Reading time: 11 minutes
It is one of the most demanded cosmetic surgeries in Spain, and also in the world. The reason? The natural drooping of the tissues surrounding the eyes is one of the first signs of aging. In order to revert that trace of the passage of time, blepharoplasty seeks to correct the excess of skin in the upper eyelids and the bags that appear under the eyes. According to data from the International Society of Aesthetic and Plastic Surgery (ISAPS), it is the technique that ranks third among the most requested surgical procedures globally, and is the second most successful among men. In Spain alone, to understand the magnitude of the phenomenon, about 30,000 operations of this type are performed per year, a number that places it on the local podium at the top of the surgical interventions of the face.
Dr. Ida Parisi is a specialist in surgery and aesthetic medicine, is one of the members of the training team of EIMEC, and with an experience of over 25 years in the profession, explains when this intervention is indicated, how it is performed and in which cases it is not recommended to patients. Parisi answers and exhausts all doubts in this interview about blepharoplasty.
Dr. Ida Parisi performing a blepharoplasty.
-Yes, it is true. The skin of the eyelids, that is, the periocular skin, is by far the thinnest skin in our body, especially that of the upper eyelid. Its thickness ranges from 0.33 to 0.35 millimeters. This means that it is five times thinner than the skin of the rest of the face. Therefore, visible signs of aging, such as wrinkles around the eyes, appear much faster than in the skin of the rest of the face.
-It is indicated for those patients, both men and women, who wish to rejuvenate the palpebral[upper and lower eyelid] and periorbital area. As we said, it is performed by removing excess skin, muscle and fat from the upper and lower eyelids. In this way, we correct the appearance of the drooping eyelid or closed eye, and often vision problems are also solved, which is often called eyestrain. Because many times this drooping skin, especially on the upper eyelid, can interfere with peripheral vision. Generally, all this occurs after the age of 35, although there are patients with a genetic family tendency to form bags that may be candidates for surgery even when they are younger.
Marking of the area.
-Except for some small variations, the technique is always the same. It is performed through a hidden incision in the crease of the upper eyelid or just below the eyelashes in the lower eyelid, thus gaining access to the fat pads and removing them, if present. Occasionally, it can also be accessed transconjunctivally, which means that we can access the inner part of the eyelid. This is done if there is only excess fat, but no excess skin.
-The choice of surgical technique as well as the approach will be decided after the correct diagnosis, examination and discussion of the different options with the patient. Normally, the procedure is performed under local anesthesia. Sedation can also be added for greater peace of mind, and it is an outpatient surgery. The duration is variable in each home, and also depends on the complexity. That is, if both eyelids are done or not. But in general terms it is an intervention that lasts between one and two hours.
-It is not well indicated if there are no bags or a real excess of skin. I must also say that it may not be convenient in very old patients, in very advanced ages where the muscle tone of the periorbital area has been completely lost. So, as there is a significant flaccidity we consider that there may be a risk of complications. There are no treatments that replace it, or that have a result comparable to that of a blepharoplasty, but there are other procedures that can be performed. These can be, for example, ablative lasers such as CO2, where a small retraction of the skin can be seen, or radiofrequency treatments. Obviously, in these cases we cannot remove the fat with these techniques, but we can improve and diminish the flaccidity of the skin.
-We could say that before it was a surgery that was demanded by older patients and, many times, the determining factor was the factor of eyestrain and night vision problems. Now, it is a surgery required by younger people, who are beginning to notice the signs of the passing of time and want to look better. We see it in men, for example, when they say in the consultation room that they want to have a fresher look, a less tired look. Also, it should be added that, in the past, the tendency was to remove all the fat and remove as many bags as possible. Nowadays, this is not done as much because it has been seen that, in any case, removing too much fat – that is, leaving the eyes more sunken – is also a sign of aging. So now we tend to be less aggressive in this regard.
-There is noreal difference, but there is a difference in terms of the results that each one is looking for. For example, women want to have a much cleaner, clearer mobile eyelid. So, we tend to remove more skin because it’s good for makeup and everything else. Men simply want to remove excess skin, excess bags and that’s it, they are happy with that.
Personalized blepharoplasty course at EIMEC.
-The objective of blepharoplasty is to improve the appearance of the eyes. Well performed is a surgery that should not alter the look of the person. Yes, on the other hand, you will have a more rested, fresher look. But it does not have to modify neither the shape of the eye nor the expression. This is something that patients ask us a lot when they come to our office. They are very concerned about how their eyes will change, fearing that they will not be recognizable. But that doesn’t have to happen.
-Yes, the round eye is literally when the lower eyelid is lower, so it gives this rounded appearance of the eye, and it is a complication. Technically we call itscleral show and it is probably one of the most feared complications in this type of surgery. To avoid it there are techniques, and we do what is called canthoplasty, canthopexy, which is to anchor the upper eyelid to the orbital bone, so that it does not fall.
– No, because we always stay in the tissues around the eye. We are not going to touch the eye itself, the eye bulb. It can affect the vision in a positive way, as we were saying before, in the sense that it improves tired vision,but never affect it negatively.
-Many patients ask us if there is a specific age for surgery. There is no specific age. It depends a lot on the aging of the skin and the indicated age is when it is really a problem for the patient. We must not forget that, although it is a cosmetic surgery, it is a delicate surgical procedure that can generate, as we said, complications. Therefore, it is essential to be in expert hands and, obviously, in an appropriate health center. In addition, it is a surgery and as such requires recovery. The patient will not look good a week after a blepharoplasty. It is necessary to go through a process of inflammation, surely with black eyes, which are not a complication but an expected consequence. Especially because the skin, as we said, is so thin that obviously lets you see more purple. So, you must be patient and know that the final result will be seen approximately one month after the surgery.
