Tutorial - Marking the Upper Lid Blepharoplasty

Step by step description of how to mark the skin prior to performing an upper lid blepharoplasty from Mr Richard Caesar and www.oculoplastics.info

[@dr.trevidic]

As a young plastic surgeon, i did few upper lid blepharoplasty. I love to watch videos about it and so far it is the BEST one explaining the marking!!! Congratulation Sir. Best regards.

[@miabs9081]

It is by far the best blepharoplasty tutorial I have ever seen, thank you sir 🎩

[@drswapnil1234]

Amazing amazing amazing. I am an ophthalmologist whos starting on this surgery. Nothing could have been clearer than this video. Thanks a million

[@stephenlee2797]

Absolutely amazing step-by-step instructions with specific considerations. Many thanks on this video. I really don't understand people thumbing down a video that has an amazing content. More power to you doc ric!

[@riccaesar]

Dear Stephen. Many thanks! I think (I hope!) some of the thumbs down are for the low production costs - ie not professional quality sound etc etc. But - keeping the costs low keeps the videos totally free :) I really enjoy teaching and get great reward from people like you, who take time to make a kind comment. I appreciate it! Best wishes Ric

[@patriciap.553]

Brilliant video! Thank you so much for taking the time and explaining all the necessary steps! Great work!

[@rmkfranky]

Excellent presentation.👍 Loved the approach, sequence, different clinical scenarios, addition of browlift and the checklist.

[@beatrizvallejo5824]

Muchísimas gracias Dr Caesar, para mí es uno de los vídeos más detallados y explicativos que he visto

[@ralucakocsis609]

I have been searching a lot for explicit videos on the entire internet and this doctor and his channel are by far my favs! Keep up the good work and many thanks!

[@riccaesar]

Dear Raluca. I knew I liked you. :)

[@arwam9404]

Thank you..You are the best oculoplastic lecturer!

[@Jamalai]

Absolutely wonderful ! Thanks a lot sir for sharin' this great series of tips leading to a successful upper eyelid blepharoplasty ! Lookin' forward to watchin' new videos from you...

[@riccaesar]

Dear Jamalai, delighted you're finding the videos helpful, and that your patients then benefit - that's what its all about! Best wishes for all your surgery. Ric

[@DAVIDSANCHEZ-gw7je]

Great video! Thanks Dr. Caesar for providing excellent information and explanations. I learned a lot!

[@Drhilmi]

Awosome presentation Sir, this is the best instructive video ever on bleparoplasty ,your sketchings in video are keys for success.

[@jamalshaterian]

thank you dr caesar . an astonishing presentation. very helpful and informative.

[@susanbuenaventura4570]

Outstanding. Thank you so much for sharing your expertise and passion for blepharoplasty.

[@vijaykakkar9959]

Absolutely fantastic explanation. Wunderful teacher

[@boseemlc]

Overtly useful and great tips for good upper lid blepharoplasty, particularly the checkpoints.

[@anacabo976]

Indeed the very best video I've found on upper blepharoplasty marking!! I'm an Ophtho resident and this was super helpful. Thank you so much :)

[@riccaesar]

Hi Anacabo. Glad you like it! Please feel free to download and use in any of your own tutorials - spread the love :) Best wishes. Ric

[@ozguruslu5534]

I say as a doctor; Excellent knowledge and explanation. You are really fabulous. Very informative content. Thank you very, very much.👏👏👏

[@riccaesar]

Dear Ozgur, thank you indeed for taking the time to write - I'm delighted you find the video useful. Best wishes with your doctoring :)

[@ozguruslu5534]

@@riccaesar How polite of you to reply. Again 👏👏🙏

[@lehelm7834]

Thanks for sharing your experty. Congratulations for the nicely documented presentation. It was very relevant and I learnt a lot form it.

[@nin7464]

Perfectly explained step by step markings!

[@Sumkindamon]

Great channel and very helpfull videos! Big thanks and best wishes to you from Siberia, Mr. Caesar!

