Oculoplasty | IOA Madrid

Treatments > Oculoplasty


Oculoplasty surgery deals with both functional (diseases on the eyelids) and aesthetic alterations that may appear around the eyes, eyelids, eyebrows, etc,

The eye contour is the most delicate and fragile area of the face. It requires our attention because age, fatigue and stress leave their mark on it in different ways which range from rungs under the eyes to crow's feet, bags and swelling of the eyelids.

The Oculoplasty Department of Miranza IOA Madrid is also responsible for treating anomalies located in the lachrymal ducts and dry eye.


Botulinum toxin

Visible results from the first session. With the exclusive and personalised care that characterises Miranza IOA Madrid.

The botulinum toxin is know for its relaxing effect on muscles, which makes it one of the "stars" of rejuvenating and beauty treatments. Our surgeons use it to attenuate expression lines caused by the passage of time and to smoothen annoying and unsightly wrinkles.

This is achieved by relaxing in a controlled manner some of the muscles responsible for facial expression, achieving a younger and smoother look. It is important to point out that the action of the botulinum toxin lasts for a few months and has to be applied periodically depending on each person (if he/she gesticulates a lot or not). The side effects may include a small haematoma and on some occasions, slight asymmetries that are corrected with a retouch.

Likewise, this drug can be used to treat certain diseases. In this regard, by applying the botulinum toxin in a controlled way it is possible to treat essential blapherospasm, a disease in which the eyelids close suddenly and unintentionally.



Out of all the microsurgical techniques used in Oculoplasty, blepharoplasty is the most frequent, as this treatment eliminates the "bags" of the eyelids or dropped eyelids.

The procedure consists of extracting the fat at the same time as the excess skin and muscles of the upper and lower eyelids. The surgery can correct the separation of the upper eyelids and the bags of the lower part of the eyes, traits that can make a person look older and more tired that what he/she feels, and in some cases can even interfere in the vision.

This procedure, however, does not eliminate the wrinkles or the so called "crow's feet"; it hardly eliminates the dark circles under the eyes nor lift dropped eyebrows, as this is solved with other techniques.

The operations are carried out in the operating rooms of Miranza IOA Madrid, with local anaesthetics and under sedation, which allows the patient to be awake although very relaxed and not feel any pain.

Periocular wrinkles may also be treated by injecting botulinum toxin in strategic points of the periocular region, significantly smoothing the wrinkles without reducing the expressiveness of the face.


Orbit and eyelids

Regarding aesthetic problems, the passage of time, together with external factors such as cold weather, intense sunlight, very dry atmospheres caused by air-conditioning or heating systems, causes a deterioration of the skin's structure that shows specially on the face, and mainly on the eyelids and eye contour, conferring our face a sand and tired appearance.

This deterioration can be retarded with cosmetic treatments, although there are some signs, like the known "crow's feet", "bags" on the eyelids and changes of shape and position of the eyebrow that require small surgical operations to be corrected, that are increasingly demanded by both men and women, with the aim if improving their appearance, to solve:

Aesthetic problems in the periocular region.

  • Periocular wrinkles ("crow's feet").
  • After-effects of previous cosmetic surgery (palpebral retraction, dry eye syndrome, etc.).
  • Alterations of the anophthalmic cavity.
  • Palpebral anomalies associated to the anophthalmic cavity.
  • Laxity of the eyelids, drop of the lateral edges.


Dry eye

The tear secretion usually decreases with age. Dry eye is a multifactor disease of the tear film and the eye surface that causes symptoms of discomfort, visual disorders and instability of the tear film, with potential damage on the eye surface. It is accompanied by an increase of tear osmolarity and inflammation of the eye surface.

It can be due to the lack of tear secretion (hyposecretor dry eye), as happens with some immunological diseases, hormonal factors or with age, among many other causes, or due to a bad quality of the tear (evaporative dry eye), due to local alterations such as blepharitis or allergies, among others, which are also affected by environmental factors, such as heating systems, air-conditioning, working in front of a screen, etc.

Dry eye is the most frequent pathology in our consultations, as it produces a wide and varied combination of symptoms that alter the patient's quality of life and work performance.

For an appropriate diagnose it requires a good examination and identification of the symptoms and circumstances, and specific tests among which are analysis of the tear osmolarity, essential to identify the type of pathology, severity of the affectation of the eye surface and underlying illnesses.

The treatment for dry eye will be specific for each patient and situation, and ranges from the use of tear substitutes (artificial tears), the implant of plugs in the tear duct or the correction of the secretion of the glands at the edge of the eyelid by means of steam goggles, to the use of anti-inflammatory drugs or revitalising serums extracted from the patient's blood (autologous serum).

This pathology should not be trivialised, because in addition to the frequency in which it appears and the deterioration of the quality of life of the patient, may be the tip of the iceberg of endocrine, hormonal and especially autoimmune diseases, the early diagnose of which is the essential.


Tear ducts

The obstruction of this duct is one of the frequent causes of tearing and eye infections. The solution to these obstructions is always surgical. The most used techniques to solve this problem are detailed below:

  • Temporary intubation of the tear duct. Used in cases of partial obstruction.
  • Dacryocystorhinostomy consists in the creation of a new duct to take the tear from the tear points of the eye to the nose overcoming the existing obstacle. It can be performed with an external or transcanalicular approach with diode laser (DCRTC).
  • Dacryocystectomy Consist in removing the lachrymal sac, obstructed and usually infected, and the performance of a Dacryocystorhinostomy has been contraindicated. 

