WHAT IS BLEPHAROPLASTIC?

WHAT IS BLEPHAROPLASTIC?

blepharoplasty - Face

The blepharoplasty , more commonly known as cosmetic eyelid surgery , is a surgical procedure that corrects defects such as upper eyelid drooping, fat bags and dark circles that make the eyes look tired, aging and the face and sometimes interfering with vision. Blepharoplasty consists of the surgical removal of excess skin and fat located in the upper and lower eyelids (lower blepharoplasty and upper blepharoplasty)  and the repositioning of the falling eyebrow. 

THE UPPER BLEPHAROPLASTY

The upper blepharoplasty is an operation which consists in ‘removal of excess skin and fat in the removal of bags that are located in the upper eyelid region. Often during a superior blepharoplasty the lacrimal gland is also repositioned which is often dislocated and falling.
This surgery can be performed in day hospital, both under local anesthesia and under general anesthesia , and lasts about 30 minutes. Shortly before, an accurate preparatory drawing is performed which is a fundamental guide for the surgeon during the eyelid operation.
The intervention of upper blepharoplasty it ends with very thin stitches that are removed after 3-4 days from the intervention and with a practically invisible scar located in the upper eyelid crease. 
The intervention is painless and after 7-10 days the patient can return to all work and social activities without particular signs or results.

Upper blepharoplasty: post-operative swelling and recovery times

The upper blepharoplasty surgery ends with very fine stitches that are removed after 3-4 days from the surgery and with a practically invisible scar located in the upper eyelid fold. The post operative swelling is normal and intended to go in a few days. Recovery time : after 7-10 days the patient can go back to all work and social activities without any particular signs or results.

LOWER BLEPHAROPLASTY

The lower blepharoplasty is an intervention a bit ‘more complex than the upper blepharoplasty and also can be performed on an outpatient basis, under local anesthesia or general anesthesia.
In the lower blepharoplasty an incision is made in the under ciliary edge of the lower eyelid which is falling  through which the three bags of fat that are located in this region and the excess skin and muscle that can contribute to determine a cosmetic defect are reshaped needing correction.

In some cases the removal of the fat bags is not essential , but a repositioning is sufficient and their use may be necessary for the correction of the so-called jugal nose sulcus.

Even the intervention of lower blepharoplasty  involves the result of a very small scar which is however practically invisible, and this type of intervention is absolutely painless.
The recovery of normality in this case is slightly longer and it takes about two weeks to return to the usual work and social activity.

Upper blepharoplasty and lower blepharoplasty can obviously be associated with each other.

Lower blepharoplasty: before and after and recovery times

Even the intervention of lower blepharoplasty involves the result of a very small scar that is practically invisible, however, and this type of intervention is absolutely painless both in the pre and post-operative period.
The post-intervention and, therefore, the recovery of normality, in the case of lower blepharoplasty , is slightly longer. Recovery time: it takes about two weeks to return to normal work and social activity. Upper blepharoplasty and lower blepharoplasty can obviously be associated with each other.

THE CROSSJUNJUNCTIVAL BLEPHAROPLASTY

A very particular and specific technique only of lower blepharoplasty is transconjunctival blepharoplasty : this technique consists in removing only the lower fat bags through a conjunctival incision inside the lower eyelid through which it is possible to reshape excess fat without external skin scars.
The technique of transconjunctival blepharoplasty  is indicated for people who have only excess fat without the need for remodeling of the skin and muscle.
With blepharoplasty it is also possible to change the shape of the gaze by lifting and / or repositioning the lateral angle of the eye (so-called cantoplasty and cantopexy).
There Transconjunctival blepharoplasty is a surgical procedure with which it is possible to eliminate the bags under the eyes through an incision made inside the conjunctiva of the lower eyelid .
The region around the eye is one of the parts most easily subject to aging processes. Many people complain of wrinkles and bags under the eyes even before they are 30 years old. Furthermore, the lower eyelid is more subject to the effects of aging than the upper one.

