Blepharoplasty is an operation for rejuvenation of the eyes and the orbital area; many changes occur on the periorbital area in the years, such as: relaxation of the cantal ligaments, anatomical structures that keep a young shape of the eye, relaxation of the orbicularis muscle, herniation of the retroorbital fat, skin excess and changes in skin quality. The changes happen both for upper and lower eyelids; upper eyelid shows excess of skin and patients can have a feeling of heavyness and sometime reduction of sight. Lower eyelid shows a relaxation of the skin, fatty bags and modifications of the periorbital area due to loss of volumes of the tissues (tissues droop in time). At the time of the consultation we carefully check all theese details because the rejuvenation of the eye depends on all the different components of the area: an aging face has loss of volumes, so it would be a mistake remove too much fat rather than redistributing the fat and the volumes to fill the orbital rim and the nasojugal groove. A careful examination of the tone of the lower lid is also important to avoid complications as ectropion (eversion of the lower eyelid). The procedure on the upper eyelid starts with an evaluation of the skin to be resected; after skin resection a strip of orbicolaris muscle is also taken out for a better definition of the orbital fold, the fatty bag if present is also taken out, then the incision is closed with stitches that will be removed after three or four days. Through the incision we can also resect the corrugator muscle improving the wrinkles in between the eyebrows. Upper eyelid operation is usually performed under local anestesia as outpatient; blood tests and EKG will be performed before the operation; patients should avoid Aspirin and medications aspirin-like two weeks before the operation and one week after. Swelling and bruising will disappear in a few days. Lower eyelid operation starts with an incision one millimiter below the lash, a skin flap is elevated for a few millimeters to preserve the pretarsal part of the orbicolaris muscle, then a skin muscle flap is elevated with exposure of fatty bags that are carefuly resected if occurs or redistribuited on the orbital rim and on the nasojugal groove, so to fill the loss of volumes in the area. Repositioning of the lateral cantal ligament is also performed both with suspension of a lateral strip of orbicolaris muscle to the orbital rim for a natural and younger look. The skin excess is evaluated and carefully resected, then sutured with interrupted stitches that will be removed after four days. Because of this double suspension the risk of ectropion is really minimal. The oparation is performed under local anesthesia with I.V. sedation and the patient will be discharged after a few hours. Possibile complications as ematoma and eyelids malpositions are very rare with this technique, bruising and swelling can last for a few days, after a week patients can go back to the normal activities. Prof. Tarallo has been one of the first in Italy to outline the concept of getting back volumes in an aging face for facial rejuvenation.

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