DCRTC is a very fast technique, almost painless and minimally invasive, that enables re-channelling the tear duct without having to make incisions in the skin and that significantly lowers the surgical risk and the discomfort of conventional surgery. It consists in opening a communication between the lachrymal sac and the nose with a laser probe of 600 microns that is inserted through the canaliculi with nose endoscopic control, thereby achieving for the eye to stop tearing and causing infections, with minimum discomfort for the patient.


Periocular rejuvenation

The periocular region, the eyes and the structures around them (eyebrows, eyelids, corners) is the part of the face that receives most attention and constitutes one of the axes of our expression and is also one of the main mirrors of premature aging. This area experiences changes as years pass, as well as due to genetic and hereditary conditions, that may include:

  • Increase of the periocular lines of expression ("crow's feet" wrinkles between the brows, etc.).
  • Presence of bags on eyelids.
  • Excess and loss of hair on eyelids (droopy eyelids).
  • Drooping of the eyelid itself (ptosis).
  • Drooping of eyebrow.

Compared to other specialists, ophthalmologists have the enormous advantage of knowing the anatomy, physiology and surgery of this area.

The presence of one or several of these alterations makes the eye look older, gives the impression of being tired and "abandoned" that do not correspond to the person's actual situation.

Unfortunately, these changes are progressive and irreversible, unless we take action.

1. Surgical treatments:

In the case of having bags, drooping of the skin and eyelids, the only effective and definitive solution is to perform a series of simple surgical procedures to help restore the harmony of this area naturally and elegantly. Fortunately, the new trend in cosmetic surgery is to achieve the results desired by the patient with minimum procedures; this implies for these minimum procedures to be performed safely and effectively on an outpatient basis and under local anaesthetic, with very short recovery periods, and above all with safety and effectiveness.

The correction of the upper eyelid can be performed in less than one hour, with local anaesthetic and without any discomfort for the patient. The results are evident and almost unnoticeable only a few days later.

Likewise, the correction of bags implies small operations, fast and simple with notable results. Depending on the degree of deterioration, the surgery to correct bags can be done through the conjuntival route without skin incisions or, in cases of skin laxity, a fine incision can be made under the line of the eyelashes that will soon be unnoticeable, and a subjection of the lateral edges may be necessary to prevent problems in that area or difficulties when closing.

It is important to point out that to try and achieve these results and facilitate the surgical technique; a prior preparation is required, simple and easy, with the aim of minimising the stigmas of the operation, such as the inflammation and haematoma. That is why we recommend the use of certain products that prevent the formation of haematomas and moisturise and strengthen the skin at the same time. Once the operation has concluded we recommend basic care to accelerate the recovery, which includes applying anti-inflammatory products, manual lymphatic drainage and sun protectors.

In this regard it is important to insist that our objective as surgeons when performing those corrections is to maintain the patient's personal expressivity, without exaggerated or remarkable changes, yet only improve and optimise the appearance, restoring the joviality, joy, freshness and naturalness of the area.

2. Treatments without surgery::

  • Fillers.

Over the years, the skin and tissue around the eyes loses smoothness and elasticity. This causes for the fatty tissue beneath the eyeball to prolapse forward, causing the known periocular bags.

Furthermore, many patients, especially young ones (between 30 and 40 years old) complain about having "bags" or "dark circles", when what they really have is a deformity of the soft tissues called orbito-malar furrow or "valley of tears". It is the line that separates the lower eyelid from the cheek.

This sinking can be corrected by injecting fillers, especially hyaluronic acid or collagen. They are both molecules that are naturally present under the skin yet they are lost over the years. By applying it strategically we achieve several objectives:

    Visibly smoothen the lack of volume between the nose and the bags to prevent optic effect of their increase.

    Stimulate the lymphatic drainage of the area.

    Avoid the shadows that usual lights cause on the lower area of the eye when there are prominent "bags", which often make the area look darker.

This procedure is performed with only one or two pricks through fine round-point microcannulas that do not cause trauma in this sensitive area, thereby avoiding haematoma and the patient can incorporate immediately to his/her daily life. It is carried out at the clinic in just a few minutes and it is not at all painful; its effect lasts between 8 and 12 months.  

And it is only contraindicated for patients with a background of eye herpes or keloid formation.

  • Butolinum toxin.

It is a drug that is injected in very small doses into specific muscles of the face to improve the expression wrinkles. It changes the muscular dynamic achieving a more rested and relaxed look. The treatment is carried out at the clinic and is totally individualised according to the needs and capacity to move certain muscles of each patient. The effects appear in a few days and last for 6 to 8 months.

The butolinum toxin has been used in medicine for more than 30 years. Its cosmetic use started more than ten years ago, with very broad safety profile. The highest risk, when the patient is not treated by an expert doctor, is the drooping of the eyelid. It is a temporary effect that lasts for three or four weeks. The best way to prevent it is to have a good knowledge of the anatomy and of the disorders of the periocular area.

The wrinkles between the eyebrows can be treated in this way, as well as "crow's feet", expression lines on the forehead and some facial asymmetries.

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