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 belpahroplasty at a much younger age in our Caribbean plastic surgery clinic at Trinidad Institute of Plastic Surgery 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.
In younger patients with early aging in the lower eyelid, an alternative to traditional open blepharoplasty should be considered. It is only necessary to remove a very small amount of fat and a very small strip of skin and do something about the crow’s feet. This can be achieved with our MIDI blepharopasty technique in the lower lid (mini incision distributed intervention blepharoplasty)
MIDI blepharoplasty foregoes the skin and muscle flap technique of traditional blepharoplasty 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 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.
The combination of the described three small interventions can yield lasting results without the lengthy recovery phase of a more extensive operation. 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.
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 Caribbean plastic surgery clinic at Trinidad Institute of Plastic Surgery.
MIDI blepharoplasty reflects our treatment philosophy in cosmetic and plastic surgery: The extent of the operation should be adjusted to the severity of the problem.
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