Upper eyelid blepharoplasty in Valencia:

• In an upper eyelid blepharoplasty, the pre-marking process is very important, as we will specifically delimit the maximum amount of skin that we can remove, without preventing eye closure.
• Then, we perform the infiltration of local anesthesia in the area of skin that will be removed, to ensure the absence of pain during the blepharoplasty procedure. The infiltration of local anesthesia itself is a process that causes minimal discomfort during its execution.
• The blepharoplasty intervention begins by making an incision around the entire area of skin marked for removal. Then, with a fine scissors, all the skin is detached that will be removed. Then, the fat packets in the medial area of the eyelid (the part adjacent to the nose) are located and some of that fat is removed (the amount that needs to be removed varies between people, as in some patients this fat protrudes too much and in others it is not necessary to remove it).
• Then, coagulation and heat are applied to the eyelid bed with the electrosurgery, to favor tissue contraction.
• Finally, the wound is closed, for which extremely fine threads and suture techniques are used that will favor the good evolution of the scar, so that, after some time, it is practically imperceptible.

Lower eyelid blepharoplasty in Valencia:

• In the case of lower eyelid blepharoplasty, if the technique used is percutaneous, the incision is made very close to the free edge of the lower eyelid and is slightly prolonged laterally. If the technique is transconjunctival, the incision is made in the part of the lower eyelid that is in contact with the eye, the eyelid mucosa.
• Through these incisions, the fat accumulations that form part of the “bags” are located and partially mobilized or removed. The resection should not be complete, as its overresection could give an appearance of an orbital hollow too empty.
• Then, if the approach is percutaneous, the excess skin is removed and finally, the approach is closed with a continuous very fine thread suture.

One of the main concerns of patients who undergo any type of intervention, especially in the facial area, are scars.

In upper eyelid blepharoplasty, the scar is hidden in the natural fold of the eye, and only a small strip that extends outwards towards the side is visible, blending in with the natural folds of the outer corner of the eye.

In percutaneous lower eyelid blepharoplasty, the scar is immediately hidden below the lower eyelid, simulating a natural fold. If it is performed transconjunctivally (when it is not necessary to remove skin), the scar is hidden on the inner face of the eyelid.

In addition, the wound closure of blepharoplasty is mainly done with a non-absorbable intradermal suture, which is removed early to improve the appearance of the resulting scar. Initially, in the case of blepharoplasty, scars may acquire a reddish color, which can be easily concealed with makeup, and that with the passage of months will mature becoming practically hidden.

Upper eyelid blepharoplasty is frequently performed using only local anesthesia. It is a process in which the level of tolerance is very good, painless, and relatively comfortable for the patient.

The lower eyelid surgery is always performed under general anesthesia, since the discomfort for the patient during its execution is much greater with this technique, and we consider that the suffering involved in performing a lower eyelid blepharoplasty under local anesthesia is not justified.

Upper eyelid blepharoplasty is a technique that in addition to providing a great aesthetic result, is accompanied by a very low rate of side effects and complications and a very high satisfaction rate. During the postoperative period of upper eyelid blepharoplasty, from the second day it is possible to continue performing the usual activity, even the work, as long as it does not require physical effort or social exposure.

• After the blepharoplasty procedure, periocular inflammation and bruising may appear in the eyelids that, depending on each case, may be more or less severe and may last between 3 and 12 days.
• Another side effect of blepharoplasty, with a frequency reported in recent scientific studies between 8% and 21% (article “Blepharoplasty complications”, published in the journal “Facial plastic surgery” by Mack W), is the appearance of transient dry eye. Therefore, we recommend the administration of eye drops to promote eye hydration. In addition, due to the possibility of having dry eye for a few days, it is advisable to avoid the use of contact lenses for a week.
• Regarding the possibility of suffering an infection in the intervened area, the incidence of surgical wound infection in blepharoplasty is estimated at around 0.2% of patients, generally being mild infections, according to a study published by E. Ferneini and collaborators in the scientific journal Journal of oral and maxillofacial surgery in 2017 (“Antibiotic Prophylaxis in Blepharoplasty: Review of the Current Literature”).
• One of the risks in a blepharoplasty procedure most feared by patients is the limitation of eyelid closure due to the removal of excessive amounts of skin. In that sense, by applying an appropriate technique, and preoperative measurement of the amount of skin to be removed, it can be guaranteed that this complication never appears. This maneuver consists of pinching the skin that is to be removed from the upper eyelid with a pair of tweezers, and asking the patient to close their eyes. If he could not close them, it would be a sign that the amount of skin marked for removal is excessive, and it would have to reduce the size of the marked area for resection.
• Other possible risks associated with blepharoplasty, with a much lower incidence of appearance, are the injury of eye muscles, alteration of skin coloration and alteration of the scarring process, in addition to other risks inherent to the use of local or general anesthesia.