WHO IS THIS TYPE OF INTERVENTION FOR?

The best candidates for blepharoplasty  are men and women whose skin has begun to show signs of subsidence, but has retained good elasticity. The transconjunctival blepharoplasty is suitable for men and women whose skin has begun to show signs of slowing down, but kept a good elasticity. However, this technique is not indicated for patients who have an excess of skin around the eyelids because this type of imperfection can only be eliminated with traditional blepharoplasty.

 Blepharoplasty video

In this short video on blepharoplasty, Prof. Mario Dini answers questions from a patient who intends to undergo cosmetic eyelid surgery. 

ARE THERE ANY AGE LIMITS FOR SUBJECT TO BLEPHAROPLASTICS?

There are no age limits for undergoing this type of intervention. Most patients who resort to blepharoplasty are aged between 40 and 60, but cosmetic eyelid surgery is also successfully performed in people between 70 and 80 years old. The transconjunctival blepharoplasty can be performed on patients of all ages. Most people who require this type of surgery are between 30 and 60 years of age, but cosmetic surgery of the conjunctival eyelids is also successfully performed in older patients.

WHAT OTHER INTERVENTIONS CAN BE CARRIED OUT TOGETHER WITH BLEPHAROPLASTICS?

The intervention of blepharoplasty can be performed alone or in association with other surgical techniques such as the lifting of the face or of the eyebrow, breast augmentation, liposuction or other cosmetic surgery.

WHAT ARE THE RISKS OF BLEPHAROPLASTICS? WHAT ARE THE COMPLICATIONS OF THIS TYPE OF INTERVENTION

Cosmetic eyelid surgery is a fairly simple surgical procedure. When blepharoplasty is performed by a plastic surgery specialist within licensed facilities, the results are generally very satisfactory. However, this is a real surgical procedure where the risks and complications (bleeding, infection) are rare, but they can happen and be easily solved only if the intervention is performed by a specialist in plastic surgery within authorized structures . To decrease the risks of blepharoplastyand its complications, however, it is important to carefully follow the advice and instructions that the surgeon will give you before and after the operation. Smokers should reduce the use of cigarettes because smoking can increase the risk of complications and healing delays.

HOW IS THE PRE-OPERATIVE VISIT DONE?

The blepharoplasty is a very personalized intervention that, as such, needs a meticulous specialist examination. During the first visit, the surgeon will have to evaluate the bony structure of your face, the quality of the skin and the muscles of the eyes, the presence of any aesthetic and / or functional defects and illustrate the objectives and aesthetic results that can be obtained. The surgeon will also have to evaluate your health conditions to exclude the presence of alterations (high blood pressure, clotting or scarring problems) that could affect the final result of the surgery. Before blepharoplasty surgery you will receive precise instructions on pre and post-operative nutrition, on the intake of drugs, alcohol and cigarettes. At the end of the visit, the surgeon, in agreement with you, will choose the most suitable surgical procedure for your case.

WHAT TYPE OF ANESTHESIA IS PRACTICED?

The eyelid surgery is usually performed under local anesthesia with sedation (which means that you will be awake but relaxed and insensitive to pain) and in outpatient care. In transconjunctival blepharoplasty, the lower eyelid is moved away from the eyeball, after which the surgeon makes an internal incision through the conjunctiva and eliminates the bags under the eyes. Using the transconjunctival approach in a blepharoplasty has several advantages. Firstly, there are no external scars in the lower eyelid. This technique also allows a more precise remodeling of the areas around the lower eyelids. Finally, after the operation, the treated area is less prone to swelling, which allows you to return to normal life much more quickly than traditional techniques. This surgery is performed under local anesthesia with sedation or under general anesthesia and in a day-hospital regime.

WHERE ARE THE ENGRAVINGS MADE?

