Before, and two weeks after
maximum 5 mm of skin taken
Upper eyelid surgery or “blepharoplasty”
After neck liposuction, the most straightforward cosmetic surgical procedure offering to give the appearance of “turning back the clock” is blepharoplasty or “mini-snip” upper eyelid surgery.
With the long-term effects of gravity and loss of skin elasticity and collagen can come a loosening and drooping of the skin of the upper eyelid, giving you a tired bored and old look.
This loosening and drooping of skin can become so severe that the excess skin can interfere with vision! Rarely in Australia would a patient leave this problem so long for this to occur, but it can happen if this excess skin is neglected.
Before, and 2 weeks after
6mm skin removed bilaterally
Another week, and my patient turned up ready for a night out!
The process of blepharoplasty at Peach, our “mini-snip” upper eyelid surgery, is fairly simple. The skin above each eyelid is marked out with a surgical marking pen to delineate the incision lines. Generous doses of local anaesthetic are introduced under the skin (anaesthetic drops are applied to the eyes as well, along with antibiotic ointment, for comfort and safety) and then the excess skin is excised (scalpel, laser or radiofrequency incision). Skin edges are brought together with a very fine continuous suture (6/0) and then the job is done.
THE MOST IMPORTANT PART OF THE PROCEDURE IS THE PLANNING.
Despite being such a straightforward procedure, results are often suboptimal and sometimes seriously adverse.
The commonest problem with blepharoplasty occurs when an ambitious surgeon takes too much skin.
Surgeons commonly commit four assumptive errors leading them to take too much skin when performing upper eyelid surgery.
They will believe:
1) That there is such a thing as an “ideal eye shape”, leading them to try to reproduce this in all their patients
2) That they should take the maximum amount of skin (short of causing lagophthalmos)
3) That by taking more skin, the results will be more dramatic and the patient will be more grateful
4) That taking maximum skin in blepharoplasty is maximally rejuvenating.
By way of example, take a look here at a photo of a well-known country singer highly successful in the 1970s
At the height of his success this fellow had quite a lot of skin above his upper eyelids (“suprapalpebral hoods”). These are clearly genetic: his parents probably look the same. These upper eyelids look normal on him, not ageing at all.
No doubt it was a fine and highly qualified surgeon who performed upper eyelid surgery on this man, but the surgeon did not appreciate that this fullness of skin above the upper eyelid was largely genetic and not primarily age-related. The result was that too much skin was removed:
Whilst it is possible to interpret these eyes as younger-looking, alert and refreshed, they also look incongruous with the rest of the face and render this fellow unrecognizable.
Here is another pair of photos.
We all recognise the guy on the left (if you don’t, you’re probably too young for a blepharoplasty!) , but who is the guy on the right? Again, the surgeon, who was no doubt highly qualified, failed to recognise that a degree of upper lid hooding was part of this fellow’s natural, youthful, and, in his day, remarkably good looks. Whilst the result of this blepharoplasty is correct by-the-textbook, the post-operative eyes are barely recogniseable.
Too much skin taken.
Let’s hope this chap’s contemporary equivalent never makes the same mistake:
Here at Peach we believe these surgical assumptions are incorrect.
We believe that, for most patients, the goal in blepharoplasty is to take only enough skin to refresh the eye appearance whilst maintaining the recogniseability of the patient. We try to help you look the way *you* used to look, not the way the textbook says you should look.
This involves removing a *minimum* of upper eyelid skin rather than a maximum. It involves a subtle change rather than a dramatic change.
It involves understanding that the way to reverse age-related upper eyelid changes is to remove only that amount of extra skin that has accumulated with age, and for most patients this is around 5-6mm.
Many surgeons would complain that this is too little, but if we remember that there’s only around 30mm of skin between eyelash and eyebrow (wide variation of course) then 5-6mm is still quite enough to make a substantial difference.
The key is: if we take what turns out to be too little skin, we can always take more, but if we take too much, we cannot put back the skin that is lost.
So here is our undertaking: we’ll take no more than 6mm of skin, so you can be confident we won’t over-treat you.
But if this doesn’t turn out to be enough, come back 6-12 months later and we will perform the surgery again at no extra charge.
We guarantee a subtle job, and we’ll take more later if you need more taken.
Ask another surgeon if they are prepared to give this undertaking.
Our patients are happy that we can offer such a service.