Upper eyelid surgery
Indications to upper eyelid surgery are:
Skin excesses (dermatochalasis)
Increased part of oblique eye muscle
It is drooping of upper eyelid, which interferes beyond the border of cornea. Ptosis can be congenital or caused during life. Mostly it is caused by underdevelopment of muscle that raises the eyelid or by damage of innervation of this muscle. Often also so-called pseudoptosis occurs, when the eyelid does not droop but is covered with skin fold. Pseudoptosis can be also caused by facial asymmetry and therefore is resembles look of a patient with ptosis.
Solution: At first we check the function of eyelid levator. The surgeon fixes the eyebrow with index finger. It disables function of frontalis muscle that works as adjoining muscle to eyelid elevation. After that he/she checks the movement of eyelids. If the movement is greater than 10 mm and ptosis is up to 3 mm, it means that the levator is in good condition.
Fasanell-Servat surgery (Müllerectomy) – Solution to moderate ptosis up to 2 mm with functional eyelid levator. The surgeon turns over the eyelid and cuts out part of conjunctiva and tiny adjoining muscle (Muller’s muscle) and it is sewed to levator. It shortens and reduces the ptosis.
Aponeurosis of levator palpebrae superioris (levator muscle of upper eyelid) – Solution to ptosis greater than 2 mm when the levator’s function is preserved. The surgeon folds the tendon of levator on the smooth cartilage that thickens upper lid.
Resection of musculus levator palpebrae (eyelid levator) – Solution to moderate ptosis with non-functional eyelid levator. The surgeon can choose either approach through skin (transcutaneous) or approach through interior of eyelid (transconjunctival). In case of transcutaneous approach the incision is lead in natural skin fold, so that the final scar is minimally visible. After that part of the muscle is lifted and the rested parts are sewed.
Frontalis suspension – Solution to non-functional levator and/or heavy ptosis. The surgeon makes two short incisions above the eyelashes of upper lid and two incisions above eyebrows. He/she creates tunnel between holes on lids and forehead and laces through them thin fascia artificial or own to the body (firm and flexible muscle cover). Patient after this surgery opens and closes eyelid with the help of frontalis muscle. He/she learns to control the eyelid with this method during rehabilitation.
Fat prolapses, dermatochalasis, and increased oblique muscle
The incision on the upper eyelids and therefore even final scar is lead so that it is hidden in the skin fold of the lid. This way the surgeon gets into the subcutis. After removal of fat prolapses he/she gets to the muscle. Reduction of muscle fibres is not performed commonly, only in case the muscle is too big. By cutting the muscle the surgeon penetrates into fibrous septum, which separates the orbit (part of the cranial cavity containing eyeball) from its external part. It also avoids the transfer of infection to the interior of orbit. Cutting this septum can remove fat that prolapses behind the eyeball. Greater effect can be achieved if the surgeon presses slightly on the eyeball. At the end of the surgery the muscles are sutured. The fibrous septum does not have to be sewed. During the upper blepharoplasty after previous measurement and draft excessive skin is removed. The surgeon must be careful not to remove too much skin, the lid won’t close then.