Strategies of upper blepharoplasty in aging patients with involutional ptosis

Abstract

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.

One Patient of Blepharoptosis Caused by Levator Palpebrae Superioris Aponeurosis Degeneration

“…The cause of ptosis in this patient is due to the progressive degeneration of the aponeurosis of the levator palpebrae superioris aponeurotic membrane, which is a common degenerative eye disease in the elderly, and the cause of the disease is that the tendon membrane of the upper eyelid is broken, breakage or missing, causing part or all of the upper eyelid margin to cover the pupil, and due to the laxity of the aging skin, the weight of the upper eyelid plate is increased, which aggravates the patient’s ptosis 8. Blepharoplasty in elderly patients acquires young eyelids by removing sagging tissue.…”

Upper Eyelid Skin Laxity in Elderly Patients

“…Aging-mediated skin elasticity decrease and periorbital epidermis thinning cause skin laxity 1 . There are various manifestations secondary to the senile degeneration, such as sagging and drooping eyelids, multiple upper eyelid folds, drooping eyebrows, ptosis, and so on.…”

“…However, it is often observed in clinical practice that the main appeal of the elderly is to obtain a natural eye contour without visible scar, rather than acquiring ideal double eyelid folds. The near-eyelid-marginal incision of double-eyelid surgery has been reported to offer better adaptability and concealment 1,5 . This method has been extensively used in clinical practice.…”

“…Aging-mediated skin elasticity decrease and periorbital epidermis thinning cause skin laxity. 1 There are various manifestations secondary to the senile degeneration, such as sagging and drooping eyelids, multiple upper eyelid folds, drooping eyebrows, ptosis, and so on. Degeneration of the periorbital skin leads to aged appearance as well as visual field defect, entropion, trichiasis, and epiphora.…”

“…The near-eyelid-marginal incision of double-eyelid surgery has been reported to offer better adaptability and concealment. 1 , 5 This method has been extensively used in clinical practice. For patients with involutional upper eyelid skin laxity with or without blepharoptosis, we have proposed a feasible surgical scheme of parallel palpebral margin incision for the correction of upper eyelid skin laxity.…”