Blepharoplasty, one of the surgeries with the greatest impact on facial rejuvenation

Blepharoplasty, one of the surgeries with the greatest impact on facial rejuvenation

As the ancient Roman saying “the eyes are the mirror of the soul” reminds us. That is why today’s topic is blepharoplasty, and its far-reaching effects on the appearance of our patients. It is undoubtedly one of the surgeries with the greatest facial rejuvenating effect.

As we age there are a series of changes that occur in the periorbital tissues: the skin becomes more lax and thinner, wrinkles appear between the eyebrows and crow’s feet, the connective tissue, including the orbital septa, etc., loses its firmness. This last phenomenon, together with the atrophy of the fat in the periorbital compartments and the fact that these fat accumulations begin to “fall” and protrude outwards and downwards, cause the appearance of the popularly called “bags”, which are nothing more than pseudoherniation of this tissue. Other alterations that may appear with the passage of time are ptosis of the eyebrows, elevation of the palpebral sulcus, etc.

All these changes that contribute to the aging of the periorbital area will produce a sad, tired appearance in the patient, even when the patient is well, rested and in an excellent mood.

Classically, blepharoplasty was considered a problem of excess tissue and the procedure basically consisted of removing the excess tissue, including skin, muscle and fat compartments. However, nowadays the attitude is rather to remodel the area, removing excess tissue, but also providing tissue in those areas where it is deficient, in short, remodeling the areas that need it.


Upper eyelid

The most frequent alterations in this area are blepharoachalasia or excess skin, which can sometimes be of such magnitude as to cause visual problems, as it falls on the eyelashes or even occupies part of the visual field.

If there is a significant excess of adipose tissue bags, they are removed, although it must always be from a conservative point of view, since an excessive removal could cause a sunken, skeletonized basin, with an aged appearance, just the opposite effect to the one sought with this surgery.

As for the skin, a conservative resection must also be performed, since excessive resection could cause the dreaded lagophthalmos as a complication.

Finally, in some cases it is also recommended to remove the thickened orbicularis oculi muscle.


Lower eyelid

Lower eyelid bags are one of the most frequent causes of a sad, tired and haggard look. For the treatment of this structure, two complementary procedures have to be performed:

– On the one hand, a small skin resection, discreet, since there is not usually a large excess of skin in the lower eyelid. In fact, there are occasions in which if the excess skin is mild or moderate, it can even be treated with peels, lasers or other treatments with local and superficial action.

-Resection of adipose tissue “adipose bags” through a transconjunctival approach preferably, as this will avoid altering or violating the septum or the orbicularis and thus reduce the possibility of ectropion.


Adipose tissue grafting

Sometimes the treatment of both eyelids can be complemented with an adipose tissue graft, especially in the malar area and the tear through deformity, in such a way that the volumes that have been lost or altered with age are repositioned.


What considerations are important to take into account before surgery?

Before surgery, the patient’s history should be known and a complete eye examination should be performed to determine if there is a history of dry eye, explore the laxity of the lower eyelid, check if there is ptosis or drooping of the eyelid due to dehiscence or disinsertion of the levator muscle of the eyelid, or if there is ciliary ptosis (eyebrow ptosis).

It is important before surgery to avoid taking aspirin or NSAID-type anti-inflammatory drugs, as they may increase the risk of perioperative bleeding.

Similarly, the patient must arrive at the surgery with proper blood pressure control, since hypertension is also associated with an increased risk of bleeding.

After surgery, it should be noted that due to the nature of the lax tissue of the eyelids, they tend to swell and accumulate fluid inside. It is therefore recommended to rest during the week following surgery, sleep with the head elevated (on two pillows for example), apply cold for short and repeated periods in the area, and maintain adequate control of blood pressure and pain (avoiding taking anti-inflammatory drugs such as NSAIDs and / or aspirin).


Dr. María Eloísa Villaverde, Specialist in plastic, aesthetic and reconstructive surgery.

Hospital 9 d’Octubre. Consultation 22.

Contact:, phone 684148979