Eyelid Surgery: Upper Eyelids

Excess skin on the upper eyelid, often called dermatochalasis, is common and can develop gradually with age. Some people find their eyelids feel heavy, the skin may rest over the eyelid crease, and some also experience functional problems. Upper eyelid surgery, or upper blepharoplasty, involves removing excess skin. When needed, a limited amount of underlying tissue can also be treated. A good assessment looks at more than how much skin can be removed. The anatomy of the eyelid, brow position, any ptosis, eye health, dryness and the overall proportions of the face must all be considered together. The goal is an individually tailored treatment that respects the function of the eyelid and gives a natural expression.

Who may be suited to upper eyelid surgery?

Upper eyelid surgery may be relevant for:

• excess skin on the upper eyelid

• heavy or drooping eyelids

• skin that rests over the natural eyelid crease

• asymmetry between the eyelids

• functional problems related to the excess skin

It is also important to distinguish between excess eyelid skin, eyelid ptosis and a low brow position. These conditions can occur separately or together and require different assessment and treatment.

Eyelid, ptosis or brow?

A heavy eye area is not always caused only by excess skin on the upper eyelid.

The brows are anatomically and functionally connected to the upper eyelid. When the brows are low, more skin can be pushed down toward the eyelid. In some people the eyelid margin itself also sits lower than normal, which is called ptosis.

For this reason, the upper eyelid should not be assessed in isolation.

During the consultation we assess, among other things:

• the amount and distribution of excess skin

• the height and shape of the brows

• the symmetry of the eyelids

• the position of the eyelid crease

• any eyelid ptosis

• the eyelid's ability to close

• signs of dry eyes or irritation

• previous eye or eyelid surgery

This assessment is essential for deciding whether upper blepharoplasty is the right treatment.

Dry eyes and eye health before surgery

Upper eyelid surgery affects structures that are important for eyelid closure and the surface of the eye.

For this reason, questions about dry eyes, irritation, contact lenses, previous eye surgery and general eye health are part of the preoperative assessment.

Patients who already have dry eyes may in some cases experience a temporary worsening after the procedure. If there are symptoms or risk factors, further assessment may be needed before surgery.

How is upper eyelid surgery performed?

The procedure is usually performed under local anesthesia.

Before the operation, the excess skin is carefully marked. The incision is usually placed in the natural eyelid crease, so that the scar follows the anatomy of the eyelid.

Excess skin is removed. When needed, the surgery may also include limited treatment of underlying tissue.

How extensive the procedure should be is assessed individually. The aim is to correct the excess skin without compromising the function of the eyelid or its ability to close the eye.

Where is the scar after eyelid surgery?

The scar is usually placed in the natural crease of the upper eyelid and, when needed, extended slightly toward the outer corner.

At first the scar may be red or more visible. Over time it gradually matures and usually becomes less noticeable.

Scar maturation takes several months and varies from person to person.

The period after eyelid surgery

Swelling and bruising are expected after upper eyelid surgery and are usually most pronounced in the first few days.

Stitches are removed by appointment.

Many people can return to work and normal social activities after about one to two weeks, but recovery varies.

Mild residual swelling, a feeling of tightness, dryness or changes in sensation may last longer.

The final result is assessed only after swelling and scar tissue have had time to mature.

How long do the results last?

Skin that has been removed during surgery does not return in the same way.

The natural aging process continues, however, and the skin, brows and tissue around the eyes will gradually change over time.

The duration of the result therefore varies from person to person.

Risks and possible complications

Upper eyelid surgery is a common surgical procedure, but as with all surgery there are risks.

Possible complications include:

• bleeding and hematoma

• infection

• pronounced or prolonged swelling

• dry or irritated eyes

• temporary difficulty closing the eye completely

• asymmetry

• a visible or irregular scar

• altered sensation

• too little or too extensive correction

• the need for later correction

Serious complications affecting vision are very rare, but they will be discussed as part of informed consent before surgery.

Consultation for eyelid surgery in Bergen

An individual consultation is required before any surgery.

During the consultation we assess both the eyelids and the area around the eyes, including excess skin, brow position, symmetry, any ptosis and factors that may affect eye health.

You will also receive information about what can realistically be achieved, possible limitations, the surgical process, recovery and risks.