Upper Eyelid Blepharoplasty: The Evaluation

Abstract

The initial step in a successful blepharoplasty involves careful preoperative planning and patient discussion. The physician must consider all factors that play a role in a patient’s candidacy for a blepharoplasty. It is important to ensure that the patient’s goals are consistent with those that can be achieved with a blepharoplasty and that their complaints would not be better addressed with another procedure. The margin-fold distance (MFD) is the distance from the eyelid skin to the eyelid margin. There are three principal factors that contribute to a decreased MFD: excessive eyelid skin, low eyelid crease, and brow ptosis. It is possible to address excessive eyelid skin and low eyelid crease with a blepharoplasty; however, brow ptosis requires a brow-lifting procedure. Evaluating the contribution of these three factors to your patient’s complaints will allow you to tailor your surgery to be consistent with their goals. Functional concerns also play a role in the preoperative evaluation and management. Visual field testing should be performed to document any visual defect that is attributable to ptosis or pseudoptosis. A complete history and ocular examination is crucial in ensuring the procedure is not contraindicated. History of dry eyes, lagophthalmos, poor Bell’s phenomenon, refractive surgery, or use of anticoagulant medications are necessary to consider and may preclude the patient from having a blepharoplasty.