Reviewed by José Luis Tovilla-Canales, MD
Upper eyelid blepharoplasty (UEB) is the most frequently performed invasive facial esthetic procedure, according to José Luis Tovilla-Canales, MD. The procedure can remove excess skin, muscle and sometimes fat from the upper or lower eyelids. It is performed for either functional or cosmetic indications. UEB may be performed in a traditional fashion, using stainless steel instruments, or may be modified with radiosurgery incisional techniques or laser incisional techniques.
Following UEB, the visual fields can improve by as much as 26.2%. Dr. Tovilla-Canales, director, Orbit and Oculoplastics Department, Instituto de Oftalmologia, Mexico City, Mexico, enumerated his pearls for performing a successful UEB. “The surgery is usually considered a simple procedure, but there are key points that must be adhered to before surgery to avoid adverse events,” he said. Dr. Tovilla-Canales offered several key points to consider for successful UEB procedures:
- The procedure is not a recipe. Each patient will have different anatomic landmarks, and, therefore, have different surgical needs.
- The brows and the different amounts of skin to be excised must be considered.
- Understand the anatomy. Knowledge of the anatomy is essential to perform an appropriate technique for each patient.
- The preoperative assessment is one of the most important steps before surgery is even undertaken. The physician must obtain a history and perform a complete examination, discuss expectations with the patient, select the appropriate technique, and discuss potential complications.
- Patients must be instructed to stop taking aspirin and anticoagulants before surgery.
- Physicians also should obtain preoperative photographs in the event that patients question the postoperative outcome.
Another consideration in the preoperative assessment is determining whether just skin or skin and fat are to be removed.
“Watch the eyebrow,” Dr. Tovilla-Canales said, pointing out that the eyebrows are always considerations when performing UEB. He demonstrated cases with the preoperative presence of upper lid ptosis, a droopy eyebrow, fat pads in the lateral aspect upper lids disguised as upper lid ptosis and bulging of the upper lids caused by supraobicularis fat, indicating that these must be addressed to achieve an appropriate UEB.
Perhaps the most important surgical factor is marking the incisions, according to Dr. Tovilla-Canales.
“With the patient supine, I create the crease in the patient’s natural crease, usually 10 millimeters from the lid margin in women and a little lower in men,” he explained, demonstrating the pinch test, performed using forceps with the patient sitting and with eyes closed, to determine the amount of skin to remove.
Jośe Tovilla-Canales, MD
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Dr. Tovilla-Canales has no financial interest in any aspect of this report.