Objectives: Different procedures can be selected for upper blepharoplasty, varying from simple skin excision to open sky blepharoplasty. Less complicated operations lead to a faster recovery, but sometimes hold the risk of insufficient correction. The rationale for ancillary microcoagulation of the orbicularis oculi muscle in less complicated cases, and the indications for more complex procedures are reviewed.

Introduction: In the author’s practice, 85-90% of upper blepharoplasties consist of skin excision and pretarsal microcoagulation. 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.

Materials / method: Representative photography, films of the surgery, and patient records were studied to identify the factors that influence the type of operation selected for upper blepharoplasty candidates.

Results: Less complicated blepharoplasty is useful in most patients who have a clear definition of the pretarsal skin crease without protruding orbital fat.
Open sky exposure allows unequivocal identification of all relevant anatomical structures and precise correction of skin excess, fat position and quantity and levator extensions. Suturing the severed skin end to the deep suture line helps to create a beautiful and stable pretarsal crease.

Conclusion: Most upper blepharoplasty patients can be helped by skin excision without deeper exploration. High, pretarsal microcoagulation of the orbicularis oculi muscle helps to redefine the pretarsal skin crease and improve skin invagination. The wire electrode and the CO2 laser pen offer certain advantages over the surgical blade. An "open sky" approach through the orbicularis oculi muscle is usefel for the correction of fat volumes or when the pretarsal skin crease needs more definition. The application of platelet-rich plasma (PRP)may have a positive influence on the healing process.

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Objectives: Fat grafting represents an additional tool to increase the aesthetics of the peri-orbital region in combination with the most traditional technique of blepharoplasty.

Introduction:
Traditional blepharoplasty procedures do not always address the changes that occur with age in the orbital area and can actually degrade the appearance of the eye.
Fat grafting represents the most important new addition to surgical procedures to rejuvenate the orbit since the inception of the “blepharoplasty” technique.

Materials / method: 200 patients underwent peri-orbital rejuvenation surgery such as temporal lifting, brow lifting, upper and lower blepharoplasty. 50% of them were also injected with autologous fat tissue (lipofilling). The two groups were compared by using a personal survey for patient satisfaction regarding the final aesthetic outcome.

Results:
Periorbital fat grafting is easy and fast to perform and provides the opportunity for comprehensive improvement of the entire orbital region, not just spot filling of the tear trough.

Conclusion: Fat grafting is an artistically powerful method to rejuvenate the periorbital orbital area that often provides a more healthy, fit, youthful, and sensual appearance than traditional blepharoplasty procedures.

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Objectives: The objectives of this keynote is to highlight the importance of a good preoperative evaluation before a "simple blepharoplasty" and its consequences if basic principles of reconstuctive surgery are not applied, such as, in the case of the lower eyelid (90% of the problems): VECTOR, SNAP / DISTRACTION TEST, TILT, ARCUS MARGINALIS, MIDFACE ANALYSIS, CANTHAL DISTANCE, ESCLERAL SHOW, VERTICAL RESTRICTION

Introduction: During the last times and especially the last two years, facial expression has become something important. For that reason, in social networks, blepharoplasty has become an "easy, cheap, and" "tool" without problems, to gain that lost expression. I present examples after "simple blepharoplasty" that had to undergo complex reconstruction

Materials / method: Using reconstruction technique , like the D.O.P or Dermal Orbicular Pennant, T.S tarsal Strip, Spacer,, Cheek support using Mitek screw

Results: All results are at leat after a period of 1 year

Conclusion: When a patient comes to our consultations, to remove that little bit of skin that is left over, we have to pay close attention since that "little" can turn into a "lot" of problems.

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