Blepharoplasty in East Paris

Aesthetic Surgery Pr Meningaud

What is blepharoplasty?

Cosmetic eyelid surgery, known as blepharoplasty, has come a long way. I remember that when I was an intern, removing a little skin and fat pockets was enough to satisfy all patients.

The procedure was straightforward, and we would see up to eight patients in a morning, usually on Fridays, the day reserved for simple operations, the day before the weekend. Things have changed. Nowadays, it’s all about treating dark circles (the furrow between eyelid and cheek), discreetly enlarging the eyes, restoring an almond shape, softening a sad look, correcting any ptosis (vertical narrowing of the palpebral slit), or even treating the center of the face (centrofacial lift), eyebrow ptosis and forehead wrinkles.

Many patients seeking eye surgery already have problems with eyelid malposition, and almost all have asymmetries. Blepharoplasty provides an opportunity to correct them.

Blepharoplasty in East Paris

Professor Meningaud at Henri-Mondor

A: Tear trough

B: Palpebral-malar groove

C: Medio-jugal fold

D: Palpebral line

Why does a man or woman seek blepharoplasty?

In exceptional cases, it’s out of narcissism. In fact, when narcissism is at stake, it’s a pretty bad sign when it comes to ultimate satisfaction. A blepharoplasty candidate’s primary motivation is to regain his or her ability to influence others. Does that surprise you? When human beings talk to each other, they rarely look at their foreheads, chins or noses. They look into each other’s eyes. Most non-verbal communication takes place through eye contact. And the essence of all communication is non-verbal. When you look tired, it’s hard to convince people that you deserve a pay rise, that you’re a good candidate, that you’re at the cutting edge of your field, or that they should vote for you.

What happens during a blepharoplasty procedure?

Blepharoplasty is usually performed under local anaesthetic, possibly with light intravenous sedation to manage patient anxiety. There is little pain either during or after the procedure. The main objective is to remove fat pockets and excess skin. However, if the dark circles are left untreated, the treatment will be incomplete. It’s a question of filling the furrow between the pocket and the cheek. This groove is caused by a progressive contracture of the orbicularis muscle, which, as its name suggests, surrounds the eye. This progressive increase in its resting tone segments the fat to create the palpebral bags and sometimes the so-called malar bags in the cheeks. The surgeon can fill the ring using the fat pocket: either by unrolling it downwards as a flap, or by grafting part of it into the furrow. The aim is to create a convexity running from the eyelashes of the lower eyelid to the cheek, and ideally even to the corner of the mouth. This is known as the “baby curve”. Unfortunately, as we age, this curve turns into a corrugated iron sheet!

In men, the treatment of excess skin on the upper eyelid must be carried out sparingly, firstly because it is fairly well tolerated aesthetically, and secondly because the scar cannot be camouflaged by make-up. The scar must be hidden in the fold. In men, excess skin on the upper eyelid often conceals a ptosis of the eyebrows, which can be treated by other means. We’ll come back to this later.

Sometimes blepharoplasty is an opportunity to perform a more elaborate surgical procedure. The aim is not to change the look, and in particular the smile, but to correct an eye that appears smaller, or a drooping of the upper eyelid (ptosis), or a tendency to scleral show (white visible between the pupil limbus and the free edge of the eyelid), an impression of a bulging eye, a peri-ocular varicose vein (dilated vein), malar bags (fatty pockets located below and outside the lower eyelid). In some cases, the operation can also be used to rejuvenate the entire upper half of the face: to treat eyebrow droop and sagging of the central part of the face, in particular the valley of tears.

Professor Jean-Paul Meningaud

Maxillofacial Surgeon Paris Est Créteil

There’s been a lot of talk about techniques for correcting eyebrow loss, and for a long time none of them were satisfactory, as they produced modest effects and, above all, complications. Such was the disappointment that we reverted to resection of a spindle of skin at the edge of the eyebrow, with visible scarring. This technique allows great precision in the design of the new eyebrow, but requires particular attention to the suture, otherwise the scar may be visible.

Recently, a brilliant Brazilian surgeon, Fausto Viterbo, has developed a simple, effective technique with no visible scarring: the Gliding Brow Lift (GBL). It consists in superficially detaching the skin by means of a punctiform scar in the scalp, then fixing the skin for 48 hours using a few pad stitches with very fine thread.

The centrofacial lift “lifts” all the fatty tissues of the cheekbones. All the soft tissues under the eye are attached to an anchor point near the eye socket with several threads. There are several possibilities, but the best passes through the bone around the orbit. This is the strongest anchor for long-lasting effect. The result is quite spectacular, and permanently corrects the valley of tears and, to a lesser degree, the lower cheeks. It can be further enhanced by fat injections.

Altering the look of the eyes is a major concern for patients. The techniques described here cannot change it. To achieve this, much more invasive procedures are required, rarely indicated for cosmetic surgery. In the case of very rare indications, and if the patient is highly motivated, a psychological assessment by a professional is essential. The risk of psychological decompensation is real. These cases are exceptional. The usual blepharoplasty will rejuvenate the eyes, giving them a rested, fit appearance, but will not change the expression.

Blepharoplasty on a man to treat fatty bags, dark circles and the upper eyelid (case of Pr Jean-Paul Meningaud).

Blepharoplasty on a woman to treat fatty bags, dark circles and elongate the almond-shaped eye (case of Pr Jean-Paul Meningaud).

[1] Viterbo F, Auersvald A, O’Daniel TG. Gliding Brow Lift (GBL): A New Concept. Aesthetic Plast Surg. 2019;43(6):1536-1546.

[1] Chatel H, Hersant B, Bosc R, La Padula S, Meningaud JP. Midface rejuvenation surgery combining preperiosteal midcheek lift, lower blepharoplasty with orbital fat preservation and autologous fat grafting. J Stomatol Oral Maxillofac Surg. 2017;118(5):283-288.