Dr. med. Eduarda Jurševiča Estētiskās medicīnas klīnika
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Plastic surgery Plastic aesthetic surgery Six misconceptions about blepharoplasty

Six misconceptions about blepharoplasty

Six misconceptions about blepharoplasty

You can’t argue that the eyes are the mirror of the soul. They radiate everything - age, mood and even health status. But what if the person was already born with a frown or the beauty of the eyes cannot be discerned due to the fat pads? Blepharoplasty will help – it is a method that allows you to look at the world with eyes wide open. Plastic surgeon, MD Eduard Yurshevich debunks myths about the most popular aesthetic surgery of the lower and upper eyelids.



That is not true. The reasons why the eyelids look somewhat unaesthetical are the “tired” muscles, the stretched skin, and the formation of fatty tissue around the eyes. There are statistics according to which every fifth inhabitant of the planet has aesthetically bad-looking bags over and under the eyes. And they can appear at 20, or at 50 years of age. Moreover, both women and men alike are affected. The same pads under the eyes or on the upper eyelids, also called fatty bags (or pads), form regardless of age.

Of course, one of the causes why the bags under the eyes form is natural aging. The skin, which is very thin in the eye area, loses its elasticity and natural tension over the years. And if adipose tissue gets under it, it appears as swelling and puffiness around the eyes. At the same time, it doesn’t cause pain and there is no discomfort. But on the outside the person looks sleepy, gloomy and tired. And much older than their actual age.

Sometimes the formation of fat pads is genetically determined - they are formed due to anatomical features. It is difficult to hide such aesthetic defect with decorative cosmetics, and it is impossible to get rid of overhanging bags under the eyes using conservative methods or at home.

In addition, if the upper eyelids droop heavily, the vision itself might get worse.

In this case, plastic surgery comes to the rescue. Specifically, eyelid plastic surgery or blepharoplasty. “This is a surgery that corrects the eyelids, as excess skin is removed and local fat is partially removed or distributed evenly. There is blepharoplasty of the upper and lower eyelids, and at the same time you can adjust the shape of the eyes, as well as slightly change the position of the tip of the eyebrows, making the face look more open,” explains Dr. Yurshevich.

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This option is undesirable. Many patients ask this question: is blepharoplasty performed under local or general anesthesia? “The safest way to conduct the eyelid surgery is under combined anesthesia. The modern approach to eyelid surgery is anesthesia, which includes not only local anesthesia, but also sleep induction, ”says Dr. Eduard Yurshevich and explains why.

There are five fat pads around the eyes - two on top and three on the bottom. When one of them - the nasal fat - is removed, sometimes a very noticeable cardiac reflex occurs, in simple terms, the patient's blood pressure drops and the pulse slows down. If an operation is performed under local anesthesia, then this phenomenon can lead to very serious consequences. If the nasal fat is not removed, the operation is considered non-radical, that is, ineffective.

To prevent this from happening, our doctors always perform blepharoplasty under combined anesthesia, when the patient has both pulse and pressure stabilized, and can be operated on without the risk of any complications. The operation is performed in more comfortable conditions for both the doctor and the patient. Stabilization of pressure is also a prerequisite for fewer bruises on the face. And that means the recovery period will be shorter,” explains Dr. Yurshevich.

 “Also think about the“ effect of presence” during the operation, the sensations of your own tissues being cut, the smell when the blood coagulates. And local anesthesia does not always provide adequate pain relief. In such difficult conditions, when the pressure and pulse are high, it is radically very difficult to carry out the operation, and to some extent even risky.

That is, an operation under combined anesthesia, in addition to being more efficient, is also less dangerous and more effective for the patient, with a shorter postoperative effect.

As a rule, under local anesthesia, only skin removal is performed. Work on fatty lumps and muscles requires combined anesthesia.


 “I often hear that someone somewhere is operating by using a new technique. Frankly, there are no new or old technologies in blepharoplasty. These are all marketing moves. There are several types of operations, the configuration of incisions is different. But there are no inherently old or new methods,” says Dr. Yurshevich.

For each person, the type of the surgery will be different. Indeed, in nature there are no identical eyes and eyelids. A surgery plan is developed for the particular patient, taking into account the features of their appearance and also their wishes. So, for example, if you make a short incision in the upper eyelid, your eyes will look “round,” and the patient itself will look gloomy and sad. And in order to change the expression of the eyes to a more affable and attractive one, the incision is made in a way so that at the same time the eyelashes are lifted and turned upwards. Postoperative scars are not visible.

“The most important thing is that after the surgery, the improved eyelids and the shape of the eyes suit the patient, so that all the individual traits and features of facial expressions and race are taken into account,” the plastic surgeon notes.

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During the plastic surgery of the lower eyelids, an additional manipulation is often performed - myopexy. This procedure allows to tighten the muscles around the eyes. Very often, it is necessary to perform this procedure after the removal of the fat deposits in the eyelid area to more effectively smooth out the static wrinkles of the lower eyelids, and to achieve an effective and lasting blepharoplasty effect. A tightened muscle will crush the remaining fat, and it will not form fat pads again.

As a result, it is possible to get rid of the “heavy eyelids” effect, the skin around the eyes will look younger, the eyes will acquire the correct proportions, the look becomes more open and friendly.

In the case of plastic surgery of the upper eyelids, the technique of fixing eyebrows in an elevated position or browpexy (eyebrow lift) is sometimes additionally used. Having made an incision in the fold of the upper eyelid to remove the pads, the doctor goes under the eyebrow and fixes the muscles in an elevated position to the periosteum of the upper orbital edge. As a result, the eyebrow looks as if it is upturned.

If you want to raise the entire eyebrows, and not just their edges, it is a completely different surgery - endoscopic lifting of the forehead and eyebrows. It is a very effective way to give the eye a more open and natural position. And more attractive in terms of how other perceive the patient.

Separately, the so-called ethnic blepharoplasty san be performed, which is mainly aesthetic in nature – the eyes of women with an Asian type of appearance are remade to retain a more “European” look, which also makes the eyes look more open and expressive.


You can already use cosmetics on the eighth day after the surgery. And you can go back to work and face the world after two weeks. All of the stiches are removed within seven days - during this time the bandages are changed two to three times. There is usually no pain after blepharoplasty.

Sometimes, when we plan an operation to raise the edges of the eyebrows, injections of the botulism toxin are performed before the operation to block (turn off) the depressor muscle groups (depressors are the facial muscles that pull the skin and tissues down). If the eyebrow is sutured, the muscle can droop downwards, and a feeling of tissue tension appears. “We block these muscles, perform the eyelid surgery and raise the eyebrow. While everything heals, the eyebrow temporarily does not work. The use of a combination of techniques - injections of botulinum toxin, browpexy and eyelid surgery provides a brilliant result. This combination is considered to be very progressive in aesthetic facial surgery,” explains Eduard Yurshevich.


“Eyelid surgery - is one of the most effective, but at the same time responsible surgeries. No nuances should be neglected. Because one nuance can cancel the whole result. Here you need to be very careful. And, if everything goes as it should, the positive effect will last a long time - up to 15 years,” explains the plastic surgeon.

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To do this, just put your finger on the bag under the eye. If the swelling shifts, then yes, there is fat tissue inside.


Most often this is due to genetic predesposition and natural aging of the body. But there are other reasons:

- problems with metabolism, blood circulation;

- stress, insomnia, overworking;

- alcohol and smoking;

- improper nutrition;

- problems with the skin and excessive exposure to the sun (or tanning bed);

 - constant use of decorative cosmetics;

 - ptosis or paresis of the eyelids.


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