Tightening my Upper Eyelid Muscle by Going Through the Underside?

Question

My doctor wants to perform blepharoplasty by only tightening my upper eyelid muscle, by going through the underside of my upper eyelid. I cannot find anything like this in he internet. Does this procedure sound like it is saf and/or possible?

A.J. Amadi, MD · Answer

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.

Mehryar (Ray) Taban, MD, FACS · Answer

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.

Lawrence Kass, MD · Answer

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.

Jonathan Hoenig, MD · Answer

Upper eyelid surgery through the underside of the eyelid is done to tighten the upper eyelid muscle and correct droopy upper eyelids. By droopy in the sense of how high the eyelashes are raised compared to the iris of the eye. I don't mean droopy in the sense of loose, saggy skin.

	This is a procedure commonly performed by oculoplastic (eyelid plastic) surgeons. It is used for a droopy eyelid, and the end result is a more refreshed, less tired appearance. No skin or fat is removed, so if loose skin or pockets of fat are your problem, the internal muscle tightening procedure will not help. The technical term for this surgery (that you can search for online for more information) is called "muellerectomy".

Moneer Jaibaji, MD · Answer

I think from your description, you are having ptosis repair. There different ways to do that and going through the underside is one of them. It is a safe procedure if done for the right reasons.

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