Quadruple blepharoplasty literally means four-lid surgery (2 upper lids + 2 lower) to change the shape and size of the eyelids. This operation can be very helpful in patients who feel that their eyes give them an aged, angry or sleepy appearance, or that the topography of the eyelids cast shadows that detract from their overall facial beauty. Of course, other patients complain that heavy eyelids make them feel tired and can even impair vision. There are a lot of different flavors of blepharoplasty or eyelid lift surgery, but the fundamentals are the same: eliminate shadows, rejuvenate the peri-ocular region, and improve function. Conservatism is key in these operations as overaggressive surgery can lead to deformity and dysfunction of intricate delicate eyelid mechanisms.
In this video, we feature a Hispanic woman who trusted Dr. Zelken to enhance her beauty through reshaping her upper and lower eyelids. Her concerns were bags in the lower eyelids as well as excess skin, and fullness and heaviness of the upper eyelids. This is very common in many populations, and possibly more so in Asian and Hispanic populations. To reshape her upper eyelids, we removed some of the volume of the upper eyelids prior to removing upper eyelid skin. The lower eyelids excess fat was repositioned, and the skin and muscle were pulled up for a mid-facelift type result. The patient is very happy with these results which speak for themselves. However, she still had persistent heaviness and hooding near the crow’s feet. While much of this is related to swelling and could improve with time and no toxins like Botox, we both agreed that a subtle repositioning of the lateral eyelid would enhance her results and overall beauty.
My standard for eyelid aesthetics is that tail of the brow is positioned at the same level or higher than the inner aspect of the eyebrow. Arching, thickness, and fullness of brow are very subjective goals, but when the tail of the brow is lower than the inside, it can present as sleepiness or sadness, and this is what I aimed to correct. Only does gentle elevation of the lateral brow improve the aesthetic appearance of the eyebrow and eyelid region, but it can also reduce heaviness causing persistent creases laterally over heavy crow’s feet. Sometimes excising skin alone is not enough, because the mobility of the lateral brow allows it to be pulled down. In addition, when things like Botox are injected in the forehead region, this can add additional weight to the brow region and exacerbate the lateral fold.
This case illustrates the point nicely. Despite a successful and desirable result of quadruple blepharoplasty, the patient still has persistent fullness of the lateral orbital region. To correct this, a minimally invasive and dynamic brow lift would allow us to easily soften fullness and efface creasing laterally. I have been developing an awake procedure that requires local anesthesia alone to elevate the entire lateral eyelid and brow region as a single unit. This can be performed in minutes and can enhance the result of upper eyelid surgery significantly. As demonstrated in this video the procedure is designed to mimic the effect of a thread lift, but it is permanent in the sense that a permanent suture is used, and it transmits the load through mobile and deep structures of the brow to a fixed anatomic structure along the temporal fusion line over the skull. The results speak for themselves and enhance brow aesthetics as well as the lateral eyelid region. This procedure is designed not only to enhance quadruple and upper eyelid surgery, but in some milder cases, to replace it. In addition, the procedure can minimize the length of the upper eyelid scar which can be bothersome in all patients, and particularly in patients of color.
