Surgical anatomy of the upper eyelid fascia

There is a network of fascia in the upper eyelid that serves to transmit and distribute the motor power of the levator palpebrae muscle to the superficial tissues. The architecture of this network was studied intraoperatively. The results demonstrate that there is a superficial fascia under the orbicularis muscle which fuses with the levator aponeurosis at the level of the lid fold. Below the fold, these fascia remain fused or "conjoined." Thus, the fold in the upper eyelid reflects the union of fascia occurring internally and dose not result simply from the levator aponeurosis inserting into the skin. This article describes the anatomy and surgical identification of the upper eyelid fascia. I contend that the fascia constitutes an important internal framework for the upper eyelid, shaping the lid fold while elevating the tarsal plate in perfect synchrony. For the surgeon, visualizing the fascial architecture is a great aid in the correction of a variety of difficult eyelid deformities.