In the most common surgical procedure, consisting in the remodeling of the orbicular muscle and the fat bags and in the removal of excess skin, the incisions are made in the crease of the upper and lower eyelids and are practically invisible. If only fat bags are present in the lower eyelid and it is not necessary to remove the excess skin, the surgeon can perform the so-called transconjunctival blepharoplasty , without making external skin incisions.

blepharoplasty-1 - Face
Fig.1 Eyelids drooping with
excess skin and fat.
Fig.2
Excess skin removal .
blepharoplasty - 3 - Face
Fig.3 Engravings.
blepharoplasty - 4 - Face
Fig. 4 Result and scars of blepharoplasty.

In transcongjunctival blepharoplasty the incisions are in fact made inside the conjunctiva and therefore are not visible from the outside.

HOW LONG DOES THE BLEPHAROPLASTIC INTERVENTION LAST?

Blepharoplasty lasts 1-2 hours , is completely painless and ends with the application of ice on the eyes. Transconjunctival blepharoplasty takes about 30 minutes, is completely painless and ends with the application of ice on the eyes.

WHAT IS THE POST-OPERATIVE COURSE OF BLEPHAROPLASTICS?

In the 48 hours following the blepharoplasty surgery you will have to rest with your head slightly raised. Starting from the third day, you can resume a normal life but avoid strenuous activities, saunas and Turkish baths and exposure to the sun. A slight post-surgery swelling may appear in the first two days  and bruising around the treated region that will persist for about 1-2 weeks. Hematomas, infections and keloid scars can rarely occur. After 7-10 days you can resume your work if not too tiring. Starting from the third week you can gradually resume all normal activities including sports. The result, appreciable already after the first three weeks, will be definitively achieved after about six months from the intervention.

WHAT TYPE OF RESULT CAN BE OBTAINED WITH BLEPHAROPLASTICS?

The result of blepharoplasty is generally very good and long-lasting but cannot be said to be permanent as it will always be conditioned by your lifestyle and the inevitable effects of gravity and aging. 
In general, with blepharoplasty , the result is that of an overall improvement of the entire periocular region and face. Specifically:
– with upper blepharoplasty the excess skin is removed from the upper eyelid and the fat bags are removed. In particular cases, if the patient requests it, the shape of the eye can also be modified by means of cantopexy or cantoplasty;
– with the lower blepharoplasty the fat bags are repositioned and resized and the eyelid skin is re-toned by removing excesses;
– Transconjunctival blepharoplasty only serves to remove the fatty bags of the lower eyelid without external skin scars.

BLEFAROPLASTICA: COSTS

The cost of complete blepharoplasty , as well as the upper and lower blepharoplasty , is determined by various factors, including:
– the health structure in which the surgeon operates, which must be safe and in accordance with the law;
– the presence of highly qualified medical personnel, such as the anesthesiologist, the surgeon and nurses;
– the surgical technique chosen, that is, if blepharoplasty is performed only on the upper eyelids, only on the lower eyelids or on both.

The surgeon’s reputation and, therefore, his proven experience and professionalism, the guarantee of the success of the eyelid surgery, also intervenes in determining the price of blepharoplasty . Depending on the surgical technique used and the variables described above, blepharoplasty has an overall cost that can range from € 2,500 to € 5,500.

The advice is always to not give in to the temptation to turn to surgeons who practice blepharoplasty  at discounted prices and too low costs  because they are symptomatic of cosmetic surgery performed in unsafe healthcare facilities and with the use of poor quality instruments.

BLEFAROPLASTICA MUTUABLE

Blepharoplasty surgery has an agreement with the national health system only in cases where the surgery does not have aesthetic but purely functional purposes. The loanable blepharoplasty is such only in cases where there is a severe ptosis of the upper eyelid which, being so drooping and completely covering the eye, significantly reduces the patient’s field of vision.

