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(From the Greek βλεφαρον, which means eyelid and plastia that means aesthetics)
 n some cultures the eyes are called the “soul's mirror”. They are the first element that shows youth and beauty, and are the most expressive feature in the face. The eyelids are the frame that exhibits the eyes.
  ow dark circles and puffy “bags” form
When the “bags” are caused only by excess of fat, they can be corrected by procedures known as transconjuntival or transcutaneous blepharoplasty.
This type of blepharoplasty offers potential advantages over conventional surgery. Through blepharoplasty fat can be extracted at the same time than the excess of skin and muscle in the upper and lower eyelids.
  he eye is protected during this surgery, where Dr. Piña uses laser to extract fat and cauterize the wound at the same time. The following pictures allow the patient see the objective and advantages of this type of surgery.
his semi-herniated fat can be eliminated through eyelid surgery using laser and CO2, which is a safe and effective technique when performed by trained hands, and has potential advantages over conventional surgery.
 omments from Dr. Piña
This surgery has two important objectives: one is cosmetic and the other is functional.
In the moment of extraction, when the bags are caused only by excess of fat, they can be corrected through cosmetic surgery.
The cosmetic surgery allows the patient to eliminate the sad expression and the functional surgery, allows the patient better eyesight when the blockage to the eyelids are removed through transconjuntival or transcutaneous blepharoplasty.
ADVANTAGES
- Minimize edema and ecchymosis
- It helps to get to the inferior oblique
- Less post-surgery pain
- There is no risk of retraction
- It allows skin treatment
According to Dr. Juan Piña, regarding droppy eyelids or eye bags, dermatochalasia blepharoplasty is more concrete and practical, that although the result is appreciated better from the cosmetic point of view, the functional aspect should be also understood, because large amounts of fat tissue that have accumulated are extracted which have formed notorious bags in the upper and lower eyelids and it could affect the visual angle and provides the eyes a sad look.
Patients feel very happy when they see their face without the semi-herniated fat that probably had for many years. We have to be aware that most people lose the elasticity of the skin and the skin becomes flaccid. This procedure will take from two to four hours to restore a youthful appearance in the face.
 oals
- Removal of pseudoherniated fat
- Correction of redundant and flaccid skin
- Correction of the eyelid position
- Removal of wrinkles
With age, the eyelid skin becomes tight, the muscles become weaker and fat accumulate around the eyes causing “bags” in the upper and lower parts.
Blepharoplasty is a procedure that is used to extract fat at the same time than the excess of skin and muscle in the upper and lower eyelids.
Blepharoplasty can be performed exclusively or at the same time than other facial surgical procedures such as facial lifting or coronal rhitidectomy. However, this procedure does not remove the wrinkles or “crow's feet”; it hardly removes the dark circles and it does not lift droppy eyebrows. Moreover, it does not change ethnic features.
  avorable results
- Maintains the eyelid position
- Provides a defined contour
- Preserves the eyelid function
- Leaves small or almost no scar
 valuation
 Excess of skin and fat
nterior blepharoplasty
| Transcutaneous |
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Transconjuntival |
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Eyelid flaccidity palpebral
Muscle cutaneous flap
ndoscopic surgery Middle third lift
 urgical sequence
 lepharoplasty can be performed exclusively or at the same time than other facial surgical procedures such as facial lifting or coronal rhitidectomy. Some medical conditions could complicate the surgery such as thyroid problems like hyperthyroidism, Graves' disease, lack of eye humectation or lack of tears, high blood pressure and other circulation problems such as cardiovascular illnesses and diabetes. There should be special precautions with retinal detachment and glaucoma.
omplications
- Eyelid retraction
- Asymmetry
- Inferior oblique lesion
- Corneal abrasion
- Haematoma and blindness
- Hyperthyroidism
- Graves' Disease
- Ectropion
Minor complications that occur occasionally after a blepharoplasty include temporary double or blurry vision; temporary inflammation of the eyelid corner and a small asymmetry during recovery or scarring. Small white points could appear after the stitches are removed; your surgeon could extract them easily with a fine needle. Ectropion is a rare complication, which is the tightness of the skin downward of the lower eyelid. In this case additional surgery would be needed.
After the surgery some patients have difficulty closing their eyes when they sleep; only in rare cases could this condition BE PERMANENT.
ack to normality
We recommend avoid sweating and reading. The patient could read or watch television after 2 or 3 days. However, patients that wear contact lenses would be able to use them again after approximately 2 weeks, and maybe for some time, contact lenses could cause certain discomfort. Most of the people feel ready to go out and back to work in a period of 7 to 10 days. And depending on the recovery and the doctor's instructions, female patients could wear make up to cover remaining blood clots.
Probably the patient will be sensitive to light, wind and other irritant products for several weeks. Therefore, the patient should use sunglasses and sun protection on the eyelids. Scarring is a gradual process and the scars could remain slightly pink for six months or more after the surgery. However, they would disappear with time and will have the appearance of an almost invisible white line.
On the other hand, the positive results of the surgery such as an alert and youthful appearance will remain for many years. For many people these results are permanent.
When bags are caused only by excess of fat, they can be corrected with transconjuntival blepharoplasty. In this case, the incision is performed inside the lower eyelid. When this type of incision is sutured, the material that is used is absorbed and it is invisible to the eye. In normal conditions, a blepharoplasty can be done in one or two hours.
 fter the surgery
Immediately after the surgery, your surgeon should apply small sterile bands on the operated area, which is not required in the case of transconjuntival surgery. Maybe it is not necessary to cover the eyes completely; however, some ointments are recommended to avoid dryness.
A certain degree of inflammation is natural
Cold soaks and elevation of the head while resting could help a fast recovery; as well as the use of anti-inflammatory drugs. During the first two weeks, the patient should clean his/her eyelids because they would become sticky, dry and irritated. Maybe the patient would need some eye drops. The surgeon should make a list of the activities and areas to avoid during the first weeks after the operation. The stitches will be removed within the first five days after the surgery, except auto absorbable stitches, when applicable.
lepharoplasty with CO2 laser
Laser eyelid surgery is a safe and effective surgery when performed by trained doctors. In fact, it has potential advantages over conventional surgery. It is popular due to its ability to close blood vessels when the incision is made, minimizing bleeding during surgery and the posterior edema.
dvantages
- Excellent haemostasis
- High precision (0.2 mm)
- Sculpting facility
- Non electro-cautery
- Facilitates fat sectioning
- Less post-operation pain
- No risk of retraction
- Allows skin treatment
- Youthful appearance
- Periorbicular
- Cosmetic blepharoplasty
- Herniated orbita
- FatOrbita septum
- Minimum edema and ecchyimosis
- Facilitates location of inferior oblique
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