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The following text and photos illustrate how I perform upper blepharoplasty surgery. The settings are specific to the ERBE ICC 80 unit and may not be directly transferable to another brand of electrosurgery unit.

  1. 1.

    Carefully adjust monopolar cutting cautery settings for each step (“Effect 2” setting used throughout).

  2. 2.

    Use a fine needle tip, such as a Colorado® needle or equivalent clone.

  3. 3.

    Continuously ice the side you are not working on (Fig. 32.1).

    Fig. 32.1
    figure 1

    Side not worked on continually iced

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  4. 4.

    Skin incision cutting mode 7. Incise gently and smoothly to avoid excess heat (Fig. 32.2).

    Fig. 32.2
    figure 2

    (a) Corresponds to incise gently and smoothly to avoid excess heat. (b) Corresponds to skin incision cutting mode 7

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  5. 5.

    Skin–muscle flap excision, coagulation mode 10 (Fig. 32.3).

    Fig. 32.3
    figure 3

    (a) Skin–muscle flap excision. (b) Coagulation mode 10

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  6. 6.

    ROOF fat sculpting, coagulation mode 15 (Fig. 32.4).

    Fig. 32.4
    figure 4

    (a) ROOF fat sculpting. (b) Coagulation mode 15

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  7. 7.

    Hemostats are used to hold gauze that secures ice over each eye (Fig. 32.5). This prevents ice from falling. Only the lower hemostat is moved to switch eyes.

    Fig. 32.5
    figure 5

    Hemostats are used to secure gauze over each eye

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  8. 8.

    Use of a tapered needle prevents orbicularis bleeding with closure (Fig. 32.6).

    Fig. 32.6
    figure 6

    (a, b) Use of a tapered needle prevents orbicularis bleeding with closure

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  9. 9.

    Early postoperative photos (Fig. 32.7).

    Fig. 32.7
    figure 7

    Early postoperative photos

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