FAQ BLEFAROPLASTICA

Q. I would like to lift my upper eyelids and, if possible, to remove dark circles, but I would not like scars to be seen. Is there an intervention or treatment capable of solving my problem without leaving scars?
A. Blepharoplasty is a surgical procedure that allows you to correct defects such as drooping upper eyelids, bags of grease and dark circles that make the eyes fatigued, aging the physiognomy of the face and sometimes interfering with vision. Cosmetic eyelid surgery consists of removing excess skin and fat located in the upper and lower eyelids and repositioning the drooping eyebrow. In the most common surgical procedure, consisting in the remodeling of the orbicular muscle and the fat bags and in the removal of excess skin, the incisions are made in the crease of the upper and lower eyelids and are practically invisible. If there are only fat bags in the lower eyelid and it is not necessary to remove excess skin,

Q. What do the bags under the eyes depend on? How can they be eliminated or improved?
A. The presence of the so-called “bags” under the eyes depends on the leakage of the periocular adipose tissue caused by the relaxation (congenital or due to aging) of the support structures such as the skin, the orbicular muscle and the orbital septum. There are no creams or cosmetic treatments that can mitigate or eliminate this type of defect. The only remedy is surgical and consists in the removal of excess skin and fat by means of an incision that can be internal to the eyelid (as in transconjunctival blepharoplasty) or external but still hidden in the crease of the eyelids.

Q. Is it possible to change the shape of the eye?
A. Yes. With blepharoplasty it is possible to change the shape of the gaze by lifting and / or repositioning the lateral corner of the eye (so-called cantoplasty and cantopexy). This type of intervention is generally required by patients who wish to have features more similar to those of the Orientals.

Q. What do they depend on and how can dark circles be reduced?
A. The appearance of the so-called “dark circles” depends on the fact that due to aging or other congenital factors (very thin skin, lack of subcutaneous fatty tissue, etc.), the dark red colored orbicular muscle appears in transparency creating a kind of dark shadow under the eyelid. Sometimes this phenomenon is associated with the presence of bags under the eyes caused by the laxity of the supporting structures of the periocular fat. The dark circles can be improved, in some cases, with a lipofilling intervention (which consists in withdrawing with a thin needle or cannula small quantities of fat which are then injected into the depressed eyelid area), or with an adipose tissue graft or , if there are also bags,

Q. Can blepharoplasty be performed under local anesthesia and in day hospital? A. Yes. Blepharoplasty is generally performed under local anesthesia with sedation (this means that you will be awake but relaxed and insensitive to pain) and in a day-hospital regime. In cases where the eyelid remodeling is particularly demanding or associated with other surgical interventions (e.g. cervico-facial lifting) general anesthesia and hospitalization for one or two nights will be necessary.

Q. How long after the surgery will I be able to put my glasses or contact lenses back on?
A. After surgery, the glasses can be worn already after the first 24 hours, while for contact lenses it will take about a week.

Q. How long can I expose myself to the sun or UVA lamps?
A. As with all scars, in the first 6-12 months it is not recommended to expose them to the sun to avoid their hyperpigmentation which would make them more visible. However, it is possible already one month after the operation to expose yourself to the use of protective lenses or full screen creams.

Q. How do you apply for funding for blepharoplasty surgery?
A. It is possible to request the payment in installments of blepharoplasty , asking your cosmetic surgeon what are the  methods of financing cosmetic surgery in cases where there is no immediate financial availability to pay for an intervention.

Q. What is laser blepharoplasty?
A. There is no real blepharoplasty that is performed exclusively with the laser. The CO2 laser in some cases can be used as a “laser scalpel” to perform the initial skin incision traditionally performed with the traditional scalpel. Numerous scientific studies have been carried out to try to understand if there were any advantages to using the laser in blepharoplasty . All the studies reported so far in the literature have shown no advantage for the patient in the results by comparing traditional blepharoplasty with “laser blepharoplasty”.

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