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Objectives: How to obtain the best and definitive results in blepharoplasty

Introduction: Blepharoplasty is one of the most required treatment in plastic surgery.
To get excellents results, lifting the inferior eyelids is the best way to get it.

Materials / method: For hundred ninety eight patients have been operated at Saint Louis hospital in Paris and Columbus Medical Centre in Milan.
In 83 % the indication is aesthetic and in 27% reconstruction.

Results: The results are very good/ exellents

Conclusion: Blepharoplasty is one of the most requested technic in plastic surgery .
To treat it by lifting the inferior eyelid is the best way to obtain excellent results
Patients are delighted and the result is permanent

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Objectives: Traditionally, the concept of lower eyelid rejuvenation involves the removal of the lower eyelid orbital fat pads . However, this led to hollow, sunken eye appearances that ironically accentuated aging. More modern concepts employed the methodology of conservative fat pad excision and/or fat transposition to restore volume at appropriate anatomical sites . Nonetheless, the lower eyelids and the midface are contiguous structures. Rejuvenation of the lower periorbital region should be accompanied by suspension of midfacial tissues to allow for a harmonious appearance at the lid-cheek junction.

Introduction: The results of the standard lower blepharoplasty are suboptimal at best. It does not address the descent of the midfacial structures, which comprises the orbicularis oculi muscle, the suborbicularis oculi fat (SOOF), and the malar fat pad. Hence even after lower blepharoplasty, a visible infraorbital rim persists with apparent lengthening of the lower eyelid (vertical lengthening). The orbital retaining ligament and tear trough ligament at the lid cheek junction has to be released as the dermal insertion of this ligament is the main anatomical cause of the tear trough deformity . Once released

Materials / method: The concept of the midface lift is based on the theory of gravitational theory of aging . The premise of this theory is that ligamentous support for the mid and lower cheek loses elasticity with time leading to descent of the facial volumes and skin. The recognition of mid-face deflation/ptosis as a key component of the aging midface, reinforced with the observation that the traditional SMAS facelift produced little to no improvement in the mid-face region, has led to development of the midface lift. There are as many proponents for the midface lift as there are its detractors.

Results: The volumetric theory of aging was first proposed by Lambros who superimposed his patients’ youthful photographs on top of a current photograph, and “animating” the images to fade from one to the other . Lambros found nevi at specific anatomic locations in the periorbital and upper midface, did not descend with aging in the photographs. He argued that cheek fat atrophy produces the deflation of the cheek skin envelope that was ultimately responsible for midface sagging. Lambros therefore supported fat grafting as the primary mode for midface rejuvenation.

Conclusion: In reality, the truth is somewhere in between. Nonetheless, it is essential to rethink the lower eyelids and midface as interconnected structures that require more than just the traditional lower blepharoplasty. Combining the lower blepharoplasty with midface lifting have yielded very satisfactory aesthetic results in our patient group. Fat grafting can be supplemented during midface lifting or as a separate procedure if deemed necessary.

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Objectives: There is a simple, convenient and easy technique for correction of mild ptosis.
The simple is the best for our patients.
That is non incisional blepharoplasty with Müller muscle tucking.
I will show you a video and figures to understand easily.
But the main complication is loosening and resulting exposure of thread.
And we can reduce comlicastions wit some tips.

Introduction: To treat moderate to severe ptosis, incisional blepharoplasty or frontalis transfer are applied. To treat mild ptosis, the incisional method can be used for the creation of the double eyelid crease and also Müller muscle tucking. Because, open ptosis correction causes big swelling, a long recovery time, it is not proper to correct mild ptosis.
In mild ptosis cases, a small amount of Müller muscle tucking can improve a small amount of MRD (distance between lid margin and light reflex). In mild ptosis cases, they prefer looking a little better with fewer scars to big improvement with the scar,

Materials / method: The authors prefer minimally invasive technique to improve mild ptosis and make three holes for continuous suture using nylon 7-0.
Incision lengths are 2mm for medial and lateral window, 5 to 10 mm for a central window.
During my procedure, the anterior lamella including levator muscle is tightened in a central opening between each subdermal stitch and conjunctival stitch.
And the posterior lamella including Muller’s is tightened at central suture in the conjunctival side. During Müller muscle tucking, the length is less than 5mm and levator muscle should not be included. In some sense, this

Results: This procedure was utilized in 68 patients from 2001 to 2018.
Postoperative asymmetry was noted always because all patients had asymmetry preoperatively.
In 7 cases, central knows were exposed and removed. It may due to loosening conjunctival stitch. Among them, 4 cases double eyelid crease fade away a few days later, and re-operation was accomplished.
But interestingly 3 cases, double eyelid crease still existed and they were just followed up. It may be due to adhesion or scarring inside.
Long term followed up, ptotic appearance recurred 5 to 10 years post operation.

Conclusion: This method is simple, convenient and easy technique. But this method is not the answer and not the best choice. This method should require patients selection.
The main complication is loosening and resulting exposure of thread. Here is a hint for preventing these complications, please do not long stitch for Müller muscle tucking or please separate suture and tie for Müller muscle tucking. You can choose an easy and comfortable way.
My technique combines non-incisional suture and some sutures in anterior and posterior lamella, allowing for easily reproducible correction of mild-blepharoptosis.

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