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Facial Plast Surg 2018; 34(02): 183-193
DOI: 10.1055/s-0038-1636918
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Upper Blepharoplasty: Management of the Upper Eyelid and Brow Complex via Transblepharoplasty Approach

Tuan Van Pham
1   Perth Facial Plastic and Cosmetic Surgery, Perth, Western Australia, Australia
› Author Affiliations
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Publication History

Publication Date:
09 April 2018 (online)

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Abstract

Upper blepharoplasty is one of the more common facial plastic procedures. The upper lid and brow complex are managed together. Whether upper blepharoplasty is performed for medical or cosmetic reasons, the aim is to improve appearance while retaining natural shape and maintaining (or improving) function. For optimal results, it is important to understand relevant eyelid anatomy and the concept of maintaining youthful volume and position of the eyelid brow orbit complex. Management of patient expectations, meticulous planning, and a degree of surgical finesse all contribute to the desired outcome. The article will focus on the assessment, techniques, and complications of upper blepharoplasty, which involve management of the skin, orbicularis oculi, preaponeurotic fat, levator aponeurosis and muscle as related to concomitant ptosis, and lateral brow complex via transblepharoplasty (internal) brow lift and fixation.

Keywords

upper blepharoplasty - dermatochalasis - brow ptosis - transblepharoplasty brow lift - internal brow lift
 

