Upper Blepharoplasty Dallas

Upper lid blepharoplasty is a procedure that aims to produce a refreshed and youthful appearance to the upper eyelids by removing excess skin and repositioning or removing some of the fat beneath the eyelids. Excess skin over the upper lids causes the eye shadow space to be inconspicuous. Besides, in extreme cases it can act as a hood and obscure peripheral vision.

Important considerations

The traditional approach to upper eyelids involved removing the excess skin over the upper eyelids along with removal of an ellipse of the underlying orbicularis muscle and most of the fat from beneath the lid. However, over the last few decades, there has been a paradigm shift to remove less fat and to preserve the orbicularis muscle. Youthful eyes are full with a little eye shadow space showing. Skeletonizing it by removing all the muscle and fat causes an aged appearance by showing too much of the lid when the eyes are open.

An elliptical incision is made such that the lower margin of the ellipse is in a natural skin crease of the upper eyelid. This elliptical area of excess skin is then removed. Beyond this point, there are several variations in technique depending on patient anatomy and philosophy of the operating surgeon. Some surgeons routinely remove an underlying cuff of orbicularis muscle while others preserve this. Next some of the excess fat especially over the inner part of the upper lid is removed to produce pleasing contours. It is important to be judicious in this process. Removal of too much fat as was prevalent in the past causes an old and unattractive appearance. Some patients with loss of fat around the upper lids may also benefit from fat grafting.

It is very important to assess brow position in all patients presenting with upper lid skin excess as brow descent can make the upper lid skin excess look worse. It is very crucial to differentiate between eyebrow skin that has descended versus eyelid skin that is in excess. The eyebrow skin that has descended needs to be repositioned up with a brow lift while the excess eyelid skin needs to be removed. Removing eyebrow skin will cause the brow to descent even further and can cause problems with eye closure leading to dry eyes and vision problems. It is also very important to determine if the upper lid is at a lower position than normal (lid ptosis). This is commonly missed during upper lid evaluation. Lid ptosis can be easily corrected during upper blepharoplasty and makes a significant difference to the final aesthetic outcome.

Limitations of upper blepharoplasty

Upper blepharoplasty will reduce the hooding and remove skin excess, reduce the feeling of eyelid heaviness, provide a more youthful appearance and decrease the fat bulge over the inner aspect of the lid. However, it will NOT elevate the eyebrows, improve crow’s feet or the wrinkles between the eyes.