FAQs Blefaroplastia

This question answers itself: The more sub-specialization, the better the results! The most indicated to perform a blepharoplasty is a specialist in Oculoplastic Surgery. The reasons are many, visit our section 10 Reasons to know them in detail.

An oculoplastic surgeon is an ophthalmologist who, after completing his training in ophthalmology, has completed a training program in oculoplastic surgery (also called a fellowship). Not all ophthalmologists who perform eyelid surgery can accredit this training. If you want the best results and maximum safety, look for a surgeon who can prove his training and who is a member of the main oculoplastic surgery societies. It’s the best guarantee you can have.

Blepharoplasty is a surgical procedure by definition, so “blepharoplasty without surgery” does not exist. Most references to this term are the result of commercial strategies that seek to make the intervention more attractive by minimizing its importance.
Other media use this term to refer to a lower eyelid skin peel with an acid or laser. This is a technique that is also performed byDr. Jose Nieto and is aimed at improving the texture and fine wrinkles of the lower eyelid and is used alone or in combination with a blepharoplasty. It has also been called ‘chemical blepharoplasty‘.

Excess skin in the upper eyelids can appear after the age of 35, although some patients before that age already have a “full” eyelid due to their individual anatomical characteristics.
Fat pads in the lower eyelids are also more frequent with age but sometimes appear from an early age, even before the age of 25.

Only exceptionally do we contraindicate a blepharoplasty in a patient with some ocular pathology. These are usually cases of severe dry eye. In these patients, any eye or eyelid surgery may accentuate their problem. Most patients with dry eye have mild or moderate degrees, which is not a contraindication for blepharoplasty but may require more conservative surgery.
Retinal problems or glaucoma are not contraindicated or aggravated by blepharoplasty. Cataract surgery or laser surgery for myopia or hyperopia are not either.

In patients who present a pronounced groove under the eyes together with fat pads, we do not eliminate the fat pads since in these cases it can be harmful, worsening the dark circles under the eyes and giving the appearance of a sunken eyelid. In these cases we perform a repositioning (or transposition) of the fat bags, in which, by transconjunctival way, we use the own fat of the bags to eliminate the furrow of the ear.
In patients who have pronounced dark circles under their eyes without fat pads, we use hyaluronic acid because they are not good candidates for blepharoplasty.

Minimize or diminish the importance of such an intervention in an error. It is true that these are minimally invasive surgeries with a relatively quick recovery, but the patient must be aware of their importance and not consider them as something banal. A doctor studies for more than 10 years to be able to start his professional career and then invests another 10 years to be able to perfect himself in his specialty. This gives us an idea of the degree of complexity of a surgical act.

Blepharoplasty is not an intervention that can eliminate crow’s feet nor is there any surgery that eliminates them completely. These are folds that appear in the skin by contraction of the orbicular muscle, and can be treated with botox and other techniques.

We have a CO2 laser for surgery, but we do not routinely use it on all patients. The word ‘laser’ is very commercial but this does not imply more modernity or better results. The most critical steps that will determine the success of a blepharoplasty are proper planning. The instrument used to make the incision (laser, cold knife or electric scalpel) has no influence on the final result. The laser produces a devitalization of approximately 0.5mm of tissue when making the cut, so the points should be left more days in case of making the laser incision. In a survey conducted among members of the American Society of Oculoplastic Surgery, over 70% used the conventional scalpel (cold knife) in blepharoplasties.

Cosmetic surgery is never covered by health insurance. That said, it is true that in many patients who desire a superior blepharoplasty we can demonstrate a degree of visual field reduction due to the “visor” effect produced by the excess skin on the eyelids. In these cases, your health insurance may take over some or all of the surgery.
Dr. Nieto works with almost every insurance company in the country.

We want to think that every professional who performs blepharoplasties is qualified to do them. However, we also believe that the decision to undergo a blepharoplasty is important enough to be a thoughtful decision and not the result of an impulsive purchase of a coupon on the internet. The process should be first to inform and choose the surgeon and second to consult prices, and not the other way around.
On the other hand it is frequent that in these offers the previous price is “inflated” to be able to announce discounts of 50% or even more, but the reality is that the discount is not such.

Yes. Often we perform this intervention only under local anesthesia depending on the type of patient and their preferences. If this is done, the patient should only tolerate the infiltration of the local anesthetic for one minute. Afterwards, the patient will not feel any pain since the area will be asleep. Being short term interventions, they are well tolerated by patients.

Lower blepharoplasty is always performed under local anesthesia and sedation, just like eyebrow lifts.

Only exceptionally do we operate under general anesthesia. Today’s intravenous sedations make this unnecessary. Even patients who report being ‘very nervous’ are completely calm and relaxed with sedation.

