Tightening my Upper Eyelid Muscle by Going Through the Underside?

When we evaluate the upper eyelids, there are three components that need to be addressed:

1. Brow position

2. Upper eyelid position [as it sits on the eyeball].This is called eyelid ptosis if its low.

3. Excess eyelid skin [dermatochalasis]

 

It sounds like you and your surgeon are not on the same page. He/she is recommending

surgery to address the droopy eyelid [condition 2] while you are focusing on condition 3.

You need to have another conversation with your doctor so that he/she can explain things a bit better for you.

Your surgeon is likely describing upper eyelid ptosis (droopy) surgery by tightening the muscle (levator) responsible for elevating the eyelid.  This muscle can either be tightened from anterior (skin) approach or from posterior (underneath the eyelid) approach.  The posterior approach is actually the preferred approach for mild to moderate ptosis because it is more predictable with better eyelid contour.  Blepharoplasty is a different operation where only skin (plus) fat is removed from the upper eyelid; it does not actually lift the eyelid.  It can be combined with ptosis surgery if necessary.  Consult an oculoplastic surgeon.

  Please review the difference between blepharoplasty and ptosis repair.  It sounds like your doctor is suggesting ptosis repair, not blepharoplasty, through the underside.  There is nothing wrong with this approach for ptosis, and it is used by many surgeons (including myself).  Those who do ptosis repair in this manner believe that this approach offers greater predictability of results.  It may be combined with blepharoplasty of the upper lid.