Blepharoplasty, upper eyelid; with excessive skin weighting down lid
The physician performs a blepharoplasty of the upper eyelid. Through an incision usually in the crease of the upper eyelid, the physician dissects the skin of the upper eyelid to the subcutaneous/muscle fascial layers. The skin is pulled tight and redundant skin is excised. Muscle fascia may be sutured to support sagging muscles. Orbital fat may be removed from the tissues as well as excessive redundant skin that mechanically weighs down the eyelid, obstructing the visual field. The incision is closed with layers.
Excision of lesion of eyelid
The physician administers a local anesthetic and the face and eyelid are draped and prepped for surgery. The eyelid lesion is outlined in a marking pen. The lesion is incised and the surgical wound is repaired with sutures if necessary.
Repair of blepharoptosis
Blepharoptosis is a droop or displacement of the upper eyelid resulting from paralysis. The physician administers local anesthetic and the patient's face and eyelid are draped and prepped for surgery. An incision line is outlined along the crease of the upper eyelid. A dissection is carried down the normal insertion point of the distal point of the levator tendon. The levator tendon is isolated. The physician uses sutures to advance the levator tendon onto the tarsal plate in an adjustable fashion. If the patient is old enough to undergo the procedure under local anesthetic, the patient is placed in a sitting position and eyelid height and contour are evaluated under the effect of gravity. The amount that the levator tendon is advanced corresponds to the degree of preoperative ptosis. If the patient is not able to undergo the procedure under local anesthetic, general anesthesia is used and a predetermined amount of advancement is performed. In either case, the incision is repaired with sutures once the tendon has been secured in its new location.
Canthoplasty
The physician administers local anesthetic and the patient's face and eyelid are draped and prepped for surgery. The physician increases the lid margin by cutting the medial or lateral canthus (juncture of upper and lower eyelid). The physician rearranges the anterior tissues of the lids to prevent adherence.
Conjunctivoplasty
The patient's face and eyelid are draped and prepped for surgery. Local anesthesia is administered. With the aid of an operating microscope, the physician separates the conjunctival epithelial tissue from the underlying Tenon's capsule. The site to which the harvested tissue is to be grafted is prepared to accept the tissue. Its margins are freshened and the conjunctival graft is arranged and sutured into place. The tissue for graft can be a free graft or extensive rearrangement of existing tissue.
