Tag Archive for upper eyelid

Cosmetic and Medical Upper Lid and Brow Procedures in Men

This patient complained of visual obstruction from the upper lids.  

The upper lid tissue folded over the lashes and into the visual axis.  It was appropriate to consider upper lid surgery to be medical in nature, and formal visual field testing was performed.  The upper blepharoplasty was covered by insurance.

Further discussion with this patient centered on the cosmetic impact of his brow position.  The angulation of the brow gave him an angry appearance.  The patient elected  a cosmetic direct brow lift.  The brow incisions were placed directly above the brow, centered on the inner portions.  (This technique leads to very good incision camouflage in patients with thick brows.)

The bottom photo was taken a few months after surgery. The brow position is now more neutral.  There is no angry appearance.  The incisions have healed, and the symmetry is excellent.


Drill Hole Canthoplasty to Improve Upper Eyelid Closure

Many patients cannot close their eyes properly, due to surgical complications or paralysis or aging.  This video demonstrates that, in patients with some degree of eyelid function intact, it is often possible to leverage that function with a lid tightening procedure known as a canthoplasty.  In these cases, I often prefer to use a drill hole for fixation.  This is particularly important for patients who have had multiple cosmetic surgeries, because the tissue itself is abnormal and unreliable.  The fixation with a drill hole improves the durability of the procedure. 

The video presented is in a gentleman with weakness of eye closure from a partial paralysis.  This happens in some people, is a fairly random event, and may be due to some type of common viral infection that comes and goes but leaves the facial nerve damaged.  This is called  Bell’s palsy.

Preoperatively, closure is poor.  However, there is some function.  Canthoplasty is my first line of treatment; I reserve upper lid weight implantation if the patient is still having problems after canthoplasty surgery.  

Notice that the left upper lid does not close fully, and barely moves during a normal spontaneous eyelid blink.  After surgery, spontaneous blink is significantly better and forced closure is complete.