MIDI blepharoplasty is our variation of eyelid surgery specifically designed for clients in the Caribbean. Facial aging starts especially early around the eyes and there in the lower eyelid. Clients in their late thirties often present with small fat protrusions, visible, horizontal folds in the eyelid and around the outer corner of the eye – the dreaded crow’s feet. When progressing into the forties, excess skin becomes noticeable both in the upper and lower eyelid. Early signs of aging around the eyes tend to be very noticeable, particularly in the lower lid, where the loss of once smooth and firmer skin affects the fresh and youthful appearance. This circumstances result in clients with lower lid aging presenting for cosmetic eyelid surgery at a much younger age than those with upper lid aging. Certainly there is also the expectation to postpone or avoid a future more extensive procedure by performing a more limited lower blepharoplasty earlier.
The time line for aging around the eyes is quite similar across ethnicities in our experience. Eyelid skin is uniformly the thinnest skin of the body regardless of the ethnic group the client belongs to. The anti-aging effect of thicker skin (with more elastic fibers etc.) in other areas of the face is absent in the eyelids. Although we have not studied the phenomenon in a scientifically rigorous fashion, it is our clinical impression that skeletal support and suspension of the eyelid to the bony margins of the eye socket shows age related changes later in East Indians, Afro-Caribbeans, Creoles and Arabs in the Caribbean compared to Caucasians. A lowered lateral canthus (outer angle of the eyelids) is thus seen predominantly in advanced age groups in the Caribbean. Baggy lower lids due to fat protrusions on the other hand are seen with equal frequency but less severity in the Caribbean compared with Europe or North America.
These considerations prompt the design of a rational lower eyelid surgery technique for rejuvenation – removal of fat pockets to improve the appearance of baggy eyelids and thus the contour of the eyelids, removal of a small amount of excess skin, improvement of the quality of skin and reduction of fine wrinkles.
Eyelid surgery for lower lid rejuvenation with the MIDI blepharoplasty technique foregoes the skin and muscle flap technique of traditional cosmetic eyelid surgery and instead removes only a small strip of skin below the eyelashes. Then the small protruding fat pockets are removed through a small incision on the inside of the eyelid. The overall surgical trauma induced by the eyelid surgery and scarring in the eyelid is minimized, which shortens the recovery time, reduces the formation of swelling and bruising markedly and decrease the risk of ectropion to almost zero. The crow’s feet and aged skin in the lower lid are treated with a combination of Botox and chemical peeling with TCA (trichloracetic acid). As no large skin and muscle flap is undermined during MIDI blepharoplasty, chemically peeling can be safely performed in the same session as the eyelid surgery.
The combination of the described three small interventions can yield lasting results without the lengthy recovery phase of a more extensive eyelid surgery. Swelling and bruising are very limited. The actual recovery is determined by the time of regrowth of the skin surface after the chemical peel, usually around five days.
Cosmetic eyelid surgery with the MIDI blepharoplasty in is a perfect procedure for younger patients with limited, early signs of aging in the lower eyelid. Adding a couple of milliliters of fat graft to the tear trough or transition of the eyelid to the cheek can further enhance the effect. We have performed entire procedure under local anesthesia in our office, but prefer a formal operating room with any form of sedation of the patient’s choice.
MIDI blepharoplasty is an excellent procedure for clients with dark skin. The small external incision is unproblematic even in Fitzpatrick type VI skin and chemical peeling has proven to be exceptionally safe in dark skin in our extensive experience with skin resurfacing in clients with dark skin tones.
MIDI blepharoplasty reflects our treatment philosophy in cosmetic surgery: The extent of the operation should be adjusted to the severity of the problem.
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Trinidad Institute of Plastic Surgery – the superior choice for eyelid surgery in the Caribbean, Antigua and Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Bermuda, British Virgin Islands, Cayman Islands, Turks and Caicos Islands, Miami, New York, Toronto, London