What are the best options for treating aggressive upper blepharoplasty? (Photo)

Question

Do eyelid skin grafts really have a hard time looking natural or does it just take time? I have lagophthalmos due to an aggressive upper Bleph surgery.

Kenneth D. Steinsapir, MD · Answer

If you are talking with a surgeon who wants to put skin grafts into your eyelids, you are not working with someone who understands these eyes. These skin grafts are never right and are rarely needed when they are used. There is no substitute for an actual detailed in person assessment of your eyelids. Generally the blepharoplasty weakens the orbicularis oculi muscle in the eyelid that helps close the eyelids. However, a bigger issue is that it appears that your eyelid platform has been sewn to the septum. The septum is an inelastic membrane in the eyelid. Normally the upper eyelid is not directly attached to this structure but instead should be attached to the mobile levator aponeurosis. Surgeons mistakenly think that they are suppose to suture the eyelid platform to the septum and refer to this as supra tarsal fixation. But this is a misunderstanding of the anatomy that authors of various papers have perpetuated in the literature. Generally this eyelids can be repaired by lowering the upper eyelid crease and repairing the normal attachment between the eyelid platform (part below the crease) and the levator aponeurosis and breaking up its attachment to the septum.

Mehryar (Ray) Taban, MD, FACS · Answer

Upper eyelid skin graft is a complex reconstructive procedure. I am not sure you absolutely need that. Need more detailed evaluation and discussion to determine.

What are the best options for treating aggressive upper blepharoplasty? (Photo)

Answers (2)

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