Tuesday, October 11, 2011

Doc, Can You Remove the Excess Skin from the Sides of My Upper Lids?

In patients who have excess upper eyelid skin (dermatochalasis), the amount of excess skin tends to be more on the lateral side. This can be caused by several factors but two of the main ones are loss of the lateral fat pad with age (leading to loss of support for the skin) and drooping of the eyebrows. During surgery, it is important to remove this lateral skin; otherwise these excess skin (known as lateral hooding) can make the patients appear old and sad. Patients who had had surgery performed in beauty centres or by less experienced surgeons often fail to have these problems addressed because the operators were concerned about leaving behind scars beyond the double eyelids. However, when done properly, these extended lines beyond the double eyelids usually resolve within a few weeks.

This middle-aged woman underwent upper eyelid surgery in another centre seven months ago. She was unhappy with the result because of lateral hooding. On examination, her eyebrows were at the normal position and therefore lifting the eyebrows is not appropriate in this case. She was offered two options: a. excision of the skin below the eyebrows to lift the excess skin; or b. remove the excess skin directly. She opted for the later option because the heights of the double eyelids are also asymmetrical. 

Excess upper eyelid skin drooping over the lateral sides of
the eyelids (lateral hooding).

Patient also has unequal double eyelid heights.

Excision of the skin below the eyebrows can lift
the excess skin.

The excess skin can be removed by directly removing
the excess skin.

Extended upper eyelid blepharoplasty was performed together
with recreations of the upper eyelids .
The appearance of the eyes at one weeks, the scars beyond
the double eyelids have begun to fade.

The following pictures show another patient who underwent dermatochalasis (excess upper eyelid skin) operation using the extended upper blepharoplasty technique. The scars faded after 14 days.

A patient with excess upper eyelid skin and significant
lateral hooding.
Extended upper blepharoplasty was performed.
The wounds beyond the double eyelids were sutured with
nylon for better results.

Appearance of the eyes at 14 days, the scars have faded.