Abstract
Upper blepharoplasty has traditionally involved subtractive approaches with excision of different amounts of skin, muscle, and fat. However, this approach often results in iatrogenic acceleration of the normal volume depletion and bone resorption associated with aging, which leads to deepening of the superior sulcus, A-shape deformity and generalized hollowness. In recent years, the concept of periorbital volume restoration and augmentation has shifted the paradigm toward fat preservation and gland repositioning procedures. Herein, we describe the volumetric contouring concept, a contemporary approach for upper blepharoplasty that includes gland repositioning, suspension of the levator aponeurosis, fat transposition or reposition, and adjunctive filling procedures. This concept seeks for long-term restoration of the eyelid-brow complex by addressing every involutional aspect of the aging process, while treating and preventing hollow eyes and A-shaped deformity. In our experience, this approach has enabled us to attain optimal and long-lasting aesthetic results.
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