The Different Techniques
Upper eyelid blepharoplasty
- Goal: remove excess skin and, if necessary, reduce fatty pouches that create a heavy or drooping appearance.
- Technique: discreet incision in the natural upper eyelid crease, resection of skin and/or removal or repositioning of fat as appropriate.
- Advantages and limitations: improves the opening of the gaze and can correct a functional impairment; the scar tends to be barely visible once mature. Does not always correct deep crow's feet or brow ptosis, which may require additional procedures.
Lower eyelid blepharoplasty
- Goal: reduce under-eye bags and smooth the transition between the eyelid and the cheek.
- Possible techniques:
- Transconjunctival approach (no visible skin scar): incision on the inside of the lower eyelid, indicated primarily for fatty pouches without significant skin excess.
- Subciliary (skin) approach: incision just below the lashes, allowing treatment of skin excess and skin tightening if necessary.
- Advantages and limitations: reduces pouches and evens the orbital contour; complication risk is low when the indication and technique are well chosen. Does not always replace treatment for significant skin laxity or pigmented dark circles.
Complementary techniques
- Fat grafting, hyaluronic acid filler, or skin resurfacing may be proposed as adjuncts to treat hollows, dark circles, or periorbital fine lines.
- Options are chosen based on the clinical examination to achieve a harmonious and natural result.
Pre-operative Consultation
- Medical interview: discussion of motivations, past medical history, medications, smoking, ophthalmological history (dry eye, previous eye surgery, glaucoma, thyroid disease).
- Clinical examination: assessment of skin, eyelid tone, brow position, quality of the tear film, and orbicularis muscle tone.
- Technical choice: explanation of options (upper, lower, transconjunctival or skin approach), advantages and limitations adapted to the case.
- Documents provided: written quote, anaesthesia information, information leaflets, and informed consent.
- Reflection period: in accordance with legislation, a minimum 15-day period between the initial consultation with provision of the quote and the procedure is observed for aesthetic surgery.
Procedure
- Setting: procedure performed in a surgical setting, most often on a day-surgery basis (same-day discharge), sometimes with short hospitalisation depending on the case.
- Anaesthesia: local anaesthesia with sedation, or general anaesthesia depending on the extent of surgery and patient preference.
- Duration: generally 45 minutes to 2 hours depending on the extent and any complementary procedures.
- Main steps: marking of incisions, incisions in natural creases or on the inside of the eyelid, removal or repositioning of fat, skin adjustment if necessary, closure of incisions.
- Safety and traceability: complete operative record, pre- and post-operative photographs, detailed medical report, and scheduled follow-up.
Post-operative Recovery
- Common signs: bruising, swelling, feelings of tension, temporary watering or dry eyes.
- Care: light dressing, intermittent cold application, lubricating eye drops if prescribed, local care, and sun protection on scars.
- Suture removal: generally between 4 and 7 days if skin sutures were performed.
- Indicative recovery times: return to work generally between 5 and 14 days depending on bruising and profession; resumption of sport and intensive activities after 3 to 6 weeks.
- Monitoring: scheduled post-operative appointments to verify healing and ocular function. Any intense pain, decreased vision, or persistent bleeding must be reported immediately.
Results and Limitations
- Evolution: improvement becomes visible progressively; bruising and swelling decrease over several weeks, the result stabilises over several months, and scars fade over time.
- Individual variability: the result depends on skin quality, age, lifestyle, and anatomical features; it may evolve with natural ageing.
- Durability: blepharoplasty generally provides long-lasting improvement in eyelid appearance, but the natural ageing of the face may require additional procedures over time.
Risks and Complications
- General risks: haematoma, infection, unsightly scar, anaesthetic reaction.
- Eyelid-specific risks: dry eye, irritation, asymmetry, poor healing, ectropion (lower eyelid pulled downward), lagophthalmos (temporary inability to close the eye fully), temporary decreased or blurred vision, chemosis (conjunctival swelling), recurrence of pouches.
- Frequency: these complications remain rare but possible; they will be explained and specified during the pre-operative consultation.
Alternatives and Non-surgical Options
- Hyaluronic acid injections: can fill certain hollows (dark circles) and improve the eyelid-to-cheek transition but do not remove excess skin or fatty pouches.
- Botulinum toxin: useful for treating periorbital wrinkles (crow's feet) and brow elevation in some cases, but does not replace blepharoplasty.
- Skin resurfacing (laser, peels, radiofrequency): improves skin quality and fine lines but has limited efficacy on significant skin excess.
- Thread lifts or combined techniques: may be offered to selected patients, with limitations on the extent of correction.
- These alternatives have precise indications and their limitations will be discussed during the consultation.


