Upper blepharoplasty: advanced techniques and adjunctive procedures

ABSTRACT

Introduction

Various techniques of upper blepharoplasty are used to correct dermatochalasis as the common sign of aging in periorbital areas. Most patients seeking upper eyelid rejuvenation have other involutional changes in upper face which can be addressed as adjunct to upper blepharoplasty procedure to yield better esthetic and functional outcomes.

Areas covered

The aim of the present study is to review current concepts in preoperative considerations, surgical techniques, and adjuvant procedures of upper blepharoplasty. The role of social media is also discussed in this arena. A literature search was performed in PubMed database of English-language journals with no restriction on the date of publication using selected keywords. The relevant articles were selected by reviewing the titles and abstracts.

Expert opinion

Careful preoperative examination of midface and upper face is necessary to assess concomitant ageing deformities besides dermatochalasis. Nowadays, volume preservation approach is the mainstream in upper blepharoplasty. Upper blepharoplasty incisions can be used to address lacrimal gland prolapse, blepharoptosis, Asian medial epicanthoplasty and eyebrow ptosis in selected individuals.

KEYWORDS:

• Blepharoplasty
• eyebrow ptosis
• eyelash ptosis
• lacrimal gland
• ptosis
• tarsal plate show
• upper eyelid

Article highlights

• A comprehensive ocular and peri-ocular examination are critical before upper blepharoplasty planning.

• Eyebrow ptosis, fat prolapse and lacrimal gland herniation can mimic or exacerbate lateral eyelid hooding in subjects with dermatochalasis.

• ‘Supine test’ diagnose lacrimal gland prolapse which requires intraoperative repositioning during upper blepharoplasty procedure.

• Half of the subjects seeking for esthetic eyelid and eyebrow procedures have a simultaneous masked or un-masked blepharoptosis.

• High eyelid crease and large pretarsal skin magnitude are two important clues of masked ptosis in upper blepharoplasty patients.

• ‘Dynamic MRD1’ test helps diagnose unilateral masked blepharoptosis, preoperatively.

• No device preference was found for skin incision in upper blepharoplasty procedure.

• Fat preservation is a preferred practice pattern for upper blepharoplasty.

• Upper blepharoplasty improves eyelash position.

• Less severe forms of Asian epicanthal fold are significantly improved using anchor epicanthoplasty through upper blepharoplasty incision.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Consent to publish

All patients featured consented to publication of their images

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17469899.2023.2175673

Additional information

Funding

This paper was not funded.