Lid Crease
Steven Faeien
Over the years, success of a particular surgical procedure, even aesthetic, has been measured mostly by perceived outcome and to some degree by the frequency of complications. Since the overwhelming majority of aesthetic periorbital ‘complications’ have occurred with lower blepharoplasty, most of the attention on newer and improved techniques has focused on the lower periorbita’”6 (see Chapters 14-19, Lower blepharoplasty).
As functional misadventures are a much less encountered occurrence after upper blepharoplasty, complacency with existing methods and perpetuation of ill-perceived solutions to rejuvenation of the upper periorbita prevail.7,8
With rare exception, the approach to upper blepharoplasty has not been particularly physiologic or individualized and the universal application of traditional remedies for upper periorbital rejuvenation has translated to mediocrity.7″”9 The prevailing perception has been that the appearance of the aged upper eyelid is primarily due to excessive skin, muscle, and fat often in conjunction with brow descent. Additionally, there is the confounding erroneous memory in many individuals of what their upper periorbita looked like in youth. Finally, there is the influence of the ‘famous and beautiful’ people on what patients may request for their eventual appearance despite their configuration in earlier years (Fig. 8-1) that may explain some of the historical aesthetic desires as well as changes in ideas and what is currently expected after surgery.
Steven Fagien
The consultation
As with all surgical approaches to rejuvenation, we must take into account what are the actual changes that occur in the upper periorbita and whether the existing methods consider these occurrences for a wide variety of indi¬vidual presentations (Fig. 8-2). Do these techniques result in a rejuvenative appearance or simply achieve a ’cause and effect’ outcome whereby an altered appearance replaces youth? (Fig. 8-3). And, ultimately, what surgical procedures are some patients willing to undergo and what do they expect from surgery?
