Upper Eyelid Surgery / Upper Blepharoplasty

Welcome to Orange County’s best information resource for plastic surgery and, in particular, upper eyelid / upper blepharoplasty surgery. Dr. Cruise, board certified plastic surgeon, Newport Beach, CA, has filled every inch of this site with the most comprehensive upper eyelid surgery information available. Patient education is a priority for Dr. Cruise. With this in mind, he was adamant that the information be highly relevant, easy to understand and, above all, lots and lots of upper eyelid surgery pictures.

To give you a brief overview, here are some of the important topics that will be discussed. This is in addition to the many upper eyelid surgery before and after pictures available for your review.

• Will upper eyelid surgery get rid of my loose skin?
  Dr. Cruise outlines the causes of upper eyelid skin laxity. Also, outlined is a detailed explanation of facial aging. It is highly recommended to review the Custom Face Lift section.
• Why do my eyelids look tired even when I feel alert?
  See how upper facial aging causes a sad, tired appearance. Also outlined are the logical treatments to rejuvenate the upper eyelid region.
• Will a temple lift help with my upper eyelid rejuvenation?
  Aging of the upper eyelid area usually involves sagging of the outer part of the upper eyelid. See how this causes a sad, tired appearance.
• Upper eyelid surgery before and after pictures
  Find people similar to you.
• Complications , risks, recovery and safety of upper eyelid surgery
• Upper eyelid surgery cost
  Is financing available?

Overview of Upper Blepharoplasty

Eyes are the focal point of one’s face. They are the first thing people notice and are the key to facial expression. This is the main reason why so many people seek cosmetic eyelid surgery. It is not uncommon to hear over and over again, My eyes always look tired and old even when I feel wide awake.









Animated Upper Eyelid
Scroll over the image to see the effects of a skin removal from the upper eyelid. Notice how the crease is more defined and the eyes look more rested.

 

This is very profound because often if you look old and tired you will feel the same way. How many times have you dressed up and prepared to go out feeling good about yourself only to look in the mirror to see that your eyes look older than you feel? The reason for this is that during the aging process the region around your eyes shows the effects of aging much sooner than other areas.

In the attractive, youthful eye lid, the lateral canthus should be higher than the medial canthus. With age the brow and lateral canthus sag.

Aging affects the entire face. Aging around the eyes, however, is usually the first area that is noticed. The aging process can be simplified by thinking of it in terms of the three most important components of the face. These components are the skin, the underlying muscle, and the fat. Most people do not think of aging as involving the latter two structures but, in reality, these are probably the most important ones. Have you ever looked at a baby’s cheek? It is full and fatty. Look at a model’s cheek. It is not as full as a baby’s cheek but still it has significant volume due to the underlying fat.

There is a substantial amount of fat situated around the eye region. As we age, the fat will either descend downward on the face or may go away completely. When this happens, it exposes the underlying facial skeleton resulting in the familiar gaunty appearance that we recognize as aging. Also, the fat and underlying muscles act as a filler creating the volume seen in the cheeks of youth. When this filler descends or goes away, we see wrinkling. This process is similar to a grape which turns into a raisin when the water is removed.

 

 

 

 

 

 

 

The following pictures show anatomically what happens to the muscles around the eye with aging.

 

 

 

 

 

 

 

The importance of the underlying fat and muscle has been revolutionary in the field of plastic surgery over the last 10 years. It is no longer acceptable to think of eyelid rejuvenation as merely a procedure to tighten the skin. This is why Dr. Cruise feels it is so important to correct the problem itself and not just the effects of the problem.

When evaluating the upper eyelid there are three important components of the upper eye region that must be considered. The eyebrow, the upper lid itself, and the lateral canthus. Typically, these three areas sag at different rates and, therefore, each patient must be assessed individually.

Most patients need removal of fat and skin to create an elegant upper eyelid crease.

Before After	Before After
Example of 43-year-old female who only needs skin and fat removal.	Lateral view of same woman. Notice defined upper lid crease.

Other patients need elevation of the lateral canthus in addition to removal of fat and skin.

Before After	Before After
Example of 48-year-old female who needs left lateral canthus elevated in addition to skin and fat removal.	Lateral view of same patient. Notice how elevating the lateral canthus gives almond shape appearance to eye.

Descent and laxity of the lateral canthus is a major contributing factor to the appearance of old age within the eye region. This sagging gives a depressed, tired appearance. The upper eyelid of youth has a bright, open appearance. Of particular note is the fact that the lateral canthus should be higher than the medial canthus. Dr. Cruise feels that it is important to address this issue to create the best look possible. Often, he will elevate the lateral canthus in conjunction with the upper blepharoplasty to re-create that youthful, almond-shape appearance. See above.

Others need correction of all three elements comprising the upper eye: The eyebrow, the eyelid, and the lateral canthus.

Before After	Before After
Example of 38-year-old female who complains of persistent tired appearance. She required a browlift and lateral canthoplasty in addition to removal of excess skin and fat to achieve desiredresult.	Lateral view of same woman. Notice how the eye has become youthful and elegant.

Often, Dr. Cruise will perform a Temporal Brow Lift instead of a conventional brow lift when he does upper blepharoplasty. This is much less invasive, yet, still effective. The Temporal Brow Lift only addresses the temporal area but this is usually what needs elevation the most. The decision as to what is best for you can only be determined during consultation.

There is a fourth potential problem area when addressing the upper eyelid that is not talked about much and often goes un addressed. This is eyelid ptosis, also know as, descent of the upper eyelid. See example below.

Example of 26-year-old female six weeks before her wedding. She complains that her left eye(right side of picture) was lower than her left. Notice in the BEFORE, how the left upper eyelid touches the pupil, whereas, the left eye is wide open and bright. Also notice difference in eyelid height. After shows both lids at the same level and similar eyelid height.

Eyelid ptosis becomes quite common as we age. The muscle that elevates the upper lid simply breaks off and the lid lowers. It may be one side or both. It gives the appearance of a chronic tired eye . Correction opens the eye and gives a brighter, more awake appearance.

The take home point to all this information is that there are several elements of the upper eyelid region that must be evaluated during and upper blepharoplasty exam.

It is important to understand the limitations of upper blepharoplasty. An upper blepharoplasty alone will not correct crow’s feet. It will help but often a concurrent brow lift or temple brow lift is necessary. Often, Botox® may also be helpful.

It is often very useful to perform fat transplantation, as well as either chemical peeling or laser skin resurfacing, in addition to eyelid surgery. This allows Dr. Cruise to address all the components associated with aging around the eye. Remember, the aging eyelid is a result of problems within the skin, muscle, and fat.

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