Services & Procedures

Upper and Lower Blepharoplasty and Ptosis

When an excess of skin and/or fat, known as dermatochalasis, is present in the eyelids, patients may desire surgical correction for visual, comfort or cosmetic reasons. It can involve either the upper and/or lower eyelids. Surgical correction is known as blepharoplasty. Ptosis is present when the margin of the upper eyelid sags closer to the pupil, either separately or in combination with dermatochalasis. Ptosis repair may be combined with blepharoplasty.

Due to a combination of factors the skin and delicate structures of the eyelids begin to stretch. Factors include:

heredity aging chronic allergies thyroid disorders smoking

fluid retention certain medications (steroids) wearing gas-permeable contact lenses injuries

When the upper eyelids are involved, the fold of skin, which generally is well above the eyelashes, tends to rest on or over the eyelashes. The actual margin of the eyelid may drop down closer to or actually cover the pupil (ptosis). There may be puffiness of the tissue due to fluid retention or a forward herniation of the normal fat around the eye.

The patient can experience a tired, heavy feeling from muscular fatigue, especially in the forehead, from the need to raise the eyebrows. Additionally, the overhanging skin may cause interference with peripheral vision, either to the sides or above. This necessitates raising the eyebrows in order to see more clearly.

The same underlying factors are responsible when the lower eyelids are involved. The lower eyelid is suspended to the bone toward the nose and ear by tendons, which support the eyelids much the same way a hammock is suspended. If one or both tendons stretch, the edge of the lower eyelids may sag below the cornea causing a pooling of tears on the eye, or occasionally, dry eye symptoms due to exposure of the delicate surface structures to the air. The fat below the eye will bulge forward causing a puffy tired appearance to the eyes. Finally, there may be pockets of fluid just above the cheekbones known as festoons.

The eyebrows themselves may be drooping due to a combination of forehead laxity and stretching of the supporting ligaments to the orbital bone above the eye. This is sometimes difficult to detect if the forehead is being raised to compensate for the eyelids. When the eyes are closed, the need to compensate is removed and one can see the brow drop to its true resting position. If it is not corrected at the time of ptosis repair or blepharoplasty, the eyebrows will appear to be too low postoperatively because the compensating force has been removed. Therefore, it is best to repair the eyebrows at the same time (browpexy).