniated orbital fat can be removed by dissecting through the orbital septum; however removal of preaponeurotic fat should be limited due to the risk of hallowing and lagophthalmos. Lid crease fixation sutures can be placed to reinforce or elevate the eyelid crease. A sufficient crease can be achieved by taking bites of the underlying orbicularis or levator aponeurosis with the running suture used to close the incision. There are several different types of sutures and closures that can be used depending on the surgeon’s preference. A running subcuticular closure with 6-0 polypropylene and Steri-Strips provides a good cosmetic closure; however there is the potential for allergic reaction to the Steri-Strips. An absorbable suture such as 6-0 plain gut can be used; however there is the added risk of granuloma or epithelial suture cysts.