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Blepharoplasty, also known as eyelid surgery, aims to correct excess bags or skin that form on the upper or lower eyelids, which, in addition to creating aesthetic discomfort, can sometimes also interfere with vision.


The Eyelid Aging Process


As skin ages, it gradually loses its elasticity. A lack of elasticity plus the constant pull from gravity causes excessive skin to collect on the upper and lower eyelids.


Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin can hang over the eyelashes and get in the way of seeing.


The fat that cushions the eyeball from the skull can also cause bulges in the upper and lower eyelids. The thin membrane that holds the fat in place weakens with age, letting the fat come forward into the lids like a hernia.


Eyelid surgery is one of the Aesthetic Surgery interventions aimed at relaxing the skin around the eyes. It is used to eliminate drooping eyelids and bags under the eyes, depending on the needs of each patient. Moreover, it also allows to extract the fatty tissue deposited under the eyes and work on the lower and upper muscle. The goal of blepharoplasty is to recover a more vivid look and eliminate the effect of tired eyes, rejuvenating the look. It is a removal of the skin of the eyelids with aspiration of the upper parts of the bags of fat that produce the aesthetic defect, the operation is conducted with excisions of skin in the upper part of the eyelid with a small cut 2 mm from the lashes”.


It is important to point out that blepharoplasty is not used to eliminate crow’s feet or other types of wrinkles or to raise eyebrows, as also specified by the SICPRE guidelines, but it can be realized in combination with other operations in order to obtain the rejuvenation effect you want.


In summary, blepharoplasty serves to correct:


  • Excess skin that obstructs the view
  • Excess fat on the upper eyelid
  • Look tired or aged
  • Eye bags


How Is Eyelid Surgery Performed?


An eyelift usually takes about two hours if both upper and lower eyelids are done together. Your doctor will most likely use local anesthesia (a painkiller injected around the eye) with oral sedation.


If you are having the procedure done at a hospital or surgical center, you will most likely receive IV sedation.


If you’re having all four eyelids done, the surgeon will probably work on the upper lids first. The surgeon will usually cut along the natural lines of your eyelids. Through these cuts, your surgeon will separate the skin from the underlying tissue and remove the excess fat and skin (and muscle if indicated). Next, the surgeon will close those cuts with very small Stitches. The stitches in the upper lids will stay for three to six days. The lower lids may or may not require stitches, depending on the technique used.


Surgery on the lower eyelids may be done using one of several techniques. In one method, your surgeon makes a cut inside your lower eyelid to remove fat. That cut won’t be visible. Your surgeon can then soften fine lines in the skin using a. CO2 or Erbium Laser.


Another method involves making a cut along the eyelash margin. Through that cut, your surgeon can remove excess skin, loose muscle, and fat. The cut line fades after a short time.


After either of these procedures, your surgeon may recommend Laser resurfacing.


How is blepharoplasty performed?


The operation has a duration of between 1 and 3 hours, but if it were to be carried out in conjunction with another intervention, the duration will obviously be longer. Local anesthesia with sedation is sufficient, but in some cases it can also be performed with total anesthesia depending on the preferences expressed by the surgeon or patient.


After the operation an eye ointment and specific products containing very cold physiological solution are applied to facilitate the reabsorption of swellings or any discomfort. Patients can return to normal daily activities after about 10-12 days from the operation.


The signs of the incisions will barely be noticed, given that they are made in correspondence of the natural lines present between the lower and upper eyelids, under the eyelashes. These incisions allow to separate the skin from the adipose tissue and from the muscle, so as to allow the extraction of excess fat or skin. The incisions will be closed with very thin stitches.


In the case of very young patients who only have an excess of fat, generally, they opt for a Tran’s conjunctival blepharoplasty of the lower eyelids, a procedure that involves the incision inside the eyelid itself which therefore does not leave a visible scar and which will heal in about 3 or 4 days. This technique is not used in the event that an excess of skin is also removed.


Combined blepharoplasty techniques


If the patient’s goal is an improvement or rejuvenation of the gaze, which does not only include the elimination of drooping eyelids or bags, blepharoplasty can also be accompanied by some additional interventions that can help to achieve a more complete result. These combined interventions include:


Blefaroplasty with lipofilling: this is a traditional blepharoplasty, to which however the elimination of dark circles with lipofilling is added, or with the infiltration of autologous fat. The lipofilling technique also allows you to correct other facial blemishes, such as nose-genius grooves or some expression lines like crow’s feet or wrinkles between the eyebrows. This procedure gives an overall result, normally, more satisfying because it allows to rejuvenate not only the look, but the face as a whole.


Blepharoplasty with Nanofat: aims to improve the color and appearance of dark circles. Nanofat is a combination of the patient’s autologous fat, stem cells and growth factors that helps the healing of the treated area and the correction of wrinkles.


Cantopessi : in addition to rejuvenating the look, this operation serves to reshape the shape of the eyes, creating a more elongated or almond shape.


Non-surgical blepharoplasty techniques


Some patients or surgeons may prefer non-surgical treatment to resolve their blemish. For this reason, currently, there are also some alternatives to surgery:


Laser blepharoplasty: the goal is the same as for surgical technique and this procedure is also performed with local anesthesia and sedation. The difference is that the incisions are made with a laser beam instead of a scalpel. Usually the CO2 laser is used. The advantage of the laser is that the blood vessels are cauterized at the time the incision is made, so blood loss during surgery is minimal. Once the cut is made, the surgeon can remove excess fat, skin or tissue and then proceed with suturing. Another benefit of the laser is the possibility of correcting eyelid wrinkles thanks to the action of resurfacing. As for the post-operative period, it avoids scar formation and reduces pain, inflammation and redness,


Blepharoplasty without surgery: aesthetic treatments such as Radiofrequency give a rejuvenating effect even to the look and allow you to return to your daily activities immediately after finishing the session.


Blepharoplasty with filler: hyaluronic acid or other filling substances are injected into the upper eyelid or in the area above or below the eyebrow to obtain a tensor effect. On the other hand, if the injection is made in the lower eyelid area, the result will be a filling of the deep-set dark circles. The procedure takes 15 minutes.


Plasma blepharoplasty: this is another non-surgical technique lasting about an hour and a half. It is performed with plasma, a kind of ionized gas. This procedure produces a biostimulation of the skin that produces crusts that will then fall over a week. Does not produce bruises or scars.


What Is Recovery Like After Eyelid Surgery?


After eyelid surgery, you will have stitches in both lids that will remain for as long as a week. It is common to have swelling and, occasionally, bruising, but your eyelids should look normal within a week or two.


What Are the Possible Complications From Eyelid Surgery?


Complications and unwanted results from an eye lift are rare, but sometimes they do occur. They can include:


  • Bleeding
  • Infection
  • Dry eyes
  • Abnormal coloring of the eyelids
  • Eyelid skin that folds in or out abnormally
  • Not being able to fully close your eyes
  • A pulled-down lower lid lash line
  • A possible loss of vision


Complications and possible side effects


If the surgery is performed by a qualified plastic surgeon the complications will be rare and small. However the risk of infection or reaction to anesthesia may always be present to some extent. It is important to follow the surgeon’s instructions in detail in order to avoid complications as much as possible.


The minor complications that may arise will disappear in a few days: double or blurred vision, edema or asymmetry in healing.


Among the major complications one could find a difficulty in the complete closure of the upper eyelid and the ectropion due to excessive.

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