Incision upper blepharoplasty is indicated for patients who have a moderate amount of excess fat. This technique involves judicious removal of upper eyelid skin and excess fat. Thereafter, the upper eyelid crease is created by stitching the skin down to the deeper tarsal tissue. This technique minimises the chance of losing the fold. As skin excision is involved, the downtime is typically 1-2 weeks. This is also performed to correct ageing upper eyelids where the excess skin, muscle and fat are excised.
For patients with concomitant brow descent needing correction, a new technique of browlift using the Endotine Transbleph device can be performed. This allows rejuvenation of both the sagging eyebrow and the upper eyelid with one surgery performed under local anesthesia.
Sometimes, droopy eyelids are caused by overstretching of the thin tendon-like structure that helps the levator muscle elevate the upper eyelids. Here, a slightly more complex procedure known as levator advancement must be performed. As the dissection is more extensive, patients should expect a two-week downtime.
For patients who desire “longer eyes”, medial or lateral epicanthoplasty procedures can be performed. It is important to know that good eyelid surgery should be customised to suit the patient’s facial aesthetics as well as his or her ethnicity. The Caucasian “double-eyelid” usually is higher, deeply set and has a crease parallel to the lash line. The ideal Asian “double-eyelids” are more subtle with slight flaring at the lateral edge. Previously, “westernisation” of Asian eyes was very common but resulted in unnaturally high folds with excessive fat and skin excision leading to a hollowed out and aged look post-surgery.
It is therefore vital that patients consult with qualified plastic surgeons with intimate knowledge of eyelid anatomy. Only an experienced plastic surgeon can make an accurate diagnosis of the problem and recommend the appropriate surgical treatment.