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Topic 9 - 5
KISS: A Sensible Approach
to Blepharoplasty
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"Simplicity is the ultimate sophistication."
- Leonardo da Vinci

"Simplicity is . . . not simple."
- Jonathan Ive, Chief Designer, Apple Inc.


The "KISS" in KISS Blepharoplasty has nothing to do with those bite-size pieces of chocolate wrapped in foil, a tender meeting of the lips, or the heavy metal band from the seventies. It's a reference instead to a principle widely revered in science, technology, and business that states that simplicity of design should always be a goal, while nonessential complexity is best avoided.

Or, to say it more directly, "Keep it Simple, Stupid!"

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But why? Is there something wrong with complexity?

No, there's nothing inherently wrong with complexity per se, just as long as it's really required. Think back to Rube Goldberg's cartoons of those wildly complicated "non-KISS" machines, ultimate examples of complexity created just for the heck of it.

So what does this have to do with blepharoplasty? Just ask any experienced revision expert who provides care to patients unhappy with their results and you'll hear the same answer.

While improper execution of an operation by the first surgeon is typically the primary cause of many mishaps, a common and major contributing factor is often poor judgment in the very selection of the procedures that were undertaken.

Most surgeons like to think of themselves as practicing at the forefront of their specialties by offering only the latest and greatest. Despite increased invasiveness, surgical difficulty, or lack of a long-term track record, some new procedures become quickly touted as superior replacements for more reliable and less destructive techniques.

A related form of misjudgment is simple overkill -- employing multiple procedures when a single procedure would work as well or even better.

Antoine de Saint Exupéry, author of The Little Prince, noted that "It seems that perfection is reached not when there is nothing left to add, but when there is nothing left to take away (in this case, referring to the number of operations, not remaining eyelid tissue!)."

In many cases, doing less is actually more, while doing more is not only superfluous but an invitation for trouble if not disaster.

Throwing everything but the kitchen sink at a common problem with a straightforward fix can result in delayed healing, an artificial appearance, higher rates of both immediate and late-term complications, not to mention increased costs.

To be clear, the concept of simplicity as used here is by no means synonymous with the least invasive or least challenging methods, which often achieve little. For simpler to succeed, a surgeon must possess a deep understanding of both the problems at hand and all remedial methods and then devote an almost fanatical level of attention to even the smallest details to, in essence, extract more improvement out of each and every step along the way, doing no more or no less than is needed.

As Albert Einstein observed, "Everything should be made as simple as possible, but not simpler." In other words, while simplicity for the sake of simplicity alone is not the goal, unnecessarily complex solutions should be shunned.


It may come as a surprise to some to learn that practicing such simplicity demands a very high level of expertise, a good reason for patients to be more selective about choosing a surgeon than most are. After all, it takes a lifetime of dedication and practice for a master Zen calligrapher to learn to create art in just a few strokes.

Of course, some patients do indeed have anatomical conditions that require unusually aggressive or multiple procedures. However, the large majority do not. In the end, the number and complexity of procedures performed correlates poorly with the quality of the result.

Careful selection and skilled execution matter much more.

Next: The $21,000 Eyelid Lift

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