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Upper and Lower Eyelids Article 3

Traditional Upper and Lower Eyelid Surgery Techniques

The traditional upper blepharoplasty commonly must be combined with a brow elevation operation to balance the brow drop that often results from upper eyelid skin removal. The upper eyelid or blepharoplasty incision is marked according to how much tissue will be retained after excision between the upper incision and the eyebrow and the lower incision and the lid margin. The remaining tissue between these designated areas is the amount that can be removed safely and keep the eyelid crease in the proper line. After excision of the excess skin and muscle as a single unit, the orbital septum is opened, and the fat from the medial and middle compartments is teased out. All of the redundant fat freely protruding beyond the orbital septum is removed by electrocautery of the base. At that point, the closure is performed with a skin stitches. The incision and subsequent scar is hidden in the upper eyelid crease.

The lower eyelid surgery or lower blepharoplasty frequently involves removing skin, muscle, along with subtotal resection of the three lower eyelid fat pads. The fat can be transposed into the tear trough to ameliorate that area. The incision and subsequent scar is hidden under the eyelashes.