Upper blepharoplasty

Table 3.1

Indications for surgery

Functional dermatochalasis affecting vision

Cosmetically displeasing dermatochalasis and/or upper eyelid fullness

To correct associated lash ptosis, entropion, blepharitis or anophthalmic prosthetic instability

Use of upper eyelid dermatochalasis for anterior lamellar skin grafting elsewhere

Table 3.2

Preoperative evaluation

Prior facial surgery or trauma

Dry eye symptoms

Prior refractive surgery

Degree of dermatochalasis and fat prolapse

Presence of lacrimal gland prolapse

Presence of concurrent eyebrow ptosis and eyelid ptosis

Ethnic differences between Asian and Occidental eyelid crease

Introduction

Several parameters should be evaluated in the preoperative blepharoplasty examination. Documentation of functional symptoms, photographs, and visual-field testing are mandatory for coverage by many third-party carriers. When photographing the patient, images should be captured in the frontal plane, three-quarter profile, and the side plane. Before and after photographs documenting improvement and changes are essential particularly for the discerning cosmetic patient. History of dry eye symptoms, prior facial surgery or trauma and refractive surgery are elicited. Aesthetic considerations should be addressed with the patient holding a mirror during the examination to point out salient features. During the examination, the degree of dermatochalasis present should be noted as well as any co-existent brow and/or eyelid ptosis ( Figure 3.1A ). The eyelid creases are then measured for symmetry. Asymmetric eyelid creases are often associated with eyelid ptosis ( Chapter 11 , Chapter 12 , Chapter 13 ) and this should be identified and addressed at the time of blepharoplasty. Often, the higher eyelid crease is associated with levator dehiscence ptosis ( Figure 3.1B ). Lateral eyelid fullness should be noted and palpation may reveal a prolapsed or pathologically enlarged lacrimal gland ( Figure 3.1C ) and require repositing and possible biopsy ( Chapter 70 ). Examination of the tear film (tear breakup time, tear lake, Schirmer’s testing) should be performed as well as assessment for lagophthalmos with the eyelids gently closed ( Figure 3.1D ).