We sometimes consider upper eyelid surgery as functional when it is medically necessary. We may recommend functional upper eyelid surgery when any excess drooping of the upper eyelid, either through the skin or the ptosis, affects the peripheral vision and your ability to see upward and to the side. Therefore functional eyelid surgery is meant to improve the function of the eyelids, to protect the eyes better or to help you see out better.
All functional eyelid surgery should also be aesthetic as all surgeons want to do the most delicate surgery that they can do for the patient even if for medical reasons. To tell whether it is functional surgery or cosmetic (aesthetic) is to determine if the eyelid surgery is being done for important psychological reasons, to boost confidence in the case of a congenital deformity, to correct an asymmetry which is noticeable and affects the person’s ability to be social, or to obtain employment. It is not physically functional surgery, as we cannot demonstrate that the eyelid problem is interfering with their vision. In many cases, the psychological effect of excess skin or asymmetry or deformity of the eyelids can also be termed functional as it meets certain criteria which are medical.
Upper eyelid blepharoplasty is sometimes called an eye lift, and this should not be confused with upper eyelid ptosis surgery which is also a sort of eye lift. That is because blepharoplasty is a procedure aimed at raising the position of the top eyelid margin by tightening the little muscle called the levator muscle, the aponeurosis, that elevates it and that has either got an inherent problem or has stretched out as an involutional problem. Blepharoplasty surgery will sometimes lift the upper eyelid merely by removing the heaviness of the excess skin and soft tissue which is weighing down on the upper eyelid and causing it to droop. Hence it is called an eyelift.
We refer to a surgery as cosmetic eyelid surgery when the surgical procedure of removing excess skin from the upper eyelids along with any excess muscle or fat as required is not a medical necessity and is performed solely to improve the appearance of the eyes and make the patient look more beautiful and younger.
The surgical subspecialty of ophthalmology called oculoplastics has been developed to generate more consultants who do eyelid plastic surgery uniquely and also have an in-depth understanding of the relationship between the eyelids, the vision and the surface of the eyes.
Jane Olver is an oculoplastic expert who corrects eyelid malpositions such as ptosis, entropion and ectropion. She has written several papers on these subjects and has taught many other oculoplastic trainees about the techniques that she has mastered or pioneered in oculoplastic surgery.