[@vilmasemini3432]

There are lots of Videos but this is totally something else. Perfect 💫👏🏻

[@lancebodily576]

Very thoughtful video! I’ve become a strong medial triangle excision proponent myself- it adds a bit more work but I agree it closes much more nicely and in patients that need a larger bleph and so have the wider angle you’re discussing I believe they benefit from some of the more medial tissue excision the medial triangle provides but the medial triangle allows the tissue removal in a safe manner instead of carrying the regular bleph flap medial to the punctum and risking webbing.

[@GurvinderSingh-cv9fq]

Very informative and detailed presentation... Thanks for sharing!!!!

[@yamyammaot]

Thank you for sharing the thought process dr.

[@taramedhurst216]

Very well presented and easy to understand, thankyou.

[@yoliegiraldo7540]

Thank you so much Dr🤩 Fantastic information 👌

[@muhammadaliiftikhar]

Brilliant video , absolutely loved it

[@sladajankovic]

You explained perfectly🤗🤗🤗

[@hasanadel8775]

Really love your videos

[@equestrianqueen601]

Dr. R.C. You voice is very soothing to hear. I’m coming relaxed now lol😂

[@martinmauad6341]

Muchisimas gracias por compartir sus conocimientos y experiencia! saludos desde Argentina.

[@shawnmcshlow9808]

great information, thanks so much Ric!

[@emanalshahwan7902]

Wonderful informative video. Thank you very much

[@hind6207]

Perfect way of illustration

[@coffee6174]

please always share tutorial clips like this /// thanks a lot doc

[@alikucukoduk3992]

Dear Sir, this is an excellent explanation and I sincerely thank you. I am using permanent markers 0.3-0.5 mm that are used for writing on CD's or acetate sheets for marking. The ink of these pens dry very quickly and you get a beautiful thin marking which does not disperse with blinking, nor they erase after skin disinfection. Thank you again for your excellent video.

[@riccaesar]

Dear Alikucukoduk. I have some of those markers! - I'll try your recommendation. Thanks for sharing. Best wishes. Ric

[@moayadification]

Always enjoyable to watch

[@joanamorimitsu5547]

Thank you, Dr.

[@neerajkanthwal]

You are truly a master teacher and agreat surgeon

[@draman2803]

Very well explained 👏

[@omardawood5573]

Thank you very much , superb

[@gayecamo5517]

Magnificent video.

[@miguelbarreiros2553]

Thank you very much for sharing!

[@stevenanandan]

Wonderful.Thank you very much. Do you have any good video on brow lifts?

[@riccaesar]

Hi Steven - I mostly use botulinum toxin for a subtle lift and refer most of my other brow lifts on to my plastic surgery colleagues for an endoscopic lift. I do the occasional pre-trichial lift, and rarely a direct lift, and will post one of those when I can. Best wishes, Ric

[@katarzynan.3714]

fantastic

[@alaidelustre1500]

Lovely vídeo, Thanks doctor

[@timonferro2300]

Thank you so much for this video!!!

[@drammansouri9153]

thanks dear dr Caesar

[@kahina0791]

Thank you very much

[@aysennnalar4854]

Thanks for sharing

[@salwaalzahawy1799]

Thank you very much for this amazing video

[@riccaesar]

You are most welcome! Best wishes. Ric

[@Yt_elisafann]

Thank u soo much i agree with all comments🙏🙏🙏

[@sempa1838]

I have also eye lid problem,,so I watch your video mostly so I really like the way you are explaining and your results,,first of all very proud of your great job and my question is my eye lid looks like swelling so I am very upset every day so I don’t want to change it,,so how it can be dangerous or it’s there any problem that we need to face in future???

[@selmamohamed1237]

Thanks for sharing this 🙏 Can you please do avidio on brow and lacrimal gland lifting..

[@atmdiary9940]

I want to have that surgery for my eyes someday, when I have lots of money. Thanks for this video Doc!!

[@user-sn1ft4dg8r]

Had mine 11 days ago. So far so good. Amazingly pain free.

[@chazmuska]

Did you get knocked out or did local anesthesia?

[@user-sn1ft4dg8r]

@@chazmuska Out. Twilight Sleep.

[@yeoo6973]

Thank you very much for this amazing tutorial!

