Blepharoplasty is a surgical procedure in which the eyelid skin, orbicularis oculi muscle, and orbital fat are excised, redraped, or sculpted to rejuvenate the aesthetic look of the patient along with correction of any functional abnormality.1 In fact, blepharoplasty is one of the most popular cosmetic procedures in the Unites States.2
As people age, changes to the lower eyelids and midface include pseudoherniated orbital fat, tear trough deformity, lid laxity, and dermatochalasis. Surgical repair often aims at treating redundant skin or orbital fat malposition.3
Dermatochalasis or sagging eyelids are a common condition with skin redundancy and lid atrophy of the upper eyelids. This is mostly caused by aging. The overall prevalence of sagging eyelids among individuals older than 45 years is reported to be 16 percent and is more frequent in males.4
Many patients will seek blepharoplasty for cosmetic concerns related to dermatochalasis of the upper or lower eyelids.
A large amount of excess skin may contribute to physiologic pathology. Significant dermatochalasis of the upper lids may contribute to lateral hooding and visual obstruction. Upper and lower lid blepharoplasty both have their own set of indications, and the procedures may be undertaken at the same time or at different times.
With blepharoplasty, common complications that can occur are lagophthalmos, ectropion, dry eyes, chemosis, granulomas, ptosis, scleral show, and retrobulbar hemorrhaging.5,6
Lagophthalmos and ectropion may occur from excessive skin excision or damage to the zygomatic nerve leading to a reduced orbicularis tone.
Many patients are exploring the option of eyelid taping to change the contour of the upper eyelid. Eyelid taping originated in Japan in the 1970s.7
This procedure was originally used to eliminate the monolid—where the eyelid does not have a crease at all—and create a double lid. Eyelid tape has now become popular in the Unites States to aesthetically and functionally target hooded lids.
Eyelid tape is applied to the upper eyelids to re-create the eyelid crease, thereby re-contouring it. The tape can be tailored in length, diameter, and placement to adjust for any eyelid asymmetry. The tape can be removed and replaced as desired or if there is an allergy to the adhesives or products. Accident-related misdirection of instruments for application of the product around the eye area is of concern.
There are many options for eyelid taping. These options include:
• Single-sided taping strips
• Double-sided strips
• Eyelid laces and fibers
• An assortment of glues that can be used with or without the taping products
These products are available in strips and spools in a variety of sizes and shapes, precut or not, and with or without applicator gadgets and eyelid manipulation instruments.
Eyelid glue—sometimes called eye putty—is an adhesive applied to the lid using a plastic prong-like device to push the skin up and adhere to the glue. This procedure changes or creates a crease.
Taping may help
It is unclear if frequent application and removal of eyelid tape or glue changes the elasticity of the delicate eyelid skin. In a personal experiment with lid taping (see Figures 1A and B), I have experienced mild, transient lid edema at the upper edge of the tape.
Should lid taping be a service offered in our offices as we approach aesthetic eye care in our practices? Can taping be a temporary method to avoid blepharoplasty in contraindicated cases? Can temporary eyelid tape application assist our patients in surgical decision making?
Asking these questions and keeping abreast of current social trends outside our sphere of expertise is interesting and can often impact our patient care.
1. Chen WP. Oculoplastic Surgery: The Essentials. Thieme Publishing Group: New York, 2001. Pp. 125-145. ISBN-13: 978-3131274519.
2. CBS News. Top 10 most popular cosmetic procedures in U.S. Available at: https://www.cbsnews.com/pictures/top-10-most-popular-cosmetic-procedures.... Accessed 6/19/18.
3. Murri M, Hamill EB, Hauck MJ, Marx DP. An Update on Lower Lid Blepharoplasty. Semin Plast Surg. 2017 Feb;31(1):46-50.
4. Jacobs LC, Liu F, Bleyen I, Gunn DA, Hofman A, Klaver CC, Uitterlinden AG, Neumann HA, Bataille V, Spector TD, Kayser M, Nijsten T. Intrinsic and extrinsic risk factors for sagging eyelids. JAMA Dermatol. 2014 Aug;150(8):836-43.
5. Pacella SJ, Codner MA. Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show. Plast Reconstr Surg. 2010 Feb;125(2):709-18.
6. Lelli GJ Jr, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg. 2010 Mar;125(3):1007-17.
7. Phan M. Even out your eyelids without surgery. Available at: http://www.michellephan.com/michelle-phan-even-out-your-eyelids-without-.... Accessed 6/19/18.