Heavy Upper Eyelid Treatments - Blepharoplasty, Botulinum Toxin, And Filler
If you do not like the way your eyelids look and are wondering if you are a candidate for an upper blepharoplasty...the answer is definitely...maybe. :) botulinum toxin and filler injections may also be treatment options in some patients.
First, I do not consider age to be a factor in determining who is a candidate for surgery or injections. We all have different anatomy and each patient’s concerns are unique. See the sections below for considerations regarding each treatment option.
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There is a common misconception that upper blepharoplasty purely involves skin removal. While this is true in some cases, most patients require something more than skin removal to get the best results. In fact, often, the amount of skin removed is conservative and the improvement noted after surgery in my patients is more so due to the recreation of normal anatomical relationships of the tissues deeper within the eyelid. This may be in the form of a sulcoplasty in which I contour the upper potion of the eyelid as it meets the eye brow (example of surgical result in the before and after picture below) or from eyelid crease reformation which keeps the eyelid snug against the levator muscle as it moves. Further, many patients also have concurrent ptosis (drooping of the eyelid in which the eyelid hangs too low). A small amount of ptosis (microptosis) is often overlooked, but, as an oculofacial plastic surgeon, I am trained to think in microns and millimeters. Internal ptosis repair can be performed at the same time as an upper blepharoplasty and provides excellent correction of microptosis as well as more significant levels of ptosis. Recognizing the various factors at play within the eyelid and using advanced eyelid surgery techniques are critical to ensure a good outcome from upper blepharoplasty.
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With regard to non surgical options for heavy upper lids, some patients may be candidates for a non surgical brow lift (chemical brow lift). For a chemical brow lift, depending on the patient, I may first selectively target the orbicularis oculi muscle with botulinum toxin. An increase in height of the brow that results from this injection will make the heavy upper eyelid skin less prominent. In some patients who may also benefit from filler, I then re evaluate around 2 weeks after the botulinum toxin injection to see if filler injections in the brow area should be pursued. For others who do not need botulinum toxin injections, filler injections alone may be given to provide lift and projection by adding volume. Botulinum toxin injections last for around 3 months, while filler lasts around 1-2 years depending on the product and patient. Should you ever decide to undergo a chemical brow lift, be sure that you are under the care of a master injector who understands the anatomy and technique required. I see patients in which a chemical brow lift was attempted by other injectors but was executed poorly due to lack of understanding of the anatomy and how the product works. A common example of this is an injector who tells a patient that injecting the forehead with botulinum toxin will cause the brow to lift - this is not true. In fact, it’s the opposite. botulinum toxins weaken muscles. Therefore, if the forehead is treated overly aggressively, it will droop and cause the lids to look even heavier. I help people in this situation by performing additional botulinum toxin injections to relax the orbicularis oculi muscle that pulls the brow down. Another example of poor execution of a chemical brow lift is only treating the lateral aspect of the brow. Unfortunately, this is too common and can lead to an unusual brow contour where the tail of the brow is too high. Contour can be improved by additional injections that are carefully placed to create the appropriate balance.
A detailed examination will ultimately determine the best approach for treating heavy upper eyelids whether it be by surgical or non surgical methods. If you are considering blepharoplasty or injections in the periocular area, my advice is to choose a surgeon who employs advanced eyelid surgery techniques regularly and who is an expert injector. This will help ensure that you get the best results possible.
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This patient in her 40s presented with excess skin on her upper eyelids (dermatochalasis). The patient underwent customized bilateral upper blepharoplasty with sulcus reformation. Sulcoplasty with the brassiere suture technique contours the eyelid and supports the brow fat pad from below. This recreates normal anatomic relationships and prevents the eyelid skin from sagging. Some patients need more than a traditional blepharoplasty with skin excision to achieve optimal results.
