On Upper Blepharoplasty, is it better for stitches to be above or under eyelid? I am considering having my upper eyelid skin removed. Is it better to have them stitch the skin over or under the eyelid. Which heals better?
Above Vs Under Eyelid Stitches for Upper Blepharoplasty?
Doctor Answers 7
Not entirely clear what you are referring to
Dear Time Saver
Upper eyelid surgery is not a one size fits all procedure. Precisely what needs to be done vary much depends on what is going on. One of the problems of trying to be an informed consumer is that it can be very confusing sorting through all the information out there on the internet.
Standard upper eyelid cosmetic eyelid surgery is also referred to as upper blepharoplasty. This is done through an incision made at the height of the eyelid crease. Skin and muscle are usually removed above this. Fat behind the eyelid may be sculpted or excised. A procedure called anchor blepharoplasty sutures the leading edge of the eyelid platform to the tendon that raises the upper eyelid. This makes what is known as a hard crease. This component of upper blepharoplasty is a highly skilled art that not performed by a lot of eyelid surgeons. It requires an advanced knowledge of the upper eyelid anatomy. The benefit of this additional procedure is that it smoothes the eyelid platform (see my glossary of terms on my website lidlift.com) and helps correct eyelash ptosis. This makes for a much perkier looking eye.
Closing the skin incision in the upper eyelid is typically done with what is called a running closure. Some surgeons prefer a subcuticular closure where the suture is woven between the edges of the skin wound. Ultimately the upper eyelid incision heals so well that there is no clear preference for which of these methods is better.
There are upper eyelid procedures that are done from behind the upper eyelid. This procedure does not remove skin but does lift the eyelid margin when it is drooping.
The lower eyelid blepharoplasty is the one there the are two distinct approaches either with a skin incision in front of the eyelid called a transcutaneous incision or behind the eyelid which is called a transconjunctival incision. There is a preference for the tranconjunctival incision which results in less scaring but much depends on precisely what issues need to be addressed.
In Columbus Ohio, you might consider researching Jill Foster, M.D. an extremely talented oculoplastic surgeon who is very well respected nationally and internationally.
Incisions for upper blepharoplasty
With regards to an upper blepharoplasty, the incision is made in the upper eyelid crease, and the stitches are dissolvable. They fall off in approximately five to seven days. To remove upper blepharoplasty skin, an incision on the outside has to be made.
Upper Eyelid Stitches above or under
Both stitches above the skin (running cutaneous stitch in medical terms) or under the skin (subcuticular in medical terms) are equally good. The main thing is the technique of the plastic surgeon.
I personally use above the skin (running 6-0 prolene) with great results.
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Upper eyelid surgery and sutures
The upper eyelid has a very thin dermis and thus does not heal with noticeable scarring. The decision to perform subcuticular or interupted sutures makes little difference in long term outcome and is dependent on surgeon preference.
Both should heal just fine
Whether sutures are placed internally ie a sub-cuticular closure or externally does not really affect the outcome in my experience. The upper lid incisions heal very well if small enough sutures are used. We use an external approach and a 7'0 silk suture which is a very fine and delicate suture. This allows us to avoid little skin cysts called milia which can be a problem with eyelid sutures.
The upper blepharoplasty, by definition, is the excision of the excess upper eyelid skin. Therefore, the incision must be placed over the outside part of the upper eyelid. When correctly performed, the incision is placed within the natural eyelid crease which leaves an undetectable scar.
Upper blepharoplasty incisions
For upper blepharoplasty, the incision is placed within the natural lid crease. These fine scar lines heal very well and often become barely visible - even to the plastic surgeon.
Personally, I use a subcuticular (under the skin surface) suturing technique. When regular skin sutures are placed in a meticulous fashion, the line should heal very well, too. It often is surgeon preference...
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