Author: Dr. Rovatti Pier Paolo

Date: 22/04/2020

Blepharoplasty surgery has always been one of the most sought-after in cosmetic surgery because of the importance of the eyes and their appearance in the overall harmony of the face. A simple treatment on a heavy eyelid or a tired look can clearly rejuvenate a face even without treating any other imperfections.

Blepharoplasty consists in the removal of the bags of fatty tissue and excess skin on the upper or lower eyelid.

The skin of the lower eyelids is very thin and just below the eyelid skin there is a layer of muscle separated from the fat by a thin membrane called the orbital septum. The layers of muscle and the orbital septum weaken with age and in response to tissue weakening, fat deposits shift causing swelling and bags under the eyes; this is associated with changes in the skin, which loses its elasticity and relaxes with age.

Even when the problem is on the upper eyelids, it is necessary to remove the excess bag of fatty tissue associated with the sagging skin above.


  • Towards increasingly less invasive surgery

The high number of blepharoplasty operations performed every year is also linked to the fact that it is an easily administered operation under local anaesthetic and requires only a few days of convalescence for post-operative oedema. As early as 2–3 days later, it is possible to return to your social life, perhaps wearing sunglasses, and after a week when the stitches are removed, it is possible to put on make-up, thus completely disguising the signs of the recent operation.

It is often highlighted, when talking about aesthetic medicine and cosmetic surgery, how this sector has made giant strides in recent years in terms of methods and materials that are increasingly innovative with treatments that are less and less invasive. Just think, for example, of the now increasingly less widespread facelift, which has been replaced by the use of fillers to restore volume, and minimally invasive surgical methods, which still provide excellent and even superior results in terms of naturalness. The greater ease of use of these materials compared to surgical procedures, has led to a boom in aesthetic medicine not only in relation to the patients who approach it, but also in the number of doctors who decide to practise this discipline, sometimes at the expense of professionalism and preparation with the consequence of questionable results often right in front of everyone's eyes.


  • When aesthetic medicine alone is not enough

In some cases, however, the search for "non-invasiveness" at all costs has led to the spread of tools and methods, which in addition to being non-invasive have also proved to be ineffective. This is the case of "non-surgical blepharoplasty" which, as all experienced surgeons know, is already a contradiction in terms and is not supported by visible results.

Recently I have witnessed with disappointment how certain colleagues have "sacrificed" their professional dignity by talking about such nonsurgical blepharoplasty and propagating electro-medical devices of dubious effectiveness.

Surgery is a serious discipline that should not be misrepresented with "commercial" messages.

The message that we want to make clear is that even if surgeons are willing to be the first to abandon invasive methods for mini-invasive alternatives, that can still lead to appreciable results, this is not always possible. In order to definitively solve the problem of bags under the eyes or drooping eyelids, the expert use of a scalpel is still necessary, not forgetting however that it is a surgical intervention with rapid and non-demanding post-operative care and recovery.


  • Bringing back a young look to the face: the case of Lucia

One case I have recently dealt with is that of Lucia, a 54-year-old lady with a fine appearance, but with obvious lower eyelid bags.

As determined as she was to erase the dark circles under her eyes and remove the bags giving her a tired and worn-out look, Lucia was very reluctant to have surgery because she considered it a demanding solution.

We talked at length about what she wanted, her doubts, her fears. I answered her questions and outlined to her in a clear and realistic way the results that could be achieved with the surgery, the procedure, and the risks.

I explained to her how over the last few years surgical techniques have evolved to very low levels of invasiveness. In addition, in her case, blepharoplasty was the only way to solve the issue in a definitive way and with a result in line with her aesthetic expectations.

In the operating room I helped Lucia to relax with some music and, after applying local anaesthetic to the area, we started the operation which lasted about forty minutes.

When I told her that we had finished, she was quite surprised and confessed to me that she hadn't noticed the time pass.

Lucia returned home the same day and came back to remove the stitches in the studio after a week. From the smile on her face I could already sense her satisfaction. I asked her how the days after the surgery had been and she explained that everything had gone exactly as planned.

She had worn sunglasses for three days and then returned to her normal activities by covering the slight swelling with make-up.

Looking in the mirror, she could already see her fresher and more beautiful look and she revealed to me that the only question she was asking herself was: "Why didn't I do it sooner?

The importance of the eyes on the visual impact of a face makes blepharoplasty more decisive than a face lift in facial rejuvenation.

I like to think of this surgery as really able to determine a significant aesthetic improvement and my patients, like Lucia, confirm every time that this is really the case.

Rovatti Pier Paolo


Dr. Rovatti Pier Paolo

Medical Surgeon
Milan (Italy)

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