[@apeiron1984]

mesure twice, cut once. great video sir.

[@canerkarakaya135]

Very nice video, i liked it

[@DrAyyappanThangavel]

You are an excellent teacher and surgeon, you remind me of Prof Andrew Burd.

[@ingridh.7420]

Is there any vedios about brow ptosis repair? In elder orientals,there are many cases encountered both brow and upper lid ptosis.And among these cases,if they asked a combined operation for correction of blepharoptosis with double eyelid,do you think brow lift is necessary? Otherwise,the post-op cases may have a unfriendly look,I think. Thank you so much,since you’re always so kind and nice for all my doubts!

[@riccaesar]

Hi Ingrid. The best techniques for brow lift are those that leave no scar. For a subtle brow lift, then neutralising the brow depressors with botulinum toxin is very effective, and a useful add to any blepharoplasty. For a more powerful brow lift - the endoscopic technique can be very effective, but this is a larger operation and more expensive. All direct lifts with excision of skin will leave a scar. This scar may be hidden by the hair if pretrichial, or by skin creases with careful placement, but there will always be a scar. For most cosmetic brow lifts, such a scar is unacceptable. Cosmetic trends apply, and lower, fuller brows are considered more youthful than thinner higher brows. I'd always discuss the brow position with my patients, but usually find a blepharoplasty with some botox the preferred solution. This is also very safe, as an endoscopic brow lift can still be done at a later date. Best wishes. Ric

[@anwaarmohamed9946]

Thanks alot

[@annamossakowska7575]

I wish I could watch this video before a made my upper eyelid blepharoplasty, or maybe my surgeon... Unfortunately he did not pay much attention to marking. He cut my skin above the natural crease which caused additional crease/wrinkle in my eyelid. It looks really bad. I hope it can be fixed.

[@jasonludlow8523]

Very helpful tutorial for the young Ophthalmologist, thank you for sharing Dr! One question, what would be the harm in taking a small medial triangle in all cases, even those with smaller angles?

[@riccaesar]

As a general rule - never do any surgery you don't need to do! Every additional cut is additional inflammation and scar. However I agree, unless you're certain that the patient doesn't need the medial triangle, it is, in my opinion, better to do it. Always annoying for the patient if you have to take them back for a trim. Bottom line - constantly audit your results, reflect on your pre-op decisions and aim for perfection every time. (but accept that none of us are perfect ). Best wishes. Ric

[@jasonludlow8523]

Thank you!

[@Skno289]

Perfect 👌

[@natuurlijkenmooi4365]

Gerat video! thans a lot

[@electroincexercises1091]

Whic country are you in Sir? u value the symetry and its somthing that many dont consider. My right eyelid need to be lefted

[@adelalraisi5159]

Amazing 👍👍👍👍

[@afify238181]

perefect dear pro. need another more section on brow left alone and with upper plepharoplasty . thanks dear 🌹

[@Alice-tq6bl]

Imagine your surgeon turning this on while performing the operation...lol

[@aquilanoncapitmuscas3372]

Thanks sir..

[@lindatran7385]

Dr, a very informative video with many examples, great job. I didn’t see any examples of Asian eyes with hooded eyelids. Should I only consider oculoplasty surgeons who have experience with Asian eyes?

[@riccaesar]

Hi Linda. That is a very sensible question. I live and work in Cheltenham, a very caucasian part of the UK, so inevitably the majority of my patients have been caucasian. Asian upper lids have a lower fat pad and a typically flatter and lower skin crease and do need the above markings to be adjusted. There are separate tutorials specifically on marking the Asian upper lid. Much depends on how "westernised" you want you upper lid to be. I would always recommend seeking out a surgeon with extensive experience in the exact surgery you want, see their before and after photos, and check you like them when you consult with them. Thankfully, most surgeons give a good idea of what they offer on their websites and posted videos, so you don't need to do endless consultations. Best wishes. Ric

[@masaoudsousak4475]

Great work

[@kumargera8733]

How much it cost upper eyelid for both eyes please

[@adedayoadio3676]

Can you do blepharoplasty on one side only

[@cursoresidentesusp1460]

Wonderful educational video! Thank you!