  • References

  • 1 Hahn S, Holds JB, Couch SM. Upper lid blepharoplasty. Facial Plast Surg Clin North Am 2016; 24 (02) 119-127
    CrossrefPubMedGoogle Scholar
  • 2 Shadfar S, Perkins SW. Surgical treatment of the brow and upper eyelid. Facial Plast Surg Clin North Am 2015; 23 (02) 167-183
    CrossrefPubMedGoogle Scholar
  • 3 Branham G, Holds JB. Brow/upper lid anatomy, aging and aesthetic analysis. Facial Plast Surg Clin North Am 2015; 23 (02) 117-127
    CrossrefPubMedGoogle Scholar
  • 4 Friedman O. Changes associated with the aging face. Facial Plast Surg Clin North Am 2005; 13 (03) 371-380
    CrossrefPubMedGoogle Scholar
  • 5 Pepper JP, Moyer JS. Upper blepharoplasty: the aesthetic ideal. Clin Plast Surg 2013; 40 (01) 133-138
    CrossrefPubMedGoogle Scholar
  • 6 Buchanan AG, Holds JB. The beautiful eye: perception of beauty in the periocular area. In: Massry GG, Murphy MR, Azizzadeh B. , eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York, NY: Springer; 2011: 25-29
    CrossrefGoogle Scholar
  • 7 Fitzgerald R. Contemporary concepts in brow and eyelid aging. Clin Plast Surg 2013; 40 (01) 21-42
    CrossrefPubMedGoogle Scholar
  • 8 Czyz CN, Hill RH, Foster JA. Preoperative evaluation of the brow-lid continuum. Clin Plast Surg 2013; 40 (01) 43-53
    CrossrefPubMedGoogle Scholar
  • 9 Knize DM. Anatomic concepts for brow lift procedures. Plast Reconstr Surg 2009; 124 (06) 2118-2126
    CrossrefPubMedGoogle Scholar
  • 10 Pessa JE, Chen Y. Curve analysis of the aging orbital aperture. Plast Reconstr Surg 2002; 109 (02) 751-755 , discussion 756–760
    CrossrefPubMedGoogle Scholar
  • 11 Lee H, Park M, Lee J, Lee ES, Baek S. Histopathologic findings of the orbicularis oculi in upper eyelid aging: total or minimal excision of orbicularis oculi in upper blepharoplasty. Arch Facial Plast Surg 2012; 14 (04) 253-257
    CrossrefPubMedGoogle Scholar
  • 12 Pottier F, El-Shazly NZ, El-Shazly AE. Aging of orbicularis oculi: anatomophysiologic consideration in upper blepharoplasty. Arch Facial Plast Surg 2008; 10 (05) 346-349
    CrossrefPubMedGoogle Scholar
  • 13 Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 2007; 119 (07) 2219-2227 , discussion 2228–2231
    CrossrefPubMedGoogle Scholar
  • 14 Massry GG. Prevalence of lacrimal gland prolapse in the functional blepharoplasty population. Ophthal Plast Reconstr Surg 2011; 27 (06) 410-413
    CrossrefPubMedGoogle Scholar
  • 15 Saadat D, Dresner SC. Safety of blepharoplasty in patients with preoperative dry eyes. Arch Facial Plast Surg 2004; 6 (02) 101-104
    CrossrefPubMedGoogle Scholar
  • 16 Mancini R. Nonsurgical considerations for addressing periocular aesthetics: a conceptual dimensional approach. JAMA Facial Plast Surg 2014; 16 (06) 451-456
    CrossrefPubMedGoogle Scholar
  • 17 Friedland JA, Lalonde DH, Rohrich RJ. An evidence-based approach to blepharoplasty. Plast Reconstr Surg 2010; 126 (06) 2222-2229
    CrossrefPubMedGoogle Scholar
  • 18 Guyuron B, Michelow BJ, Thomas T. Corrugator supercilii muscle resection through blepharoplasty incision. Plast Reconstr Surg 1995; 95 (04) 691-696
    CrossrefPubMedGoogle Scholar
  • 19 Burroughs JR, Anderson RL. Keys to success when marking the skin in upper blepharoplasty. In: Hartstein J, Massry GG, , G., Holds J. , eds. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. New York, NY: Springer; 2015: 79-80
    Google Scholar
  • 20 Har-Shai Y, Hirshowitz B. Extended upper blepharoplasty for lateral hooding of the upper eyelid using a scalpel-shaped excision: a 13-year experience. Plast Reconstr Surg 2004; 113 (03) 1028-1035 , discussion 1036
    CrossrefPubMedGoogle Scholar
  • 21 Massry GG. Nasal fat preservation in upper eyelid blepharoplasty. Ophthal Plast Reconstr Surg 2011; 27 (05) 352-355
    CrossrefPubMedGoogle Scholar
  • 22 Mercandetti M, Putterman AM, Cohen ME, Mirante JP, Cohen AJ. Internal levator advancement by Müller's muscle-conjunctival resection: technique and review. Arch Facial Plast Surg 2001; 3 (02) 104-110
    CrossrefPubMedGoogle Scholar
