Surgery in the peri orbital area is possible in several specialties (ENT, plastic, maxillofacial, ophtalmology etc.)

In each of these specialties, training can be acquired but it is not automatic; it is therefore important to verify that the practitioner is active in this surgery (scientific lectures and publications, opinions of colleagues, presentations of clinical cases, membership in an oculoplastric society).

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Your surgeon should be able to show you a large number of examples of the most common procedures. For rare and atypical situations, do not hesitate to take a second opinion.

I have been doing this surgery for 30 years and have operated on over 20,000 patients; I will only consider surgery if it can meet your ecpectation. If, in a complex situation, we cannot be certain of the outcome, I will clearly inform you.

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To perform an cosmetic procedure, it is essential to be familiar with reconstructive techniques as well.

My activity was mainly reconstructive (tumors, ptosis, thyroid eye desease treatment etc.); for more information you can visit www.oculoplasticacademy.com .

Over the last ten years, it has been increasingly focused on cosmetic surgery  around the eye (ptosis, blepharoplasty) as well as on the development of lipostructure (micro and nano fat grafting techniques).

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Of course, all surgeries sometimes have complications and surgeons must be able to deal with them; more than the complications themselves, it is the ability to manage them well that is essential.

Moreover, the complication rate is considerably reduced if, with experience, the potential problems can be anticipated.

Your surgeon should offer you to re-operate  for a reasonable cost if there is a real problem.

I offer this for all my patients, there is no additionnal surgical charge and the hospital fees are reduced (around 200 €)

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Some practitioners systematically add the cost of the consultation to the treatment, which makes it more expensive.

I only ask for a fee for the first consultation, which is long and takes place on a different day from the act, for the renewal of injections, the consultation is included in the price of the act.

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It is preferable to check the appearance of the eyelids before you leave the clinic, especially if you are going away, however in some cases it is possible to make an exception. The sutures can be removed in consultation on the 8th day but it is also possible to have them removed by a nurse closer to your home. A follow-up consultation at 2 months is essential to evaluate the result and the healing process. If the evolution seems abnormal, you can send a photo taken with your smartphone that my secretary will send me.

Do not leave ambiguities in the shade, this site serves to allow you to find the answers that would not have been given in consultation.

Very important, the insurance policy number must be noted on the quotation.

Blepharoplasty is a procedure designed to restore the aesthetics of the eyes.

Aging leads, in varying proportions, to sagging skin (dermatochalazis), changes in fat volume (puffiness) and changes in skin texture (fine lines).

Aging of the eyelid can be accompanied by relaxation of the levator muscle, resulting in drooping of the eyelid (called ptosis), lowering of the tail of the eyebrow, and relaxation of the tissues supporting the lower eyelid, which descends (round-eye appearance).

Coverage: This surgery is usually performed for cosmetic purposes, which means that it is not reimbursed by health insurance.

However, in certain pathologies, or when the excess skin is very large, visual impairment may occur, as the skin passes over the eyelashes, reducing the field of vision. In these cases, the procedure can be partially covered, and the surgery is said to be partially functional.

Technique: Until recently, blepharoplasty was limited to the removal of excess skin. This is still the case when the objective of the operation is purely functional, to clear the visual axis.

Today, when we also want to restore the aesthetics of the eyes, this procedure will be combined, depending on the case:

- removal of excess orbital fat

- filling of hollows in the peri-ocular and peri-orbital area, either with micro-fat grafts taken from the inside of the knees (a technique known as lipostructure), or by transposition (displacement) of fat from the orbit

- reattachment of the eyelid to the orbital bone margin to prevent or correct the appearance of a round eye

- repositioning the tail of the eyebrow

- repositioning the eyelid by acting on the levator muscle

- recreate a palpebral crease by reconnecting the skin with the levator muscle

- refixation of the cheekbone (malar lift)

- the treatment of fine lines with a chemical burn (peel) or laser

There isn't just one blepharoplasty technique, but many, depending on the individual patient and the surgeon's experience and vision of aesthetics.

Hospitalization: The duration of the operation will vary considerably depending on the surgical protocol.

In less complex cases, and when only 2 eyelids are involved, the operation is performed on an outpatient basis (discharge 1 to 4 hours after the procedure), under simple local anaesthetic, sometimes supplemented by intravenous sedation with monitoring by the anaesthetist, but without intubation.

In the most complicated cases, and/or when all 4 eyelids are treated simultaneously, the procedure is lengthy and is usually performed under general anaesthesia, with a 24-hour hospital stay, or on an outpatient basis, but with a 24-hour stay in the vicinity.

Post-operative recovery: The post-operative recovery is usually straightforward. Edema will develop in the hours following the operation, increasing in the first 2 days, stabilizing on the 3rd, and diminishing rapidly from the 4th day onwards. At the same time, if minimal bleeding occurs in the first hours after surgery, an ecchymosis, i.e. a blue discoloration of the skin, will appear.

These early manifestations resolve more or less quickly, depending on the patient, often within 5-7 days, but sometimes 2 or even 3 weeks are needed for the skin color to return to normal. The stitches are removed around the 8th day, and the people around the patient usually notice nothing after that.

For the first few days, it's important to limit the risk of bleeding by avoiding physical exertion (housework, sports, etc.) that raises blood pressure, and to avoid taking aspirin.

Tingling and discrete ocular or visual discomfort may be experienced for a few weeks, but are easily corrected with gel instillations.

Healing: The scar will very quickly become inconspicuous, but healing is a process that lasts 18 months, with an inflammatory phase of varying intensity that peaks between 4 and 6 weeks. The scar is then red, slightly indurated, often with irregularities (micro-cysts) and unusual sensitivity in the eyelashes. These phenomena are normal and will gradually fade spontaneously. A healing ointment may be applied, but this is not essential. After 18 months, the scar will have regained its suppleness and a perfectly normal appearance, although a slightly lighter appearance may sometimes remain.

Complications: Complications are possible:

- Scarring may be hypertrophic, resulting in greater initial induration and slower, but always complete, scar healing.

- Delayed bleeding may occur, resulting in a collection of blood in the eyelid or orbit (hematoma), which takes several weeks to disappear, leaving a grayish discoloration of the skin that will fade after several months. In very exceptional cases, bleeding can threaten vision, requiring rapid surgery to evacuate the hematoma.

- Imperfections are possible: significant asymmetry or malposition of the palpebral crease, malposition of the upper or lower eyelid, persistence of a punctual excess of fat or a hollow, incomplete occlusion of the eyelids. These complications must be anticipated by the surgeon in order to prevent them, and if they do occur, they may lead to repeat surgery.

Result: The result should be evaluated 3 to 6 months after the procedure. Even with alipostructure or laser/peeling, which improve skin quality, the skin texture will remain different from that of a young subject, as the skin has lost its elasticity, but the procedure improves the radiance and vivacity of the eyes in a spectacular and lasting way (10-15 years).

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