Aesthetic results, avoiding complications major goals when performing blepharoplasty

Key takeaways:

• Patient satisfaction, good aesthetic results and avoiding complications are key when performing upper blepharoplasty.
• It is helpful to keep the patient seated when marking the temporal extent of the incision.

KOLOA, Hawaii — The three primary goals of upper blepharoplasty are ensuring patient happiness, obtaining an aesthetic result and avoiding complications, according to a speaker here.

During a presentation at Hawaiian Eye 2025, Andrew R. Harrison, MD, offered his pearls for performing the procedure.

“The upper eyelid in youth is full; It’s not skeletonized,” he said. “The crease is typically quite low — 6 mm to 9 mm or so —and the eyebrows do come down, but usually at a later age,” he said.

When marking the lid crease, if it is symmetrical, it is useful to mark it in the existing crease. If it is asymmetrical, Harrison said, mark the crease at 6 mm to 10 mm in females and 5 mm to 8 mm in males.

“It is important to discuss with the patients preoperatively where they would like that crease to be,” he said.

Another cornerstone of blepharoplasty is the orbicularis oculi, Harrison explained. This muscle plays a role in eyelid closure and should never be aggressively removed, particularly in patients with dry eye disease.

He also stressed the importance of making sure the patient is seated when marking the temporal extent of the incision, which will help prevent the need for revision later on in the procedure.

When marking the skin, Harrison recommended leaving at least 20 mm to 25 mm on each side of the procedure area to help ensure optimal postoperative symmetry. During the operation, he uses a boat-shaped incision.

“Nasally, I come upwards and laterally I come upwards at a little bit of an angle,” Harrison said. “The reason I do that is if you come to a point, sometimes you will take too much tissue and when you close it you will get a web. Those webs are really difficult to fix.”

When excising the lid flap with scissors, it is helpful to excise in layers, he explained. Unless there is notable bulk to the lid, it is advisable to only excise the skin.

“Blepharoplasty is, technically, a very easy procedure — it’s just a matter of deciding what to do and how much to do,” he said.

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Sources/Disclosures

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Source:

Harrison AR. Upper blepharoplasty 101. Presented at: Hawaiian Eye 2025; Jan. 18-24, 2025; Koloa, Hawaii.

Disclosures:
Harrison reports no relevant financial disclosures.

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