The sigmoid upper eyelid blepharoplasty: redefining beauty.

PURPOSE A youthful female upper eyelid contour includes a concave medial portion of the upper eyelid along with a fuller, convex lateral eyelid. The skin in the lateral eyelid is tight without hooding. This is a sigmoid shape in 3-dimensional terms. With aging, fatty herniation medially along with redundant, hooded, ptotic lateral skin creates the exact opposite eyelid curve. The sigmoid blepharoplasty is a novel surgical technique that recreates a youthful upper eyelid. METHOD A retrospective chart review of 142 female patients who underwent the sigmoid blepharoplasty was conducted. To recreate a youthful eyelid in 3 dimensions, the medial eyelid concavity is achieved by removing a strip of medial orbicularis oculi muscle along with selective medial fat removal. Excess skin and hooding is removed, and fat grafts from the medial eyelid are placed laterally below the muscle to achieve a fullness and tight skin. RESULTS All patients achieved a pleasant, rejuvenated upper eyelid as assessed by photographs and chart records. The sigmoid blepharoplasty restored a youthful eyelid appearance by recreating a concave medial eyelid and fuller lateral eyelid. There were no infections, and fat grafts took uniformly. CONCLUSIONS The sigmoid upper eyelid blepharoplasty technique recreates a truly youthful eyelid with novel eyelid concepts. The surgery is safe and reproducible, and consistent results are achievable.