[@marceyoutubification]

i very like your class, I´m argentina, you speak, very good, for us, latin .with bad englis congratulations¡¡

[@adrianaalexis9186]

Excelent

[@SonHoang-rz9lo]

This is very very helpfull, can you give more and more the same video???

[@d0perfectnanki]

may I share your video on my social media account? Thanks dr Ric

[@riccaesar]

Hi, thank you for asking. Apologies for the delay in reply. Yes, I'm very happy for you to share this video. Best wishes Ric

[@sempa1838]

Hello how much it can be danger???

[@marziyefotouhi8517]

Great😊😊

[@topokore4148]

I want make this surgery.

[@smlesmle7800]

l can t find lidocaine instead Artinibsa 4% be used in blepharoplasty?

[@riccaesar]

Hi. I have no experience with articaine in the upper lid, but as it is widely used for dental and maxillofacial work I see no reason why it should not be a safe local anaesthetic. As ever with anything new, I'd recommend a full search of the available published evidence. PubMed is a valuable resource. Best wishes Ric

[@smlesmle7800]

@@riccaesar Thanks fortaking the time to write

[@eddieparin2965]

My wife is interested in both upper and lower blepharoplasty. Are you in N.J?

[@riccaesar]

Hi Eddie. I'm in the UK! Lots of great surgeons for you to choose from in the USA. I'd recommend looking until you find a surgeon your wife feels comfortable with, who does lots of blepharoplasty, and is honest about the risks and benefits. I'm sure your wife will be delighted. It's a great operation. Best wishes, Ric

[@niarika4151]

Sir, is upper blepharoplasty last forever??? Plz reply me

[@EatwithRehan]

Wow missing ❤

[@cahillmarian]

I had a blepharoplasty last November, they did not mark my eyes first and both eyes were done at the same time , now one of my eyes looks bigger than the other and there is still a lot of eyelid, I have been told they need to do the surgery again but I am afraid they will mess up and I will look worse

[@riccaesar]

Hi Marian. If you are at all nervous I would always recommend a second opinion. All surgeons sometimes have to re-operate to get a better result, but it is important that you are happy with all your communication and experiences. I'd write down all your questions and go through them with your surgeon one at a time and tick them off to ensure you are fully satisfied. If you have lost confidence in your surgeon, it is essential to have your re-do done by someone else. Hopefully your surgeon will take time to explain everything, and you will have a great end result. Best wishes. Ric

[@cahillmarian]

@@riccaesar thank you for getting back to me, sorry for late reply but have only just seen your message.

[@OriginalEye2072]

Medial triangle issue, Amy winehouse, Brow ptosis issue(botox is very useful), Pen is alway stronger than sword. -> Very Thank you for your videdo.

[@riccaesar]

Ha Ha. Great summary of important points! Thank you to you, and to everyone else who takes time to comment. I appreciate it. Best wishes. Ric

[@user-iv9qx9dv1e]

Ausgezeichnet arbeit!

[@riccaesar]

Vielen dank!

[@mohdewaje]

Sir I would like to express my sincere thanks for such a great demonstration. My 1st question: what is your opinion about temporal brow lift? 2nd question: in cases of asymmetric brow position, don't you think that performing upper blepharoplasty alone my affect future symmetry if brow ptosis get worse with aging. Thanks

[@riccaesar]

Hi Mohamed. I think temporal brow lift has a place but hiding the scar is the issue, and hairstyles can change. For question 2 - yes. Hopefully you'll improve the symmetry for now, but you may indeed want to offer more surgery as the ageing process continues. An upper bleph will normally last about 10 years. Best wishes Ric

[@mohdewaje]

@@riccaesar thanks a million And thanks again for your beautiful teaching oculoplastic series. ⚘⚘⚘⚘

[@hayleyjenkins7233]

How long does the procedure last

[@riccaesar]

Hi Hayley, typically 10 years. Most patients do it once in their mid fifties. It is however very safe to repeat, as the original scar is removed with the repeat. Best wishes. Ric

[@clairevalentine1192]

Dear Dr Caesar thank you for this wonderful and very informative tutorial. Have you thought of using a fine felt eyeliner for your surgical marking. They tend not to bleed on the skin.

