Giuseppe Spinelli



Cosmetic Surgery

The eye is a fundamental component for the aesthetics of the face; blepharoplasty plays a decisive role in ensuring facial harmony and altering the perception of aging. Blepharoplasty is one of the most commonly performed facial cosmetic procedures.

Photo gallery intervention of
Blepharoplasty before and after

Symptoms such as: tired eyes, excess skin, drooping eyelids or circles around the eyes may benefit from blepharoplasty. Blepharoplasty (eyelid surgery) is a surgical procedure that removes excess fat and / or skin from the upper and lower eyelid. In addition to excess skin, an external prolapse of the endo-orbital adipose tissue usually occurs which determines the formation of the so-called “eyelid bags“.


However, blepharoplasty cannot correct the so-called “crow’s feet” or eliminate black circles around the eyes. This surgical method can be performed alone or in combination with face-lift or frontal minilifting. Blepharoplasty eliminates the stigma of aging by redefining the look and improving its functional aspect.

Preoperative evaluation

The preoperative evaluation of the blepharoplasty candidate patient must document the medical and eye history such as: chronic systemic diseases and drugs. The ophthalmological history must be recorded: visus, presence of corrective lenses, trauma, glaucoma, allergic reactions, excess tearing and dry eyes. Blepharoplasty cannot be performed for a minimum of six months after corneal surgery. The Schirmer Test must be considered if there is a history of dry eye. In addition to an eye examination, the assessment of the periorbital area must take into account the quality of the skin and the amount of underlying soft tissue associated with skeletal bone support.

The best candidates for blepharoplasty surgery are those patients who wish to improve their physical appearance. Many of them are 40 or older; sometimes they may be younger with a family history of eyelid “bags”. Caution should be used for those patients who present medical problems concerning the eye apparatus (hyperthyroidism, glaucoma, etc.).

The preoperative visit for blepharoplasty surgery is of fundamental importance; the surgeon evaluates the clinical situation and personalizes the type of surgery. In this phase the aspects that can be corrected and which, on the contrary, remain unchanged are expressed. In the pre-operative period it is also evaluated whether or not to correct the cut of the eyes and the look. Surgeon and patient together address the objectives, limits and expectations of the intervention. Before the operation of blepharoplasty, an accurate preoperative examination is performed by the anesthetist.

All surgical procedures have a variable level of unpredictability and risk. If blepharoplasty is performed by an experienced surgeon, complications are extremely rare. Temporary eyelid edema and redness of the scar are minor complications. Major complications are represented by: lagophthalmos (incomplete closure of the upper eyelid) and ectropion (lowering of the lower eyelid). These last two conditions require a second correction operation.

How blepharoplasty is performed

Blepharoplasty is performed under local anesthesia and eventually supported by sedation. Blepharoplasty usually lasts an hour; the intervention of upper blepharoplasty involves a skin incision at the level of the upper eyelid plica. The incision of the lower blepharoplasty by transcutaneous route is performed a few millimeters below the eyelashes and parallel to them it extends along the entire length of the eyelid.

The incision can be made with a scalpel, with a laser or with radiofrequency instruments. In inferior blepharoplasty performed transconjunctivally, the incision is made in the inner surface of the eyelid. For each clinical case, the amount of skin, muscle and fat to be removed must be customized. Finally, sutures are placed at the level of the incision lines which are usually removed after a week.

Surgical technique

Upper blepharoplasty
with the patient in a sitting position the incision line is marked less than 10 mm from the ciliary margin so that the final scar falls on a fold. After calculating the amount of skin to be removed, trace the upper incision line. The skin and, if present, hernias of fat are removed. The coagulation of small vessels is essential to avoid bruising and bruising; the suture is performed in non-resorbable thread and is removed after about 7 days.

Lower blepharoplasty
the incision line runs 2-4 mm from the ciliary margin and according to the needs only the excess skin is removed or only the fat that causes the “bag”; most commonly the skin is removed associated with fat. If the excess skin is not to be removed, the trans conjunctival route can be performed which leaves the operation free of scars.

Post-operative course

The blepharoplasty operation is usually performed in day surgery. However, depending on the patient’s needs, one day’s hospitalization can also be considered. Blepharoplasty involves minimal post-operative pain that is effectively controlled by analgesic drugs taken by mouth. The eyes are extremely delicate; in order to reduce edema and ecchymoses, frozen tablets are recommended for the first few hours.

Post-operative control is always provided in the days following surgery. The sutures are usually removed after 7 days. It is normal for edema and bruising to appear after the operation. The patient must remain at home for the next 48 hours. So it usually takes about 10/12 days to resume normal activities. After surgery do not expose the affected area to ultraviolet (no sun or lamps) for at least 2 months.

Resumption of activity

The patient can resume watching television after 3-4 days; for reading it is recommended to wait at least 7 days. It is good practice to abstain for 10 days from any activity.

Complications of upper blepharoplasty

The complications due to the operation of upper blepharoplasty are usually due to the excessive removal of the skin that prevents the normal closure of the eyelids. This condition could cause a temporary nocturnal lagophthalmos with dry eyes, redness and photophobia, especially in the morning.

An overly aggressive upper blepharoplasty operation can also damage the levator palpebis upper eyelid causing lowering of the upper eyelid (eyelid ptosis). Upper blepharoplasty, however, is a low-risk surgical procedure.

Complications of lower blepharoplasty

Excessive removal of skin during the operation of lower blepharoplasty can cause a lowering of the entire lower eyelid, causing a more circular eye as an aesthetic effect. The margin of the eyelid is lowered, making the white of the sclera more visible. A drop of just one millimeter can cause dryness of the lower part of the cornea which clinically simulates the presence of a foreign body with diffuse redness.

Even the excessive removal of fat can accentuate dark circles and give a sense of greater aging to the patient. This complication can be avoided by removing the fat conservatively or with a filler plant based on hyaluronic acid or using lipofilling.

Blepharoplasty costs

The costs of a blepharoplasty operation may vary depending on each specific case.