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Upper blepharoplasty made my eyelids heavier and the skin wrinkled. What is going on?

Published on October 27, 2011

Dr. Steinsapir specializes in fixing unsatisfactory eyelid surgery. As a fellowship trained oculoplastic and cosmetic surgeon, and a board certified ophthalmologist, Dr. Steinsapir is experienced in working closely with his patients to create a personalized treatment plan. If you are experiencing eyelid ptosis and crepey (wrinkled) skin following upper blepharoplasty, it may be that your original surgeon did not have the proper experience to successfully perform your upper blepharoplasty.

Crepey Skin

When performing upper blepharoplasty, simply removing extra skin is not enough to create a desirable outcome. Successful blepharoplasty requires what Dr. Steinsapir calls a ‘structured’ blepharoplasty. It is essential to properly support the upper eyelid skin to avoid crepey upper eyelid―platform skin that simply won’t hold makeup. To correct this problem, your surgeon will need to remove skin from below the upper eyelid crease and anchor the eyelid platform skin and underlying muscle to the levator tendon, which raises the upper eyelid. This places the upper eyelid skin on a slight stretch resulting in a smooth platform for makeup.

An experienced and skilled surgeon can address crepey upper eyelid skin after unsatisfactory upper blepharoplasty with a carefully planned excision of the excess skin left on the eyelid platform. With the eyelid open, the upper eyelid skin is anchored to the levator tendon to create a long lasting adhesion to the eyelid elevator. Recovery is usually somewhat shorter than standard upper blepharoplasty.

An anchor blepharoplasty is an important part of any comprehensive eyelid surgery. This part of your procedure specifically addresses loose skin and drooping eyelashes on the upper eyelid platform. Excess, wrinkled or loose skin here can give you a tired appearance associated with eyelash ptosis and crepey eyelid platform skin.

While ideally anchor blepharoplasty is a part of every blepharoplasty, unspecialized or less skilled surgeons may not be comfortable offering this important aspect of treatment. Anchor blepharoplasty is a very technical skill that requires great precision and specialized expertise. Without great experience, education and an artistic skill, your cosmetic doctor may have difficulty performing an anchor blepharoplasty as part of your upper blepharoplasty; unfortunately, in these cases you may find yourself disappointed after you heal and wish your eyes appeared more alert.

Heavy eyelids

Heavy eyelids following upper blepharoplasty are often the result of a pre-surgical condition that your surgeon failed to address during you consultations. Before you underwent blepharoplasty, you presumably already had heavy lids and heavy brows. The brain compensates for the heavy eyebrow by activating the frontalis muscle, the forehead elevator. The forehead lifts the eyebrow until the skin in the upper eyelid no longer rests on the upper eyelashes.

Clinically, this situation can be detected by looking for lines in the forehead and an abnormally elevated eyebrow. When upper blepharoplasty is performed in this setting, the excess skin in the upper eyelid is removed. This reduces the amount of forehead muscle activation that is needed to keep the upper eyelid skin off the upper eyelashes. The forehead relaxes and the eyebrows come down. The net result is that it appears that almost nothing was done surgically. Of course the forehead is smoother but if the objective was to make the eyes brighter by clearing space above the eyelashes, the net effect can be disappointing. Under these circumstances the best option is to perform a forehead lift in conjunction with the eyelid surgery.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked at the top with a handful of medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center. Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns. Contact us today to schedule a personal consultation with Dr. Steinsapir.

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