Blepharoplasty, the leading cosmetic surgery to correct bags under the eyes, can cause serious eye injury if not performed correctly

This is one of the main conclusions of the international course, Barcelona Oculoplastics, which, over the weekend, brought together at the IMO 300 specialists from 31 countries

“Blepharoplasty can cause serious ocular complications and, in some cases, even lead to blindness,” according to experts gathered over the weekend at IMO to attend Barcelona Oculoplastics, the second edition of an international course on oculoplastics, a growing subspeciality that tackles the functional and aesthetic problems of the middle and upper part of the face.

Leading world authorities on the speciality, including the likes of Dr Richard Collin, the father of ptosis surgery (drooping eyelids) and Naresh Joshi, along with the course director, Ramón Medel, from IMO, warned of the importance of oculofacial surgery needing to be performed by specially-trained professionals with experience in the fields of both plastic surgery and ophthalmology.

Mention was specifically made of blepharoplasty, a surgical procedure used to correct the bags that form under the eyes (in the lower eyelids) and give patients a tired, old-age appearance. This treatment, one of the most popular in the field of cosmetic surgery, can lead to serious complications if not performed by experts, according to speakers on the course.

One of the main complications is lower eyelid retraction, which affects about 20% of patients who undergo blepharoplasty and, as well as causing aesthetic problems, can pose a threat to the eye, since the retraction prevents the eye from completely closing and leaves its surface unprotected, which can lead to serious injuries to the cornea.

In addition to this serious complication, there have also been cases of irreversible blindness secondary to this surgery, which, in Spain, affects about 1 in 500 patients, according to Dr Ramón Medel. The specialist explains that “these cases are totally avoidable if the procedure is performed by a professional with training and experience in oculoplastics and can produce spectacular results without special complications.”

Although blindness secondary to a poor blepharoplasty is irreversible, it is possible to treat lower eyelid retraction secondary to blepharoplasty by means of a transconjunctival midface lift, a sophisticated technique that is performed in very few centres in the world, of which IMO is one, whose purpose is to raise the lower eyelid and cheekbone without incisions by accessing the affected area through the conjunctiva.

Elevation of a drooping eyelid through the frontalis muscle or collagen stimulation with MicroPen are major advances in the field of oculoplastics, which combines surgical techniques with therapies that can be applied in the consulting room.

If this was the pioneering technique that was the focus of interest during the first Barcelona Oculoplastics course, held in 2012, this time round the most outstanding development was a treatment to correct drooping eyelids or ptosis, a condition that can be congenital or senile, or related to other causes that weaken the levator muscle and prevent it from fulfilling its function. As well as being an aesthetic problem for patients, ptosis can interfere significantly with vision when the drooping eyelid invades part of the pupil.

One of the different methods for tackling this problem is known as the frontalis flap technique, which consists of lifting the eyelid through its attachment to the frontalis muscle, by connecting the tarsus and eyebrow using a graft as an element of intermediation between both muscles.

One of the great surprises of the conference this weekend, however, was the live demonstration of a surgical procedure in which this connection element was not used. Instead, the frontalis muscle was sutured directly to the levator muscle. This is an important development introduced some years ago by Dr Ramón Medel who, over the weekend, captured the attention of all of the speakers and attendees, including Dr Richard Collin. All of them were able to watch coverage of a total of seven oculoplastics procedures through a live connection between IMO’s auditorium and operating theatres.

According to the course director and pioneer of this innovation in the classic frontalis flap technique, Dr Ramón Medel, “by carrying out this suture directly, only one incision through the eyelid is necessary, thereby precluding the need to make several visible incisions in the forehead and ensuring more satisfactory and longer lasting results.”

Along with these surgical techniques, the experts also discussed non-surgical aesthetic techniques, such as a new development known as collagen stimulation with MicroPen – a micro-needling device that achieves spectacular results in facial rejuvenation by cleaning and tightening the skin through collagen stimulation.

The experts, which included world authorities in this field, such as Dr José Raúl Montes and Dr Luigi Colangelo, also highlighted other developments to improve the appearance of the periocular region and, in general, the face through techniques that can be applied in the consulting room, such as carboxytherapy and subcutaneous injection of carbon dioxide (CO2) to improve tissue oxygenation and promote blood flow and capillary opening, resulting in better skin tone and, more specifically, elimination of dark circles around the eyes.