  • 23 McCord CD, Seify H, Codner MA. Transblepharoplasty ptosis repair: three-step technique. Plast Reconstr Surg 2007; 120 (04) 1037-1044
    CrossrefPubMedGoogle Scholar
  • 24 Martin Jr JJ. Upper eyelid blepharoplasty with ptosis repair by levator aponeurectomy. JAMA Facial Plast Surg 2015; 17 (03) 224-225
    CrossrefPubMedGoogle Scholar
  • 25 Wu S, Shi H, Yan S, Sun Y, Pan L, Wu H. Combined anchor suture with external upper eyelid blepharoplasty in Asian patients. Arch Facial Plast Surg 2010; 12 (04) 230-234
    PubMedGoogle Scholar
  • 26 Sullivan PK, Salomon JA, Woo AS, Freeman MB. The importance of the retaining ligamentous attachments of the forehead for selective eyebrow reshaping and forehead rejuvenation. Plast Reconstr Surg 2006; 117 (01) 95-104
    CrossrefPubMedGoogle Scholar
  • 27 Cohen BD, Reiffel AJ, Spinelli HM. Browpexy through the upper lid (BUL): a new technique of lifting the brow with a standard blepharoplasty incision. Aesthet Surg J 2011; 31 (02) 163-169
    CrossrefPubMedGoogle Scholar
  • 28 Burroughs JR, Bearden WH, Anderson RL, McCann JD. Internal brow elevation at blepharoplasty. Arch Facial Plast Surg 2006; 8 (01) 36-41
    CrossrefPubMedGoogle Scholar
  • 29 Niechajev I. Transpalpebral browpexy. Plast Reconstr Surg 2004; 113 (07) 2172-2180 , discussion 2181
    CrossrefPubMedGoogle Scholar
  • 30 Sclafani AP. Comprehensive periorbital rejuvenation with resorbable endotine implants for trans-lid brow and midface elevation. Facial Plast Surg Clin North Am 2007; 15 (02) 255-264 , viii
    CrossrefPubMedGoogle Scholar
  • 31 Boehmler IV JH, Judson BL, Davison SP. Reconstructive application of the endotine suspension devices. Arch Facial Plast Surg 2007; 9 (05) 328-332
    PubMedGoogle Scholar
  • 32 Zarem HA, Resnick JI, Carr RM, Wootton DG. Browpexy: lateral orbicularis muscle fixation as an adjunct to upper blepharoplasty. Plast Reconstr Surg 1997; 100 (05) 1258-1261
    CrossrefPubMedGoogle Scholar
  • 33 Burroughs JR, Anderson RL. Transblepharoplasty internal brow elevation with Corrugator removal. In: Hartstein ME, Holds JB, Massry GG. , eds. Pearls and Pitfalls in Cosmetic Plastic Surgery. New York, NY: Springer; 2015: 141-143
    Google Scholar
  • 34 Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthal Plast Reconstr Surg 2004; 20 (06) 426-432
    CrossrefPubMedGoogle Scholar
  • 35 Parikh M, Kwon YH. Vision loss after inadvertent corneal perforation during lid anesthesia. Ophthal Plast Reconstr Surg 2011; 27 (05) e141-e142
    CrossrefPubMedGoogle Scholar
  • 36 Hartstein ME, Kikkawa D. How to avoid blepharoplasty complications. Oral Maxillofac Surg Clin North Am 2009; 21 (01) 31-41 , v–vi
    CrossrefPubMedGoogle Scholar
  • 37 Czyz CN, Lam VB, Foster JA. Management of complications of upper eyelid blepharoplasty. In: Massry GG, Murphy MR, Azizzadeh B. , eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York, NY: Springer; 2011: 109-123
    CrossrefGoogle Scholar
  • 38 Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol 2007; 125 (12) 1610-1612
    CrossrefPubMedGoogle Scholar
  • 39 Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg 2013; 15 (01) 39-46
    CrossrefPubMedGoogle Scholar
  • 40 Hamawy AH, Farkas JP, Fagien S, Rohrich RJ. Preventing and managing dry eyes after periorbital surgery: a retrospective review. Plast Reconstr Surg 2009; 123 (01) 353-359
    CrossrefPubMedGoogle Scholar
  • 41 Baylis HI, Sutcliffe T, Fett DR. Levator injury during blepharoplasty. Arch Ophthalmol 1984; 102 (04) 570-571
    CrossrefPubMedGoogle Scholar
  • 42 Kamer FM, Mingrone MD. Experiences with transconjunctival upper blepharoplasty. Arch Facial Plast Surg 2000; 2 (03) 213-216
    CrossrefPubMedGoogle Scholar
  • 43 Zimbler MS, Prendiville S, Thomas JR. The “pinch and slide” blepharoplasty: safe and predictable aesthetic results. Arch Facial Plast Surg 2004; 6 (05) 348-350
    CrossrefPubMedGoogle Scholar
  • 44 Mendelson BC, Luo D. Secondary upper lid blepharoplasty: a clinical series using the tarsal fixation technique. Plast Reconstr Surg 2015; 135 (03) 508e-516e
    CrossrefPubMedGoogle Scholar