Hybrid Blepharoplasty is Dr. June Favarin’s anatomy-based method for selecting eyelid, brow, midface, volume and skin treatments without assuming every component is necessary. The central decision is diagnostic: determine whether heaviness or hollowing comes from skin excess, brow position, true ptosis, fat prominence, volume loss, midface descent, edema or skin quality.
“Hybrid” means selective, not maximal
A combined plan should solve diagnosed problems without treating normal anatomy. Removing additional skin, muscle or fat can deepen the eyelid, expose the lower lid, change expression or impair closure.
| Concern | Possible source | Planning consequence |
|---|---|---|
| Heavy upper lid | Skin, low brow, ptosis or frontalis compensation | Assess brow and eyelid function first |
| Under-eye bag | Orbital-fat prominence | Preserve, reduce or reposition selectively |
| Tear-trough shadow | Volume transition, ligament or bone | Do not assume fat removal is the answer |
| Dark circle | Pigment, thin skin, vessels or shadow | Separate surface treatment from surgery |
| Lower-lid swelling | Malar edema, festoon or filler | Clarify the diagnosis before surgery |
Upper-eyelid planning starts with function
The examination reviews eyelid closure, dry-eye symptoms, contact-lens use, previous ocular surgery, brow position and frontalis activity. A low brow can mimic eyelid excess. Botox may reduce frontalis compensation and reveal that relationship, so recent neuromodulator treatment should be documented.
Dr. June generally removes only the required skin and preserves the orbicularis muscle. Randomized studies have not shown a consistent dry-eye advantage for muscle preservation in otherwise healthy patients. The rationale is broader: retain functional tissue, avoid unnecessary hollowing and preserve familiar expression. Pre-existing ocular-surface disease still changes risk and may require ophthalmologic evaluation.
When true ptosis is present
True ptosis reflects eyelid-elevator dysfunction rather than excess skin. Selected mild cases may be candidates for a conjunctivo-Müller approach, while other patterns require different repair. Blepharoplasty alone cannot correct an elevator problem.
Lower-eyelid surgery should preserve support
When orbital fat requires treatment, Dr. June uses a transconjunctival bi-incisional approach to access the three compartments selectively. Fat may be preserved, reduced or repositioned according to the lid-cheek relationship. The objective is not to empty the orbit.
Prospective randomized evidence comparing transconjunctival techniques confirms that approaches to fat and the tear trough have different operative and maintenance profiles. It does not establish one method for all anatomies. Lower-lid tone, ocular vector, globe prominence and previous surgery remain central to selection.
Canthopexy with absorbable support may be added when examination indicates greater lower-lid stability is needed. Routine use is not a substitute for assessing support.
The brow and midface are separate decisions
If brow descent drives upper-lid heaviness, removing more eyelid skin treats the consequence. Video-assisted brow surgery may be considered according to forehead height, hairline, brow shape, frontalis activity, asymmetry and the desired degree of change.
Midface descent can deepen the lid-cheek junction, but video-assisted elevation is not required for every tear trough. Volume loss, bone, orbital fat, edema and filler can create similar shadows.
Microfat, nanofat and resurfacing have different jobs
Microfat can restore selected structural hollows in the A-frame, temple or lid-cheek transition. Retention varies. Nanofat may be used superficially for selected skin-quality indications; it does not lift tissue or provide reliable structural volume.
CO₂ laser, radiofrequency, peels and other dermatologic treatments address selected surface concerns. Skin type, pigment history, previous treatment and acceptable downtime influence the choice. Combining resurfacing with surgery may increase swelling.
Previous injectables may change the diagnosis
Hyaluronic-acid filler can contribute to fullness or edema years later. Biostimulators, threads, permanent products and energy devices may alter planes. Dermatologic ultrasound may locate material or fibrosis when examination and history are insufficient. Hyaluronidase acts on hyaluronic acid, not PMMA, silicone, biostimulators or fat, and complete reversal cannot be promised.
Risks, warning signs and recovery
Potential complications include bleeding, infection, chemosis, dry eye, blurred vision, asymmetry, incomplete closure, lower-lid malposition, visible scars, sensory changes and revision. Double vision, severe pain, sudden visual reduction or rapidly increasing one-sided swelling requires urgent assessment.
Swelling often peaks during the first 48–72 hours. Bruising, tearing, tightness and edema-related asymmetry may persist for one to two weeks. Residual swelling and scars mature for months. Brow, midface, resurfacing or facelift procedures lengthen recovery.
Planning from abroad
Remote screening can begin the process, but the plan is confirmed after in-person eyelid and ocular assessment. Surgery is performed at Hospital São José. The Belvivere Concierge assists with transport and accommodation; clinical follow-up and flight clearance remain medical decisions.
Read the main Hybrid Blepharoplasty page and the guide to swelling after blepharoplasty.
Primary clinical sources
- Upper blepharoplasty with or without orbicularis removal: randomized trial
- Orbicularis-sparing versus excising upper blepharoplasty: randomized trial
- Transconjunctival lower blepharoplasty techniques: randomized study
This article is educational and does not replace individualized medical or ophthalmologic evaluation.
