Hooded eyelids (dermatochalasis) are a result of excess skin on the upper eyelid, thanks to skin losing elasticity over the course of the aging process. In rare cases, inflammation can cause this to occur in children, a process called “blepharochalasis”. It is treated in the same way in both cases.
The upper eyelids of men and woman are different by nature. These differences are easily recognized by the experienced eye and we take these into account when performing the surgery. The picture shows the upper eyelid of a 30-year-old woman and a 30-year-old man.
The most important feature in both sexes is the eyelid furrow, which is formed by the uniform irradiation of the fibers of the levator aponeurosis (tendons) into the tarsus (a dense piece of connective tissue in the eyelid). In women, this usually lies at a height of 8-10 mm above the upper lid edge. On the other hand, in men, the eyelid furrow is set much lower, only 6-8 mm above the upper lid edge.
There are clear differences between the upper eyelids of men and women. A male upper lid typically has more skin excess than a female upper lid. This surplus should not always be completely removed: in men, we usually leave a certain excess on the upper lid in order to preserve the natural ‘male’ aspect of the lid.
There are an infinite number of slightly different upper eyelid shapes – and the one we aim for requires a lot of consideration before the procedure. Normally, we aim to restore the eyelid shape that people had in early adulthood.
Some patients show no excess eyelid skin at a young age and, accordingly, more tissue should be removed from such patients. In other words, what represents a “normal” amount of tissue to be removed for one patient may already be too much for another patient.
On the following pages, you can see from “before – after” pictures that are individually different: in some patients, we remove only a little excess, in others more, so that the result corresponds to the patient’s self-image of years ago.
The consideration of these elementary differences is a matter of course for us and for this reason we also ask you to bring older portraits for the first meeting.
The illustration shows a patient aged 52 and 18 years. It is noticeable that in this man already in the teenage years a clear skin surplus, so a small amount eyelid droop existed. In this case, only a little amount of skin and fat excess should be removed to restore the patient’s self-image.
Upper lid blepharoplasty can be performed on hooded eyelids on an outpatient basis under local anesthesia. The procedure can usually be performed on both eyelids in the same session and takes about 30 minutes.
Before the actual procedure, we decide on the cut that should lead to the optimal result. With a pen, we draw a precise sketch on the skin. The excess skin and a fine muscle strip are delicately removed in with a scalpel using extreme care. If there is also an excess (or an unexpected distribution) of fatty tissue, this will also be corrected. Finally, the skin is closed with a fine continuous suture.
The so-called “intracutanous suture” is deliberately omitted. In other dermatological procedures, this approach can bring many benefits, but this is not the case with the upper eyelid: there’s no benefit in terms of scar appearance, and it’s also mechanically less resilient too.
The procedure takes about 45 minutes, and upper eyelid blepharoplasty can also be combined with removal of the bags under the lower eyelid (blepharoplasty).
The upper eyelid blepharoplasty on hooded eyelids can also be combined with removal of the bags under the eyelid (blepharoplasty).