One of the most common concerns among potential eyelid lift, or blepharoplasty, patients is having a hollow or sunken look to their eyes following surgery. The hollow or sunken look can be seen in some patients who had an eyelid lift by a plastic surgeon who removed not only skin but also underlying muscle and fat. When too much soft tissue is removed from the upper eyelid, for instance, the eye begins to look sunken. Although the eye now looks different (and has less skin redundancy), it is far from looking youthful and more rejuvenated, which is the goal of an eyelid lift. I think that many plastic surgeons forget to realize that the esthetically ideal eye does indeed have some volume  between the eyelid and the eyebrow. If you look at any famous model out there, you will appreciate there is a nice convex shape (not flat or hollow) going from the upper eyelid crease toward the eyebrow. What most blepharoplasty patients are after is removal of just the excess skin that drapes over their natural eyelid crease that detracts from a more pleasing appearance. In order to avoid this type of look following blepharoplasty, I try and preserve much of the underlying eyelid muscle and even fat. If there is some excess fat that warrants removal, I do this in a conservative fashion during the eyelid surgery. I will also even contour the eyelid muscle a bit but fall short of actually resection (or removal) of the muscle in a majority of cases. For the most part, though, I try and preserve much of the normal, native underlying anatomy. The adjacent photos of one of my San Diego eyelid lift patients highlights much of what I am trying to explain above. This particular female blepharoplasty patient was most concerned about the excess skin along her upper eyelids. As you can see from the photos, she has upper eyelid skin that is draping down almost over her actual eyelashes. Although she was fairly young in age, her upper eyelids were giving her the appearance that she looked much older and tired. I performed an upper eyelid (and lower eyelid) lift to remove essentially just skin from both sides. I did minimal contouring of her upper eyelid muscle and even less work on the fat. The red shaded area in the photo shows essentially what was removed from the upper eyelid. As you can see in her postoperative photo, there is a marked improvement in the shape of her eye now. We fully preserved her natural, almond shape of the eye and provided her with a much more youthful, rested look. All this was able to be accomplished without risking a hollow or sunken look. Hope this helps any of you San Diego blepharoplasty, eyelid lift candidates considering surgery.
