Upper Lids & Brow

 

The upper lids and eyebrows act as a functional unit, and they are considered together when developing a treatment plan for patients as well.  Below are case studies in surgeries of this region:  

 

 
 
Patient#1 (Preoperative). This patient complained of eyelids that were low and interfering with vision, as well as giving her a tired appearance.
 

 
Patient#1 (Postoperative, 5 weeks). After bilateral upper lid lift (ptosis repair) and external blepharoplasty of the upper lids, her eyes appear brighter and more rested,  and the upper lid “platform” allows her to evenly place eye liner.
 
 
 

 
 
Patient#2 (Preoperative). This patient complained of eyelids that were low and interfering with vision, as well as giving her a tired appearance.  
 
Patient#2 (Postoperative, 3 months). After bilateral upper lid lift (ptosis repair), external blepharoplasty of the upper lids, and external blepharoplasty of the lower lids.
 
 
 

 
 
Patient#3 (Preoperative). This young man had a progressive droop in the left upper lid.
 
 
Patient#3 (Postoperative, 1 month). External eyelid lifting performed while the patient was awake and comfortable.
 
 
 

 
 
Patient#4 (Preoperative). This gentleman had droop of the eyebrows and eyelids, along with extra skin.  The outer eyebrows had fallen from their normal attachements.  Simply doing eyelid surgery without brow surgery would have led to an undesirable “low brow” appearance.
 
 
Patient#4 (Postoperative, 5 week). Five weeks after droopy lid repair (ptosis repair), upper blepharoplasty, and direct lateral brow lift.  The direct brow procedure involves making an incision right above the eyebrows.  It works well in people with bushy eyebrows.  The incision does take several weeks to heal and become less prominent, but as you can see, at one month the incision is really not visible to the casual observer at this point and will fade further over the coming few months.
 
 
 

 
 
Patient#5 (Preoperative). This woman presented with heavy upper lids and no visible eyelid crease. Beneath the excess tissue, the lids themselves were low as well.
 
 
Patient#5 (Postoperative, 1 month). Internal eyelid lifting was performed, in conjunction with external blepharoplasty.  She can be seen postoperatively one month later below.
 
 
 

 
 
Patient#6 (Preoperative). This child was born with a drooping lid on the right which was interfering with normal visual development.
 
 
Patient#6 (Postoperative, 1 week). After right sided lid repair (ptosis repair) using the frontalis suspension technique.  Due to congenitally poor eyelid function, the repair involved inserting medical grade silicone rubber bands deep within the eyelid and connected up to the deep forehead tissue.  The forehead / eyebrow provides the extra lift for the eyelid.
 
 
 

 
 
Patient#7 (Preoperative). This gentleman complained of eyelids that were low and interfering with vision, as well as giving him a tired appearance.  
 
Patient#7 (Postoperative, 3 months). After bilateral upper lid lift (ptosis repair) and external blepharoplasty of the upper lids.
 
 
 

 
 
Patient#8 (Preoperative).ADVANCED CASE. This gentleman complained of eye pain in both eyes and dryness.  His left upper eyelid was drooping.  The eyelids did not close normally due to an underlying medical problem, nor did they open properly.  Our goal was to lift both lower eyelids to improve coverage of the surface of his eye.  In addition, a silicone rubber band was inserted to allow his left upper eyelid to open the eye when he lifted his eyebrow.
 
 
Patient#8 (Postoperative, 1 month). After repair of left upper eyelid droop (ptosis) using a silicone rubber band that attached the eyelid to the forehead deep beneath the skin and muscle.  Both lower eyelids were also lifted using collagen implants to improve his dry eye and to protect his vision.  Postoperatively, he has no pain and his eyelids are symmetry.
 
 
 

 
 
Patient#9 (Preoperative). This patient was born with a severely drooping lid, present at birth, and unoperated on into her early adulthood.
 
 
Patient#9 (Postoperative, 1 week). After right upper eyelid lift (ptosis repair) with silicone rubber band.  The rubber band (or sometimes a small strip of tendon borrowed from the leg) is utilized to provide the lift when the eyelid does not function well enough to provide it on its own.
 
 
 


 
 
Patient#10 (Preoperative). This patient complained of eyelids that were low and interfering with vision, as well as giving her a tired appearance.
 
 
Patient#10 (Postoperative, 1 month). After bilateral upper lid lift (ptosis repair) and external blepharoplasty of the upper lids.
 
 
 

 
 
Patient#11 (Preoperative). This child was born with a droop of the left upper lid (congenital ptosis) that was potentially interfering with her ability to develop normal vision in that eye.
 
 
Patient#11 (Postoperative, 3 months). After using a strip of leg tendon (tensor fascia lata) to lift the lid, connecting the eyelid to the forehead.
 
 
 

 
 
A panel of postoperative images depicting the daily progression of healing in a representative patient can be seen here.  There is more bruising at one week, and more discoloration, than the usual patient since his surgery was more extensive than the average case.

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