Upper Blepharoplasty

It has been said that your eyes offer a “window to our soul”.  If this is true then the upper eyelid is the most important window shade of your life!!  Eyelid and periorbital aesthetics are critically important to the overall appearance of your face. As a central feature of the human face and as an instrument that we use to define ourselves to the world, our eye appearance is one of the defining pillars of how we view ourselves (self-image), and how we portray ourselves to the world (aesthetics).

The ideal upper eyelid should provide a bright, youthful, and energetic look.  The eyelid and eye itself should have either an oval or almond shape.  In women, there should be a robust row of eyelashes on the upper and lower eyelid, but the upper eyelid is more noticeable.  There should be minimal excess skin in the upper eyelid, and surrounding the orbital area in general.  Crow’s feet should be minimized.  Lastly and most importantly, there should be a well defined cleft between the superior end of the upper eyelid and the inferior beginning of the lower brow.  This upper eyelid cleft is crucial to your overall appearance, as it provides definition between the upper eyelid and the brow.

During your consultation, there are 4 critical structures in the upper eyelid that must be evaluated to improve your overall aesthetics.

1. Upper eyelid skin.
2. Upper eyelid fat pads
3. The Obicularis muscle & upper orbital septum
4. Presence or absence of ptosis (aka eyelid droop)

Upper eyelid skin

As we age, our brow position tends to fall over time. We fight this brow descent by activating our Frontalis muscle (PICTURED), which lifts and elevates the brow position. By doing this, we create a tension on your upper eyelid.

These movements, which happen thousands of times a day will effectively stretch and elongate upper eyelid skin over the course of daces causing dermatochalasis, which is the term for having excess upper eyelid skin. The only truly effective treatment is upper eyelid blepharoplasty.

Fat pads

There are three fat/glandular components in the upper eyelid. The three components are the medial fat pad, the middle fat pad, and laterally the lacrimal gland (aka the tear gland). During upper eyelid surgery, we routinely reduce or remove the medial fat pad to emphasize the natural almond shape of the upper eyelid. However, we do not routinely reduce the middle fat pad as reduction or removal of this pad commonly creates a hollowed out appearance to your eye. Instead of reducing or removing the middle fat pad, we tighten this fat pad using a specific type of laser to create a revitalized appearance to the upper eyelids. Lastly, the lacrimal gland is left untouched to prevent disruption of tear flow and to maintain appropriate eye function.

We strongly advocate for defining the upper eyelid cleft during upper eyelid surgery. There is a natural elegance to a clearly defined upper eyelid and brow. If this cleft is obscured or absent, many patients will require a surgical brow lift or a chemical browlift to create the cleft. Conversely, in patients who have good overall brow position and merely have descent of upper eyelid, those patients can achieve outstanding results though reduction of the orbicularis muscle and removal of the excess upper eyelid skin and septum. By removing the septum and reducing the muscle, Dr. Durkin is able to recreate the natural upper eyelid cleft that you were born with. This specific maneuver that Dr. Durkin utilizes separates our upper eyelid results from our competitors.  By addressing the foundation tissue planes of the upper eyelid, we are able to create natural, youthful appearing eyes with lasting results.    Reduction of the orbicularis muscle and septum has no effect on eyelid function. It is an accessory function muscle and manipulation of the orbicularis does not alter your ability move your eyes.

Eyelid droop or ptosis

As we age, facial structures and landmarks tend to drift downwards.  When this happens in the upper eyelid, we call this ptosis.  Ptosis refers to the overall position of the upper eyelid in relation to the eye itself.  It does not indicate whether or not the eyelid has exta skin.  Rather, this refers to eyelid position overall.  This assessment is taken during your initial evaluation.  Repair of ptosis is traditionally done through manipulation of the Levator muscle, or another important muscle known as Muller’s muscle.  Ptosis repair can provide a dramatic improvement in facial appearance.  Dr. Durkin has extensive experience in regarding ptosis repair of the upper eyelid, and brow.  There are many causes of eyelid ptosis, and the repair of each type differs.  Ptosis evaluation is one of our cornerstones in eyelid surgery, as repair of upper eyelid droop is absolutely crucial towards overall outcome in upper eyelid surgery.

The Ocean Drive Upper Lid Blepharoplasty

As we age the upper eyelid skin tends to elongate and droop. Secondarily, it is common to have bulging eyepads, especially on the inner upper eyelid. On the outer lid, we tend to get extra skin. Taken together, these natural signs of eyelid aging can portray us as tired, fatigued or even sad. One of our most common requests is when patients come in and ask to look less tired. We commonly hear that people “don’t look the way they feel.”.  The tired appearance commonly involves both the eyes and the neck, and we firmly believe in a comprehensive, reductionistic approach to these issues with self image.  Upper eyelid rejuvenation begins with an evaluation of skin quality and volume, eyelash length, and presence or absence of excess fat. Upper  eyelid blepharoplasty is our second most common facial procedure overall and our most common procedure in men.  We like to undertake this procedure with minimal anesthesia so that patients recover quickly, and so that I can see them animate and move to ensure a natural result with removal of all excess skin.  Patient downtime is minimal.  Bruising is common, but resolves usually within 3-5 days.  Sutures are removed on postoperative day five.  Upper eyelid blepharoplasty is one of our most potent procedures, and offers a result that will last decades with minimal discomfort and very acceptable downtime.

We commonly employ up lid blepharoplasty (eyelid) with Botox® therapy and or Latisse® to get the maximum result possible. As well, all patients are evaluatied in terms of brow position.  Select patients who request up eyelid surgery may have an indication for brow lift as well, as not all patients are candidates for isolated upper eyelid surgery. Many will require brow lifting as well because their brow has fallen. This is very common in men and women. Upper eyelid evaluation is not complete unless your brow position is evaluated as well.  We will evaluate and discuss both issues with you at your consultation and define all surgical and nonsurgical options for you. We discuss this at length during your consultation and ensure all of your questions are answered before any procedure or intervention is decided upon.