This document discusses blepharoplasty of the upper eyelid and associated procedures. It notes that the eyelid, eyebrow, and forehead should be considered as a unit during aging. Upper blepharoplasty involves resection of skin, the orbicularis muscle, and fat. Associated procedures may include correction of eyelid ptosis, skin crease fixation, hollowness in the eyelid area, and forehead/eyebrow lifting. Indications, surgical techniques, pre- and post-operative considerations are covered. The importance of a thorough clinical exam and understanding all available surgical and complementary techniques is emphasized.

1. BLEFAROPLASTICA SUPERIORE
Renata Migliardi
Ospedale Koelliker Torino
ISOLA D’ELBA 2010

2. INVECCHIAMENTO DELLA PALPEBRA SUPERIORE
• Considerare l’insieme palpebra-sopracciglio
• Resezione
– Cute (+)
– Orbicolare (-)
– Grasso
• Gesti associati :
– Malposizioni palpebrali
– ptosi/retrazione/solco sovratarsale
– Piega palpebrale
• Gesti associati sulla regione sopracciglio-glabella
– Pessia interna o esterna
– Tossina botulinica
– Lifting fronto-temporale

8. LA PIEGA PALPEBRALE

9. INDICAZIONI
Skin and muscle excess skin and muscle
resection
Pre aponeurotic fat pad fat resection
excess
Medial fat pat excess
Hollow hyaluronic acid and
fat transfert
wrinkles superficial chemical
peeling laser
resurfacing
Eyelid malposition ptosis and retraction
correction
Eyelid crease malposition skin crease refection

10. INDICAZIONI
• Eyebrow ptosis internal browpexy
direct eyebrow lift
temporal forehead lift
Botox injection
• Corrugator and Botox injections
procerus Deep wrinkless

11. PROCEDURE CHIRURGICHE
• Simple upperlid blepharoplasty
• Associated procedures
– Eyelid ptosis and retraction
– Skin crease fixation
– Hollow and deep sulcus
– Forehead and eyebrow elevation

12. BLEFAROPLASTICA
• Design the skin excision
• Anesthetize the eyelid
• Excise a strip of skin and orbicularis
• Excise excess fat
• Close the skin edge
• Remove sutures after 5 days

13. SKIN AND FAT RESECTION

18. BLEFAROPLASTICA ASSOCIATA A PTOSI
• Test con neosinefrina
– Positivo simmetrico resez congiuntivo-
mulleriana
– Negativo o asimmetrico chirugia
aponeurotica

19. AZIONE DEL
MUSCOLO ELEVATORE

20. TEST ALLA NEOSINEFRINA
COSA AVRESTE FATTO?

21. BLEFAROPLASTICA E
RESEZIONE CONGIUNTIVO-MULLERIANA

22. BLEFAROPLASTICA E
RESEZIONE CONGIUNTIVO-
MULLERIANA

23. POST OP
POST BTX

25. NEO SX
BLEFARO + RESEZ CONG MULLER BIL

26. TEST NEGATIVO
COSA FARE?

27. Blefaroplastica e
chirurgia
aponeurotica

28. BLEFARO +
REINS APON BILAT

29. LIFTING DEL SOPRACCIGLIO
• Internal browpexy
• Direct eyebrow lift
• Temporal forehead lift
• Botox injection

31. PESSIA PER VIA INTERNA

32. 1 2 3
PESSIA DIRETTA
4 5

33. TOSSINA BOTULINICA
• GLABELLA
• SOPRACCIGLIO
• ZAMPE DI GALLINA
• ATTENZIONE A NON BLOCCARE TROPPO
IL MM FRONTALE

34. CONCLUSIONI
LA CHIRURGIA COSMETICA PALPEBRALE
NECESSITA :
•Conoscenze anatomiche non solo palpebrali!!
•Esame clinico rigoroso
•Conoscere tutte le tecniche chirurgiche a
disposizione
•Conoscere i trattamenti complementari (filler,
lipostruttura,tossina botulinica, laser)
•Saper gestire le complicanze