Objectives: A Lifting of the eyebrow and the entire upper third of the face is presented through 2 millimeter accesses with the only scarring stigmata of the upper blepharoplasty, if associated with a complete periorbitoplasty.

Introduction: Surgical procedures on the face are increasingly taking on the characteristics of minimally invasive, by virtue of the sharp decline in patients willing to undergo operations that require a demanding or long-lasting post-operative. Nonetheless, new techniques and materials are too often proposed that sacrifice concrete results on the altar of mini-invasiveness.

Materials / method: From September 2018 to date, 12 patients have undergone eyebrow lifting and the entire frontal area without apparent scars. The surgical procedure did not include the aid of video endoscopy or the use of wires or expensive traction devices which at best guarantee a short-lasting effect and unnatural results. A complete blepharoplasty can also be associated with the only scar of the upper eyelid.

Results: The surgery was carried out by freeing the entire frontal region and relocating it to a higher position using fixation devices held in place for about 48 hours; a pleasant "botulinum like" effect accompanies the result for several months. All the patients showed great satisfaction: the post surgery period was necessary for all of two days, seven to ten days were those necessary for complete recovery.

Conclusion: This procedure, practiced under local anesthesia, promises lasting results, previously achievable only through an endoscopic frontal lifting.

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Objectives: Transconjunctival lower lid blepharoplasty can be performed under local anesthesia in the office setting safely and with excellent outcomes with proper patient selection. Other more aggressive procedures on the lower eyelid can yield better results but have higher risk and more extensive recovery. Balancing the risks and benefits of these procedures is important and should be part of the consultation with the patient. The authors experience and thoughts on transconjunctival lower lid blepharoplasty is presented.

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Objectives: In the author’s practice, 85-90% of upper blepharoplasties consist of skin excision and pretarsal microcoagulation.
If skin was excised only, the aesthetic result would depend on the presence of a well-defined and not too mobile pretarsal skin crease, the uppermost insertion of the levator aponeurosis on the skin. High, pretarsal coagulation of the orbicularis oculi muscle just above the lower incision induces local fibrosis, including transmuscular levator extensions.

Introduction: When the coagulated zone is included in the continuous skin suture, it is likely that the levator extensions and the skin will remain well-connected and less prone to dehiscence or descent respectively later in life. Spot coagulation with the tip of closed eyelid forceps and a 4 Mhz radiofrequency current, or with the CO2 laser pen out of focus, is a simple means to achieve the intended fibrosis. It comes at the expense of a little more swelling and potential delay of healing compared to excision alone.

Materials / method: Minimal reduction of a little, medial protrusion of fat, or a more general reduction in young people with good skin quality and obvious fat excess, can occasionally be performed through small openings in the orbicularis oculi muscle.
Uncontrolled and therefore sometimes excessive removal of fat may lead to hollow upper eyelids, which look artificial or old in their own way.

Results: When upper eyelid fat needs to be explored and at least partially repositioned in the orbit, when there is tendency towards eyelid ptosis or when the contralateral upper eyelid in a patient with unilateral ptosis needs surgery, the author prefers “open sky” exposure and surgical suturing of the levator aponeurosis anterosuperiorly to the tarsus (10-15% of upper blepharoplasty cases.
Open sky exposure allows unequivocal identification of all relevant anatomical structures and precise correction of skin excess, fat position and quantity and levator extensions.

Conclusion: Unlike classic teachings about levator fixation with a single, central stitch, using three to six polyglycaprone sutures can maintain or restore a natural looking curve of the eyelid border. The medial and lateral levator horns very rarely need to be released in aesthetic blepharoplasty patients. Suturing the severed skin end to the deep suture line helps to create a beautiful and stable pretarsal crease.

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Objectives: Identify the unique anatomical differences between the aging Oriental and Caucasian eyelid
Identify the optimal procedures for rejuvenation of the Oriental upper and lower eyelid

Introduction: The eyes are the windows to the soul and successful periorbital rejuvenation has a profound beneficial effect in the appearance of a patient. Periorbital rejuvenation in the Oriental patient has unique anatomical challenges and the author shares his experience and tips and tricks to achieve better outcomes in surgical rejuvenation in this important area.

Materials / method: The author presents his technique of upper and lower eyelid rejuvenation.

Conclusion: Successful rejuvenation of the upper and lower eyelid is a satisfying outcome for both patient and surgeon. The author presents his technique and experience in rejuvenation of the upper and lower eyelids in Oriental patients.

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Objectives: Recognising tired eyes as a distinct condition different from ageing.
Pathology of tired eyes
Anatomic correlation
Technique of correction with Fat grafting
Clinical examples and results

Introduction: Looking tired even when you are actually not tired, is a frequent complaint. We do see this as we age, and tired eyes is a sign of aged eyes. However, there is a distinct subgroup of patients, who look tired even when young.

Materials / method: We retrospectively examined fifty consecutive patients who complained of looking tired, and segregated those who looked tired but not necessarily older. Under local and rarely General anaesthetic, Fat was harvested, processed and injected in to the fat pockets around the eyes. Cases were followed up up to two years

Results: Restitution of volume by Fat grafting was seen as an effective way of reverting a tired look to a fresh eyes look.

Conclusion: Deflation of peri orbital fat pockets is the main reason for eyes to look tired. Identifying the fat pockets and restitution of fat in precise aliquotes helps in restituting the refreshed rejuvenated look.

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Objectives: The under eye area is a common cosmetic concern. Issues in the area include eyelid bags and tear trough deformity and are often associated with tired looking. Understanding the anatomy and the contributing factors will aid the physician to provide customized treatment to each patient. Patient with mild to moderate periorbital volume loss without severe orbital fat herniation may be good candidates for filler injection. However, patients with more pronounced deformities are often better treated by lower blepharoplasty with fat reposition or combined fat grafting.

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