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Blepharoplasty Procedure Description (Eyelid Surgery)

Upper eyelid-
PreOp Evaluation- Brow position and shape – Animated vs. Relaxed (eyes closed)
Relationship of brow to supraorbital rim
Dynamic/ Static forehead wrinkles

Markings- Precision – fine tip pen
Dotted line
Sitting – Medial point
Inferior aspect of lateral wrinkle
Center transposition of lid crease anteriorly
Supine – Lid crease – lash line to LC 7-10 mm
Takeoff from lateral canthus to lateral aspect of brow
Superior line 10-12 mm from inferior aspect of brow

Technique- Excision of skin and orbicularis muscle
Adjust lateral skin discrepancy first with interrupted sutures
Closure with running subcuticular 6-0 prolene

Lower Eyelid-
PreOp Evaluation- Shape of eye
Palpebral tilt – Medial vs. Lateral canthus
Lid laxity – Snap Test and Distraction Test
Vector – positive vs. negative
Fat ballottement and patient history
Mirror Test*

Special Considerations – Fat pad preservation vs. conservation
-Negative vector and good quality skin
Canthopexy vs. canthoplasty
-Need for elevation of lateral canthus
-Blunted/rounded lateral canthus

Technique- Skin muscle flap
Wide release at Arcus Marginalis
Dissect out medial middle and lateral fat pads
Division/release of inferior crus of lateral canthus
Skin and muscle excision
Dissect orbicularis of lower eyelid skin
Suture lateral orbicularis to lateral orbital periostium (4-0 polydek/ P-2 needle)
Closure with running subcuticular 6-0 prolene
EVALUATE PATIENT IN SITTING POSITION
Tarsorrhaphy suture in all quad blepharoplasties