January 18, 2025
1 minute reading
Basic foods:
- Patient satisfaction, good aesthetic results and avoiding complications are key when performing upper blepharoplasty.
- It is helpful to keep the patient in a sitting position when the temporal extent of the incision is noted.
KOLOA, Hawaii — The three main goals of upper blepharoplasty are to ensure patient happiness, obtain an aesthetic result and avoid complications, according to a speaker here.
During a presentation at Hawaiian Eye 2025, Andrew R. Harrison, MD, he offered his pearls to perform the procedure.
Image: Eamon N. Dreisbach
“The upper eyelid in youth is full. It is not skeletonized,” he said. “The crease is usually quite low – about 6mm to 9mm – and the eyebrows do fall, but usually at a later age,” he said.
When marking the lid fold, if it is symmetrical, it is useful to mark on the existing fold. If it’s asymmetrical, Harrison said, mark the fold at 6 mm to 10 mm in females and 5 mm to 8 mm in males.
“It’s important to discuss with patients preoperatively where they would like that aspect to be,” he said.
Another cornerstone of blepharoplasty is the orbicularis oculi, Harrison explained. This muscle plays a role in eyelid closure and should never be aggressively removed, particularly in patients with dry eye.
He also emphasized the importance of making sure the patient is seated when marking the time span of the incision, which will help avoid the need for revision later in the procedure.
When marking the skin, Harrison recommended leaving at least 20 mm to 25 mm on each side of the surgical site to ensure optimal postoperative symmetry. During the operation, he uses a boat-shaped incision.
“Rotally, I’m coming up and laterally I’m coming up at a little bit of an angle,” Harrison said. “The reason I do that is if you get to a point, sometimes you’ll get a lot of tissue and when you close it you’ll get a tissue. These tissues are really hard to fix.”
When cutting the lid flap with scissors, it’s helpful to cut in layers, he explained. If there is no noticeable volume in the cap, it is recommended to cut only the skin.
“Blepharoplasty is, technically, a very easy procedure – it’s just a matter of deciding what to do and how much to do,” he said.
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Harrison AR. Advanced Blepharoplasty 101. Presented at: Hawaiian Eye 2025; January 18-24, 2025. Koloa, Hawaii.
Harrison does not report relevant financial disclosures.
