Treatment of the Heavy Upper Lid

Abstract

The patient presenting with a heavy, curtain-like upper lid in the third or fourth decade of life poses a real surgical challenge and often receives excessive treatment and an unflattering outcome. These patients almost always have a pleasing but crowded upper lid and are frequently overoperated with a radical blepharoplasty. The crowded but pleasing horizontally based lid is thus changed to an unnaturally round lid and eye, which causes a disturbing change of character of the upper face. The author recommends treating such patients with a forehead lift and a very limited resection of skin and orbicularis strip. This modality preserves the horizontal characteristic of the lid and the three-dimensional harmony of the region, reducing the heaviness and curtain-like appearance and avoiding the creation of an unnatural, overoperated, round lid and eye.