Younger patients or those who have little skin laxity usually do not need any skin incision since the removal of the fat pads can be done transconjunctivally. Patients with greater laxity may require an additional skin incision to tighten the skin. But in any case, the treatment on the bags must be done by transconjunctival way because it minimizes the risk of retraction.

In the case of fillers, it is better to wait a few months if they have been placed in the furrows of the dark circles and you want a lower blepharoplasty. In the rest of the cases there is no problem.
Botox is not a problem either.

It is not a problem to have a blepharoplasty operation. Micropigmentation will not be altered by the operation.

Yes, upper blepharoplasty surgery and ptosis correction can be performed in the same surgical act and does not involve any additional incisions. A lower blepharoplasty can also be performed.

Anti-aggregate medications (Aspirin, aas, Plavix, Tromalyt and others) and anticoagulants (mainly Sintrom) that many patients take should be discontinued prior to blepharoplasty, as they interfere with blood clotting and may cause post-operative bleeding. We will discuss with your doctor the possibility of stopping this medication.
In some patients who have suffered heart attacks or strokes it is not advisable to stop this medication. In these cases we will evaluate the possibility of performing the intervention depending on the medication and the specific patient.

Hypertrophic scarring of the eyelids is absolutely exceptional, even in patients with this history. The reason is that the skin of the eyelids is the thinnest on the body, and therefore the healing process is smoother. The skin of the abdomen, back, or other regions cannot be compared to the skin of the eyelids.

Dr. Nieto is not clear that it is “reasonable” to perform multiple interventions in one act. This involves long-term general anesthesia and prolonged recovery. It’s a major shock to the body. A decision of this importance should not be made conditional on saving money by doing “everything at once”.

No, Dr.Nieto never covers the eyes after the operation, as he is interested in you being able to apply local cold from the first hours.

It depends. In cases of lower transconjunctival blepharoplasty, during the first week since there is no incision in the skin. In cases of upper or lower blepharoplasty where there is an incision in the skin and stitches, it is better to wait 2 weeks to apply make-up near the incision.

As long as the purple ones last, you should not sunbathe. Afterwards, in cases of lower transconjunctival blepharoplasty you will be able to expose yourself to the sun. In cases of upper or lower blepharoplasty in which there is a skin incision, you can do so a month after the operation with the use of sunscreen.

You will be able to shower normally the day after the operation unless the doctor tells you otherwise.

After an upper blepharoplasty you will probably be able to wear them at the end of the first week. After a lower blepharoplasty you may have to wait two weeks.

Most patients have no problem reading from the day after the operation. There may be a feeling of dry eyes the first few days that can be treated with moisturizing eye drops.

It basically depends on what your job is. If it is a job that requires significant physical effort, you should rest for a week, while if you work from home with a computer you will probably be able to do so two days after the operation. The time you take off from work also depends on whether you are facing the public. If this is not the case, you can return to work during the first week when you are sufficiently recovered. We will always try to keep the downtime as short as possible.

As long as the patient is committed to caring for and protecting the wounds and not sunbathing early, there is no problem.
The incisions in an upper blepharoplasty are hidden so they are not directly exposed to the sun, but it is still advisable to use sunscreen
In the case of a lower transconjunctival blepharoplasty, since there is no incision in the skin, you will simply have to avoid the sun while you have some bruising. In the case of lower blepharoplasties that have an incision in the skin, it will be necessary to protect them from the sun with high protection factors if you have the operation in the summer months.
Eyebrow lifts are not a problem in this sense, since the incisions are hidden in the scalp.

During a blepharoplasty the eyeball is protected and is not touched under any circumstances, so there should be no change in the prescription. It is normal to have a little blurred vision the first few days, and this is due to transitory alterations in the tear film.

It’s called palpebral retraction. It occurs when, due to surgery, the tissues heal in an “abnormal” way and that healing pulls the eyelid down. The risk of retraction increases when surgery is performed carelessly (greater surgical trauma) and when blepharoplasty is performed externally rather than transconjunctivally. The risk of retraction in transconjunctival surgery is very low.
It can also occur in a lower blepharoplasty when too much skin is removed.
Most cases of palpebral retraction can be solved by corrective surgery.

When too much fat is removed from the lower eyelid, the result is a sunken, drooping eyelid, a deep groove and a sad look. Many patients do not require a removal of the fat bags but a repositioning of that fat, which removes the furrow under the eyes without risk of removing too much volume from the eyelid. These techniques are only available to an experienced oculoplastic surgeon.
Most cases of this type can be improved with corrective surgery or infiltrations of fat or hyaluronic acid.

This is called upper eyelid retraction and is probably due to too much skin and muscle being removed from the upper eyelid. It is a major problem and its best treatment is prevention, with careful planning of the intervention.
The solution to these cases is not simple. If the surgery is recent, you must wait a few months, since it will improve during the first months. Meanwhile we must ensure good ocular lubrication and perform massages to soften the healing process.
In the worst case, it may require corrective surgery through skin grafting.