It is not necessary to be admitted to the hospital for either a upper eyelid blepharoplasty or a complete blepharoplasty. Both procedures are more commonly performed on an outpatient basis. However, some patients prefer to spend a night in the hospital, although there is no medical justification for doing so routinely.

Generally, patients from farther provinces tend to opt for an overnight stay in the hospital (since they would otherwise have to spend that night in a hotel), but those from nearby provinces like Albacete, Teruel, Castellón, Alicante or municipalities of Valencia, perform the procedure on an outpatient basis.

In the postoperative period of a blepharoplasty in Valencia, there are a series of measures that allow to optimize recovery and reduce the possibility of complications:

• Apply local cold on the intervened areas during the first 48 hours, for intermittent periods of 5-10 minutes. For this, cold gels, ice covered with gauze or other devices can be applied. Care should be taken not to keep the skin in direct contact with ice, since initially the sensitivity may be altered, and prolonged exposure could condition the appearance of cold burns. Cold constricts blood vessels, reducing the possibility of bleeding and decreasing post-surgical inflammation.
• Sleep in supine position (face up) and with the head of the bed elevated (semi-upright) for the first 5 days. For this, recliner chairs or stacking cushions on the bed may be helpful. Keeping the head elevated helps to reduce blood pressure in the intervened area, reducing the possibility of bleeding and bruising, and favoring inflammation.
• Avoid making sudden movements and intense physical exercise in the first 48 hours. Especially, it is necessary to avoid quickly lowering the head (a movement that we typically make, for example, to tie shoelaces or pick something up from the floor), as an increase in blood pressure in the eyelid area could lead to bleeding.
• Daily care: Apply chlorhexidine to the steri-strips (strips) covering the incisions, being careful that the product does not enter the eye (as it is very irritating).
• Take the prescribed medication: Usually, an antibiotic to prevent wound infection and analgesic medication to optimize pain control.
• Apply artificial tear on the ocular surface if dryness occurs during the postoperative period.
• Once the stitches are removed, maximum sun protection factor (50) should be applied on the scars every time they are exposed to sunlight (even on cloudy days) to ensure the best possible healing. If bruises appear, sun protection factor 50 should also be applied on the “stained” areas until the bruises resolve.

The postoperative period of blepharoplasty is not painful. Most patients do not need to take painkillers during this period. Localized, minor discomfort is usually described, and discomfort due to the presence of the steri-strips (strips) on the eyelids.

When having a blepharoplasty in Valencia, there are no relevant reasons that justify performing this procedure at any specific time of the year. Sun protection should be applied on the scars both in summer and in winter, whether it is sunny or cloudy, because the element that has negative effects on the scars is UV radiation, which reaches us even on cloudy days.

The results of a blepharoplasty are immediate, perceptible from the moment the operation is completed. However, the inflammation that takes place during the postoperative process and the possible appearance of bruises makes the final results not be observed until the inflammation process is completed, which may take weeks.

The main limitation during the postoperative period of a blepharoplasty is social, as inflammation and bruises may appear in the treated area, being very visible to the outside.

However, from the day after the blepharoplasty operation, you can perform your usual activities that do not involve excessive physical efforts, including working, as long as the presence of facial inflammation is not considered relevant or limiting. To perform intense physical efforts, it is advisable to wait until the removal of stitches, which takes place 5-6 days after the intervention.

Blepharoplasty is not a technique whose benefit or indication is limited to advanced age people. There are cases of very young people who, due to genetic constitution, can present excessive accumulation of skin in the eyelids, hypertrophy of the orbicularis oculi muscle or the fatty packets of the orbit. The technique applied in these types of cases has minimal variations compared to that used in older people, but the visible result in terms of scars and outcome is similar.

The cost of a blepharoplasty can vary depending on the areas to be treated, the anatomical variants that each patient presents and the techniques that must be used, which can condition a longer surgery time. A blepharoplasty operation in Valencia has the following approximate costs:

• Upper blepharoplasty – 1500€
• Lower blepharoplasty (general anesthesia) – 3000€
• Complete blepharoplasty (general anesthesia) – 3900€
• Direct eyebrow tail lift – 1500€
• Complete blepharoplasty + Facial Lipofilling – 4900€