Once upon a time, upper eyelid surgery solely involved removing the excess skin on the upper eyelid in the form of an "ellipse" and then suturing it up nicely. Even in this simplest form, where and how much of that skin should be removed was a very sensitive matter that had to be carefully planned for each patient.

Driven by the experience accumulated over the years by the science of plastic surgery, this surgery has today gained a more comprehensive (extended) form that covers all layers of the eyelid when necessary, and even the nearest adjacency of the eyelid can be accessed through the eyelid incision.

Let’s see what's going on in and around the aging upper eyelid.

There is a relative excess of skin around the eyes. This excess of skin is relative because we don't actually produce new skin as we age. Many structures under the skin from muscle to connective tissue to fat tissue to bone lose volume and shrink in size. As a result, a relative excess of skin compared to the underlying structures emerge. You can think of it as losing weight and not fitting into your old clothes as they are loose now. Removing this relatively excess skin is still a viable strategy because it is not yet possible to return the subcutaneous tissues to their youthful volume. In other words, we will send the dress to the tailor, but we still have to take care of what is inside the dress. Extended plastic surgery of the upper eyelid is about everything under the dress.

As we age, the muscle called “orbicularis oculi”, which is adjacent to the skin under the eyelid and serves to close the eyelid like a curtain, also gets loose. Removing this muscle when necessary will relieve the clump on the upper eyelid. In cases where the muscle is abundant but not removed, the muscle will fold on itself and form a roll on the upper eyelid fold. As you can imagine, you will not like this roll very much.

As we age, the connective tissue layer we call the orbital septum, which separates the superficial and deep layers of the eyelid, also loosens, and the slackness in this layer causes the upper eyelid fat pads to protrude from the eyelid like hernia. The loosening in the septum can be evaluated and surgically tightened if necessary.

We can say that the septum is the deep layer of the eyelid. Here are the fat pads that form the upper eyelid bags. We shape these fat pads individually for each patient. Sometimes we remove the fat, sometimes we push it to the back of the eye, and sometimes we transfer it from one bag to another.

 

 

The most important structure in the deep layer is the "Levator" muscle, which is used to open (lift) the eyelid. This muscle has a curtain extending from its body to the cartilage structure at the ciliated border of the eyelid. Micro-tears occur in this curtain as a result of wear over the years. This wear is more evident in patients who have had low eyebrows for a long time and try to keep their eyelids open against the load of the eyebrow. Repairing this curtain is also an element of modern upper eyelid surgery.

Another important structure in the deep layer is the gland which produces tears. This gland may sag in some patients and if it is not noticed before the surgery and lacks support during surgery, it can manifest itself as an annoying swelling in the external part of the upper eyelid after surgery.

One of the most aesthetically important details in upper eyelid surgery is the position of the upper eyelid fold. An aesthetic upper eyelid should have a distinct and sharp upper eyelid fold. What creates the fold is a connective tissue connection between the curtain of the deep Levator muscle and the skin. Thanks to this connection, as the eye is opened, the surface skin is pulled towards the back of the eye, forming the upper eyelid fold. In an aging eyelid, this fold may rise, become indistinct and deteriorate. It is very important for an aesthetically ideal result to surgically repair and even redesign the anatomical connection that forms the fold.

Modern upper eyelid surgery involves understanding all of these layers and structures and manipulating them when necessary. But the scope of extended plastic surgery of the upper eyelid is not limited to these. There is more.

It is possible to use the incision for upper eyelid surgery to change the surrounding tissues. You know, there are the muscles around the eyes that we weaken with BOTOX. These muscles can be accessed during the upper eyelid surgery and can be weakened permanently. Thus, you will not need to have BOTOX injections for your frowning eyebrows in the years following the surgery. Similarly, it is possible to intervene in the muscle group that makes up the crow's feet.

Another maneuver that can be performed during upper eyelid surgery is to fix the eyebrows on the bone roof by moving upwards from the upper eyelid incision towards the eyebrow. Although it is not possible to raise the eyebrows significantly with this approach, the drooping eyebrows that we see frequently after upper eyelid surgeries may be prevented to some extent.

In summary, don't underestimate the upper eyelid. Aesthetics around the eye requires detailed and meticulous work. It is very important to inform the public about the seriousness of the work and the opportunities that modern surgeries can offer in competent hands today, when some health institutions send shuttles to neighborhoods to collect patients from their homes and organize "eyelid surgery parties" - like mass circumcision ceremonies - at "discounted prices".

Take good care...

... of yourself and your beauty.