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Do you need a blepharoplasty?

By Dr. José Villamarín.

Today we are going to talk about eyelid surgery or blepharoplasty and when is a good time to do it.

The look is crucial in facial aesthetics. Over the years, the eyelids and periocular tissues deteriorate, with thinning or sinking of the area and drooping of the eyelids, cheeks, and eyebrows.

At the moment when you already dislike the image of your face or there are clear reasons to make a change, it is the time to seek professional advice.

The decision to act to improve your image must be agreed upon. There are often options to solve the problem for a while before going into the operating room.

Should I have blepharoplasty surgery or not?

I always repeat to my patients that aging is a privilege and rejuvenation is an option. Some people age faster. Others the opposite. Each patient is a world. The first thing we must do is study each patient, see the degree of wrinkles, folds and sagging that they have and at what level or stage they are in relation to the changes in the eyelids.

On the one hand, there is the problem, that we can objectify even with deterioration scales and map the face with the changes due to age. On the other hand, there is the image of the past, of how we were 20 years ago, for example, also objective in some way through photos from years ago.

Then, we have the image that the patient has in the present of himself, his visualization and sensations that accompany that image, and that can sometimes be different from the reality that anyone can appreciate, but that, in any case, has led to my inquiry.

Finally, there is the image idealized by the patient of what he wants after surgery. Coordinating all this to offer natural and satisfactory results is one of the most difficult tasks of the surgeon. For this, communication with the patient and understanding must be fundamental pillars in the satisfactory management of each case, from the beginning to the end.

If the patient is willing and committed to improving his image, we will do the rest.

But what techniques are there?

There are many techniques, some are aesthetic medicine procedures, others are surgical, but we can usually combine them. To do this, I have developed a series of programs adapted to a scale that I have created and that are properly coordinated to achieve natural results.

In general, the smaller the change due to aging, the less action we need to take. The routine is that we start with temporary and soft recommendations or procedures. Among them we have: protection from the sun and external agents, going through a personalized diet and oriented micronutrition, a skin care routine, mesotherapy and regenerative therapy with induced neocollagenesis and the reduction of metabolic oxidative stress.

Of great importance is the anti-wrinkle treatment with neuromodulators. The anti-wrinkle substance, introduced in medical care and in the aesthetic world by an ophthalmologist, has actions relaxing the muscles where it is applied. This can also be used as a prevention of future wrinkles.

On the other hand, microneedling with neuromodulators can be used at lower doses to improve the skin and pores; and using micropunctures with neuromodulators and other specific substances, a combination with substances that regenerate periocular collagen.

Moreover, the combination of these substances with fillers or dermal fillers, among which I include hyaluronic acid, can temporarily solve folds and sagging and improve the image by providing smoothness and volume.

The use of procedures based on radiofrequency energy or others, to directly tighten the tissues under the skin of the eyelids, presents conflicting opinions, since adverse effects of tissue retraction, ectropion and blurred vision have been observed with some of the procedures and devices.

In this extremely delicate area of the eyelids, with the thinnest skin on the body, I prefer to avoid some of these tightening procedures based on energy applied to tissues under the eyelid skin.

On the other hand, the use of certain modifying substances in the form of injections that alter the metabolism of subcutaneous fat, reducing its volume, has not been shown to be safe. This is due, among other things, to the fact that the fat of the eyelids and the orbit are highly interconnected and the tissues are too fine, making these substances unsafe today in relation to sight and the eyeball, for their use in the reduction of bags or non-surgical liposculpture.

Personally, I do not recommend these substances that modify the metabolism of the adipocyte, or main cell of fat tissue, nor do I use them for the palpebral or periocular area, until there is evidence of their safety in the future.

We also treat the skin as it deserves, as it is part of the hat-trick or triple action concept that I have developed, and which seeks to win with the final result. Skin care includes medical peels or special lasers, all of which can drastically improve the appearance of age wrinkles.

When is it time to go into the operating room?

Either because the laxity of the skin and deep tissues does not admit more medical-aesthetic measures, or because the alterations are clearly surgical solutions, we can take the step of entering the operating room.

Blepharoplasty operations usually last 1 hour or at most 1h30, and in general, local anesthesia is used. In my experience, lower blepharoplasty often requires sedation for both men and women.

Depending on the case, more or less volume of skin, fat and muscle is removed, and other periocular actions are performed, such as permanent smoothing of wrinkles or folds, for example. I prioritize minimally invasive blepharoplasty and preservation blepharoplasty, as I have commented in other blogs.

After surgery, detailed recommendations are given, both oral and written, as well as a schedule of check-ups.

The conclusions…

Whether or not you need a blepharoplasty is a complex decision, in which you decide and Dr. Villamarín advises and guides. You will notice the changes and the need or willingness to go to solve it.

We will offer you several options, both without surgery and with it, or even combined and personalized for your case, and always with its benefits, risks, alternatives and nature of the procedure fully explained, so that you can make the final decision with peace of mind and security.

If you want more information, do not hesitate to contact Dr. José Villamarín requesting an appointment in person or through his online consultation. Thanks.