Hybrid Blepharoplasty is not a fixed combination of procedures. It is Dr. June Favarin’s preservation-based framework for deciding which structures around the eye should be treated—and which should be left alone.
The diagnosis includes more than eyelid skin
An apparently tired eye may reflect upper-eyelid skin excess, brow descent, true ptosis, lower-eyelid bags, lid laxity, hollowing, pigmentation, malar edema or festoons. Several causes can coexist. Removing more tissue does not compensate for an incomplete diagnosis and can create hollowing or functional problems.
| Finding | Selected component | Important limit |
|---|---|---|
| Measured upper skin excess | Minimal skin removal with orbicularis preservation | Does not lift a low brow or repair true ptosis |
| Mild selected ptosis | Conjunctivo-Müller correction | Requires functional eyelid assessment |
| Lower bags | Transconjunctival access to the three fat compartments | Does not treat festoons or pigmentation |
| Lower-lid laxity | Selective canthopexy | Not routine for every patient |
| Periorbital hollowing | Microfat in selected planes | Retention varies; excess volume can look heavy |
| Superficial skin concerns | Nanofat or selected dermatologic treatment | Does not replace structural surgery |
Upper-eyelid preservation
The upper eyelid is evaluated together with eyebrow position and frontalis compensation. Dr. June generally preserves the orbicularis muscle and removes only the amount of skin supported by examination. This helps protect eye closure, volume and expression. A low eyebrow or ptosis should not be treated by excessive skin removal.
Lower-eyelid strategy
Dr. June generally favors a transconjunctival, bi-incisional approach to reach the three lower-eyelid fat compartments without a routine external incision. Fat can be preserved, selectively adjusted or complemented with microfat according to the lid–cheek transition. Canthopexy with absorbable support is used selectively when lid stability requires it.
This approach does not mean that lower-eyelid surgery is risk-free. “No external incision” also does not mean “no scar,” because internal incisions heal and additional skin treatment may still be appropriate.
Microfat, nanofat and skin treatment
Microfat provides structural volume to selected areas such as the A-frame, tear trough or lid–cheek junction. Nanofat is more finely processed and used for selected superficial goals; it does not create lift or structural filling. CO₂ laser, Morpheus8 or other dermatologic treatments address different aspects of skin quality and are not mandatory components.
Previous injectables matter
Hyaluronic-acid filler, biostimulators, threads, PMMA, silicone and previous energy treatments must be disclosed. Filler can persist and contribute to edema, but it should not automatically be dissolved. Dermatologic ultrasound may identify product, location and tissue response when history or examination is uncertain.
Risks, recovery and warning signs
Swelling, bruising, tearing, dryness, sensitivity to light, temporary blurred vision from ointment and early asymmetry may occur. Risks include bleeding, infection, chemosis, lagophthalmos, visible scars, lid malposition, persistent dryness, diplopia, fat-graft irregularity, pigment changes and the rare risk of visual loss.
Sudden pain, rapidly expanding swelling or a change in vision requires emergency evaluation. Most patients become progressively more presentable during the first weeks, but edema, scars and fat-graft integration evolve for months. See the guide to blepharoplasty recovery.
Planning for international patients
The preliminary plan begins remotely and is confirmed after examination in Brazil. Surgery is performed at Hospital São José when appropriate. The concierge service supports accommodation and local logistics, while medical follow-up determines recovery and travel clearance.
