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Angelo Rebelo

Angelo Rebelo

Clinica Milenio, Portugal

Title: Blepharoplasty with external mini-incisions


Biography: Angelo Rebelo


The author presents an efficient technique to improve the appearance of people with herniation of fat pad bags of the lower lids. Compared to the unsatisfactory results of the classical blepharoplasty with “sclera-show”, “round eye” and ectropion and given the retractile skin capacity of the eyelid region, the author has for several years used this technique, abandoning the classical blepharoplasty with the resultant 4 cm scar. It was Fontana, Spain, who described this technique to remove the fat pad bags of the lower lids through minimal transcutaneous incisions of 2-3 mm. It’s a very simple technique, easy to perform, with indication in cases with excess or herniation of the fat pad bags but the author also performs this procedure in patients with skin excess and/or wrinkles, with satisfactory results. It’s a good alternative to the conjuntival approach because of fewer risks to the patient. The author verified that the removal of the simple fat pad gives a much better appearance to patients with a good skin retraction and if necessary can be complemented with peeling or laser procedures. Performed under local anaesthesia, through a small 2-3 mm incision with a 11 blade, in the lower lid at pupil level, cutting at once skin and muscle until the central bag, at the same time putting pressure on the eye to facilitate the extrusion of the fat with the removal of the blade. With the help of a forceps the fat is gently pushed and cut with a thermocauter (or electrocautery using low intensity, radiobisturi or laser). Through the same incision we have access to the internal and external fat pad bags always with gentle and directioned movements. Sufficient fat, not excess should be removed. Incision closure is carried out with a 6/0 nylon that is removed after 3 days. No dressing is used. Swelling is much less evident and recuperation is quicker. The author has also performed a similar procedure on the upper lid, but with very specific indications of herniation of the medial and internal fat pad bags, through a 2-3 mm incision in the inner portion of the upper lid, in a wrinkle near the naso-frontal field with the same steps as for the lower lid. In all cases there are neither problems nor complications and there is no risk of eye deformation as the “sclera-show”, ”round eye ” and ectropion. It’s a simple quick technique, with very good results, scars are almost invisible, recovery is quick, risks and complications are very few.