[@riccaesar]

Hi Claire. I'd be delighted to try - is there a particular one you recommend?

[@clairevalentine1192]

@@riccaesar Good morning Dr Cesar yes I can recommend blinc ultrathin liquid eyeliner pen. It is excellent for makeup so I cannot see why it would not work for your surgeries. Funnily another I was just about to call your office to book a consultation with you. Hope to meet soon.

[@riccaesar]

@@clairevalentine1192 Look forward to it! I've just realised a potential problem with the eyeliner pen - it may contain micropigments that could be tattooed into the scar as the skin is cut. We are however constantly on the lookout for better surgical markers, as the bleed of the ink is quite annoying.

[@clairevalentine1192]

@@riccaesar ahh yes that really would be an unwelcome side affect!!!

[@shawkathassan7086]

Thank sir wonderful

[@MariaSydneyacww]

I had surgery 2 months ago and I can only close my eyes halfway. My eyes are open at night. He also removed all my fat, my eyes are hollow and I look sick. The reason I came to him was to remove a little skin on the outer corner. Now my eyes dont close and I look horrible

[@riccaesar]

Hi @MariaSydneyacww. Who was your surgeon? You need to see them again as soon as possible as your cornea can be at risk if you can't close your eye. Use maximal lubricants and gently stretch your upper lid down several times a day, but most important see your surgeon asap. They need to see you both to help, and to know what the results of their technique have been. I wish you the best of luck in your recovery. Ric

[@jenniferscheffel6020]

Excellent demonstration. I'm looking at surgeons in my area. Do you have advice on the best questions to ask a surgeon before surgery and how to select a surgeon.

[@riccaesar]

Hi Jennifer. For a blepharoplasty I'd always recommend an oculoplastic surgeon over a normal cosmetic plastic surgeon, as we train in the knowledge of how to protect the eye. (But there are also excellent plastic surgeons - I'm happy to admit my bias). The questions include - have you been struck off, are you being sued, have you been sued, what is your complication rate, how do you deal with complications, who do I call if something goes wrong. Vital to write out the "rude" questions into a list so you simply ask them all and tick off your list. No surgeon should be the least offended and should be able to answer each question honestly. Every good surgeon will eventually experience all the possible complications. The best surgeons can be sued. You're looking for honesty and someone you trust. Then ask around, word of mouth really matters, not just "reviews" on a website - speak to someone who has had that surgeon operate on them. Then when you meet your surgeon trust your instincts. They should be interested in exactly what bothers you, and how they can help, not just in selling you their service. Be prepared to see more than one surgeon before you choose. (although this can get expensive). Watch out for "free" consultations. A good surgeon should charge you for their time. In the UK, we always recommend a surgeon who also has an NHS post, as this means they have already won that position in open competition and have been fully trained. Take your time and I wish you all the best with any eventual surgery! Best wishes. Ric

[@jenniferscheffel6020]

@@riccaesar thank you for your thorough reply. I will absolutely make a list! There are only two Oculoplastic surgeons in my area (and I’m nervous about both of them from lack of reviews) I live in a relatively large city in the US. I think I’m going to have to search for surgeons outside of my area. Really appreciate your advice! And yes, I plan to pay for more than one doctor consultation before making such a big decision.

[@Sam-bn9vw]

Where are you based and what is the price range?

[@riccaesar]

Hi. For all those answers take a look at www.cosmeticeyesurgery.co.uk Best wishes. Ric

[@aliomran32]

Thank you prof.

[@jadaross3975]

the way the title says tutorial as if you can do this at home as a diy 😂😂😂

[@kailashpatel1706]

Is it possible to have a upper and lower lid blephharoplasty at same time?

[@riccaesar]

Dear Kailash. Very much so. It is quite a long procedure for the patient so some sedation or even full GA can be more pleasant than local anaesthetic alone. The overall level of bruising and swelling is also amplified and the recovery is longer than for either upper or lower blephs alone. Best wishes. Ric