Upper Eyelid Surgery - Upper Blepharoplasty
Overview of Upper Eyelid Surgery
Eyes are the focal point of one's face. They are the first thing people notice and are the key to facial expression. During the aging process, the region around your eyes shows the effects of aging much sooner than other areas. This is the main reason why so many people seek cosmetic eyelid surgery. We often hear complaints such as, "My eyes always look tired and old even when I feel wide awake." This is very profound because if you look old and tired you will feel the same way. How many times have you dressed up and prepared to go out feeling good about yourself only to look in the mirror to see that your eyes look older than you feel?
In the attractive, youthful eye lid, the lateral canthus should be
higher than the medial canthus. With age the brow and lateral
canthus sag.
Aging affects the entire face. Aging around the eyes, however, is usually the first area that is noticed. The aging of the face can be thought of in terms of its three most important components: the skin, the underlying muscle, and the fat. Most people do not think aging involves the latter two structures but, in reality, these are probably the most important ones. Have you ever looked at a baby's cheek? It is full and fatty. Look at a model's cheek. It is not as full as a baby's cheek but still it has significant volume due to the underlying fat.
There is a substantial amount of fat situated around the eye region. As we age, the fat will either descend on the face or go away completely. When this happens, it exposes the underlying facial skeleton resulting in the familiar gaunt appearance that we recognize as aging. Also, the fat and underlying muscles act as a filler to create the volume seen in the cheeks of youth. When this filler descends or goes away, we see wrinkling. This process is similar to a grape which turns into a raisin when the water is removed.
Skin With Aging
 |
 |
| Youthful Upper Eye. Notice well- defined eyelid crease. | Aged Upper Eye. Notice descent of eyebrow and lateral canthus. |
The following pictures show anatomically what happens to the muscles around the eye with aging.
 |
 |
| Youthful Eyes. Muscles around the eyes are circular in shape. | Aged Eyes. Notice the drooping of the eyebrow and lateral canthus. |
The recognition of the importance of the underlying fat and muscle has been revolutionary to the field of plastic surgery over the last 10 years. It is no longer acceptable to think of eyelid rejuvenation as merely a procedure to tighten the skin. This is why Dr. Cruise feels it is so important to correct the problem itself and not just the effects of the problem.
When evaluating the upper eyelid there are three important components of the upper eye region that must be considered: the eyebrow, the upper lid itself, and the lateral canthus. Typically, these three areas sag at different rates and, therefore, each patient must be assessed individually. Most patients need removal of fat and skin to create an elegant upper eyelid crease.
 |
 |
| Example of 43-year-old female who only needs skin and fat removal. | Lateral view of same woman. Notice defined upper lid crease. |
Other patients need elevation of the lateral canthus in addition to removal of fat and skin.
 |
 |
| Example of 48-year-old female who needs left lateral canthus elevated in addition to skin and fat removal. | Lateral view of the same patient. Notice how elevating the lateral canthus creates an almond-shaped appearance to the eye. |
Descent and laxity of the lateral canthus is a major contributing factor to the appearance of old age within the eye region. This sagging gives a depressed, tired appearance. The upper eyelid of youth has a bright, open appearance. Of particular note is the fact that the lateral canthus should be higher than the medial canthus. Because Dr. Cruise feels that it is important to address this issue to create the best look possible, he often will elevate the lateral canthus in conjunction with the upper blepharoplasty to recreate that youthful, almond-shaped appearance. See above.
Others need correction of all three elements comprising the upper eye: the eyebrow, the eyelid, and the lateral canthus.
 |
 |
| Example of 38-year-old female who complains of persistent tired appearance. She required a browlift and lateral canthoplasty in addition to removal of excess skin an fat to achieve desired result. | Lateral view of same woman. Notice how the eye has become youthful and elegant. |
Often, Dr. Cruise will perform a temporal brow lift instead of a conventional brow lift when he does upper blepharoplasty. This is much less invasive, yet still effective. The temporal brow lift only addresses the temporal area, but this is usually what needs elevation the most. The decision as to what is best for you can only be determined during consultation.
There is a fourth potential problem area for the upper eyelid that is not always talked about and often is not addressed. This is eyelid ptosis, also know as descent of the upper eyelid. See example below.
Example of 26-year-old female six weeks before
her wedding. She complains that her left eye(right side of picture)
was lower than her left. Notice in the before how the left upper
eyelid touches the pupil, whereas, the left eye is wide open and
bright. Also notice difference in eyelid height. After shows both
lids at the same level and a similar eyelid height.
Eyelid ptosis becomes quite common as we age and can affect one or both sides. The muscle that elevates the upper lid simply breaks off and the lid lowers. This gives the appearance of a chronic tired eye. Correction opens the eye and gives a brighter, more awake appearance.
The take home point to all this information is that there are several elements of the upper eyelid region that must be evaluated during an upper blepharoplasty exam.
Animated Upper Eyelid Surgery
Scroll over the image to see the effects
of a skin removal from the upper eyelid.
Notice how the crease is more defined
and the eyes look more rested.
It is important to understand the limitations of upper blepharoplasty. An upper blepharoplasty alone will not correct crow's feet. It will help but often a concurrent brow lift or temporal brow lift is necessary. Often, BOTOX® can be helpful.
It is often very useful to perform fat transplantation, as well as either chemical peeling or laser skin resurfacing, in addition to eyelid surgery. This allows Dr. Cruise to address all the components associated with aging around the eye. Remember, the aging eyelid is a result of problems within the skin, muscle, and fat.
Testimonial
Dr. Cruise, thank you so much. Because of you I had a wonderful wedding. Everyone was telling me that I looked beautiful. I love my eyes and nose.
Thank you again,
Jola
Upper Blepharoplasty Cosmetic Surgery Information Resource for Southern California including Newport Beach, Orange County, Los Angeles, San Diego, Orange County, and Beverly Hills.