Eyelids


The Chapters

Upper lid skin excess
Brow ptosis
Entropion & Ectropion
Ptosis
Basalioma

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Upper lid skin excess (Dermatochalasis)

Causes

An excess of upper lid skin in adults is called dermatochalasis. These changes are due to aloss in elasticity and are part of the natural aging process of the skin.

In rare cases these chances may already found in children and this is then called blepharochalasis syndrome.




Male and female lids

There are distinct differences between men and women: a male upper lid typically shows more excess of skin than a female eyelid. This excess should not be removed completely. In men, we therefore always leave a certain excess of upper lid skin in order to preserve the natural facial expression.


An upper lid blepharoplasty may be performed as an outpatient procedure and under local anesthesia.

In a first step, thorough marking of the excess of skin is performed by creating an exact drawing. Then, the excess of skin and a small strip of orbiculare’s muscle are removed surgically. In many instances, a prolaps of fat may be found in the deeper structures of the eyelids. If present, excess of fat will also be removed. Finally, the skin is closed with a fine continuous surge. The procedure is usually performed on both eyelids in the same session and takes approximately 30 minutes.


Blepharoplasty in women – our results



Performing upper lid blepharoplasty – Video in german



Blepharoplasty in men – our results



Brow Ptosis


The position of the eyebrows may lower over the years. This pushes down the skin of the upper lids and mimicks a dermatochalasis. The therapy of choice is not an upper lid blepharoplasty, but rather a direct brow-lift. Whereas the surgery is similar to an upper lid blepharoplasty, it is rather performed at the level of the eyebrows.




Entropion and ectropion


Entropion

An Entropion is an inverted lower lid. The main cause for entropion is a progressive laxity of the lids that comes with age.

An entropion can not resolve spontaneously and will deteriorate with time. The eye is constantly irritated since the lashes of the lower lid get in constant contact with the cornea. Typical symptoms include pain, redness of the eyes, tearing, and photophobia. In long-standing cases, severe infections of the cornea may occur.

An entropion might be corrected by horizontal and vertical tightening of the lower lid. Horizontal tightening is corrected by tightening the lower lid at the exterior margin. The surgery takes approximately 45 minutes, and the success rate is 80-90%. May be performed as an outpatient procedure and under local anesthesia.


Entropion surgery – our results



Ectropion

An ectropion is an everted lower lid: the inner side of the lower lids is exposed to the air constantly and dries out. Most often an ectropion is caused by a horizontal laxity of the lower lid, combined with a low action of the orbicularis muscle.

In rare cases, ectropion may occur in various skin diseases, infections or scaring of the lower lid skin.

An ectropion might be corrected by horizontal and vertical tightening of the lower lid, similar to an entropion. Horizontal tightening is corrected by tightening the lower lid at the exterior margin. The surgery takes approximately 45 minutes, and the success rate is 70-80%. Depending on the amounts of ektropion, we will perform the operation on the local anesthesia or under narcoses. In most cases local anesthesia is sufficient.

Special case: in cases where the ektropion results from shortening of lower lid skin (scar tissue, skin disease) a transplantation of skin may be necessary to release the traction on the lower lid skin. We may use the upper lid of the same side or the contralateral side or skin from behind the ear for transplantation.


Ectropion surgery – our results



Horizontal lid laxity


The position of the eyebrows may lower over the years. This pushes down the skin of the upper lids and mimicks a dermatochalasis. The therapy of choice is not an upper lid blepharoplasty, but rather a direct brow-lift. Whereas the surgery is similar to an upper lid blepharoplasty, it is rather performed at the level of the eyebrows.



Ptosis


A ptosis is a hanging upper lid. It may be either congenital or acquired, with age or after years of contact lens wear.

A ptosis may limit the visual field, and may also damage the cervical spine in severe cases, because patients try to compensate the reduced visual field by constantly tilting their head backwards.

The success of surgical therapy largely depends on how good the remaining acion of the levator muscle is. Different approaches may be used, from Fasanella-Servat operations to levator reinsertions and levator resections.


Ptosis repair – Video in german




Ptosis surgery – Our Results


Basalioma


Basaliomas are light-induced malignant tumors. They may occur on the skin, and also on the lower and upper lids. Fortunately, basaliomas very rarely develop metastases: once the tumor is removed, and the lid reconstructed, the remission rate is very high.

A number of surgical approaches can nowadays be used to remove basalioma, with good to excellent functional and cosmetic outcome.


Eyelid reconstruction – our results