Tissue Removal Considerations in Blepharoplasty Surgery

Abstract

When deciding how much tissue to remove in cosmetic upper blepharoplasty, it is important to remember a few critical mantras:

• 1. It is not the tissue that you remove, but what you leave behind that counts. As we are all asymmetric, measure not what you remove, but the residual eyelid tissue for symmetry.

• 2. Function trumps form every time. Blepharoplasty is not a procedure designed to achieve maximum tautness of the lids. This in fact is an aging change. It is critical to ensure that the patient can close their eyes completely on the OR table. It is not recommended that the patient have residual lagophthalmos. If the patient has lagophthalmos in the OR, he or she certainly may have lagophthalmos in the office the next day. This situation does not improve spontaneously. Additionally, it is important to leave the orbicularis. This is not a structure that becomes redundant with age. The orbicularis is important to ensure adequate eyelid closure, especially in a population at risk for dry eye.

• 3. Blepharoplasty is not a procedure designed to achieve maximum skeletonization or excavation of the eyelids. Fat is the lubrication of the eyelid. A cushion of fat is a sign of “youthfulness,” ensures adequate levator function, and decreases the possibility of postoperative scarring. Overexcision of fat can overly hollow the eyelids, leading to a “lost in time,” obviously surgical appearance.