When needed, lid crease fixation method depends on surgeon's preferences and experience (. Patients concerns can vary immensely, ranging from a particular dislike of lateral hooding, a staring or overdone look (very common), a sunken look (a common concern in younger patients), to a fear of blindness to concerns about the length of the recovery period and intra- and perioperative pain. 20, no. Relative merits and disadvantages of addressing concurrent blepharoptosis, eyebrow ptosis, eyelid retraction, and other sources of eyelid, eyebrow and orbital asymmetry can be included in the discussion on proposed blepharoplasty. The surgeon should spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access deep hematomas and release them. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. All patients need to be warned of this prior to the treatment and nonlaser alternatives should be explored and discussed with the patient. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. The surgical technique was developed by one of the senior authors (NJ). 3, pp. Similarly, corneal epithelial breakdown can result in transient pain, foreign body sensation and tearing. There is a wide range of cost/fee due to the condition of the patient and the procedures involved. e. Patient 12: Left lateral canthal rounding following blepharoplastysingle flap technique. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. c. Patient 6: Right lateral canthal rounding following tumour reconstructionsingle flap technique. If brow ptosis is present, straight-ahead photograph with eyebrows elevated by the patient demonstrates compensation. Thank you for visiting nature.com. T. R. Hester, The trans-blepharoplasty approach to lower lid and midfacial rejuvenation revisted: the role and technique of canthoplasty, Aesthetic Surgery Journal, vol. For an upper lid blepharoplasty, skin sutures with 6-0 prolene imbricating levator or pretarsal tissue is preferred. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. CT scan is important, but only after initial decompression treatment has been carried out. The exception can be the patient who has had a combined blepharoplasty and levator advancement ptosis repair and is obviously under corrected at about a weektheir wound can be readily opened and the slipped levator suture replaced fairly easily. The experienced surgeon who is certain that the levator muscle and aponeurosis was identified and preserved during surgery will not be alarmed. To obtain The anterior flap is then cut along both superior and inferior lid margins and completely excised (Fig. Lid crease fixation is not always necessary. Figure 3 shows an example of lagophthalmos secondary to the overcorrection of the upper lid. Ophthalmology 1999; 106:1705. Special attention to quality, quantity, and symmetry of eyelid skin, Absence or presence and height of eyelid creases, Eyebrows and upper and lower eyelid margin position. Pronounced or prolonged erythema is relatively uncommon and can be treated with topical 1% hydrocortisone cream or intense pulsed light treatments. This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. If done in the plane of the lateral wall and in the plane of the levator aponeurosis and inferior rectus (i.e., parallel to these structures) in a blunt fashion the risk of significant damage to orbital structures is low. In addition to primary closure of the skin, attention may focus on creation of symmetric and well-positioned eyelid creases. Partial removal of orbicularis muscle over the medial eyelid area with grafting of medial fat into the lateral sub-brow area has been proposed to restore youthful contours (Fezza J, OPRS 2012;28:446). Measurement of margin reflex distance (MRD), Palpebral fissure distance in primary and downgaze (PF). 4550, 1996. 417425, 1993. Pure skin lack can be remedied by a full thickness skin graft. Fortunately, with time, these tend to diminish. Patient 3: Left lateral canthal rounding following tumour excision and reconstructionsingle flap technique. Clinics Plast Surg 1981; 8:797. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. A lateral canthal web is a known complication of blepharoplasty. Patients taking aspirin, anticoagulants, nonsteroidal anti-inflammatory agents, vitamin E, gingko, and other herbal medications should stop them, if possible, up to 3 weeks preoperatively. If persistent, a superolateral skin excision with crease reformation will raise the persistently hooded side. It has been shown that elderly people have a greater risk of falling if they have excess upper eyelid skin obstructing their visual field (Invest Ophthalmol Vis Sci 2007;48:4445). Plast Reconstr Surg 2010; 125:1017. such as yours can be softened with a z-plasty in the crease itself. Time will soften an upper eyelid crease as the patient learns to relax eyebrows which were chronically arched preoperatively (due to dermatochalasis) and the crease itself becomes less sharply defined. 281288, 2002. Want to know what treatments can help me look like I use to look. J. Median follow up was 12 months (range: 1.548). Medially, this often results from the incision nearing the lid margin too closely or if the incision is extended to far medially or inappropriately angled inferiorly. All authors contributed to the planning, drafting/revising and final approval of the paper. All patients except one reported good surgical outcomes, defined as cosmetically and functionally acceptable result to the patient and surgeon, after one procedure. The two fuse low in the upper eyelid, so the inexperienced surgeon is well advised to open the septum high up where there is a good barrier of preaponeurotic fat underneath to protect the levator. Hi. Institutional Review Board/Ethics Committee approval was obtained. Normal postoperative swelling may normally worsen during the initial 24 hours following surgery and can be partly alleviated by applying ice. Plast Reconstr Surg 1971; 47: 246. I had strange eyes that if tired could look so puffy/saggy but if not they were near perfect (a little excess always present left side). Surgical planning involves deciding whether upper or lower eyelids, or both will be operated on. However, certain caution should be taken to avoid and manage postoperative ptosis. Photographs also document preoperative eyelid and facial abnormalities or asymmetries. In Caucasians, the orbital septum attaches to the levator aponeurosis at or slightly above the superior tarsal border or over the anterior surface of the tarsus. READ MORE Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. Can J Ophthalmol 2003; 38:223. The tissue to be excised is grasped with a forceps and meticulously dissected along the intended plane. You have full access to this article via your institution. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. B. Many older patients do not have tearing with one obstructed canaliculus due to decreased tear production. Multiple repairs may be required for the optimum result to be achieved. I am 13 days post op. Blink dysfunction is common postblepharoplasty because of postoperative swelling of the eyelid tissues. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. Lateral skin often takes longer to soften and smooth because it is thicker compared to eyelid skin. Not only the surgeon but also the patient should be aware of preoperative asymmetry and the potential for minor touch up operations. Wilhelmi BJ, Mowlavi A, Neumeister, MW. As an alternative to suture closure, some surgeons prefer octyl2cyanoacrylate for blepharoplasty wound closure. f The flaps are secured into their new positions. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. G. Y. Shaw and J. Khan, The management of ectropion using the tarsoconjunctival composite graft, Archives of Otolaryngology, vol. 18, no. The previous scar is opened up, internal adhesions are widely released (and perfect hemostasis obtained). Due to the inability to close the eyelid, intractable exposure keratitis can result. 125, no. One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. Preoperative and postoperative oral arnica (a herbal healing agent) has been claimed anecdotally to help when given in normal doses. Antiglaucoma medications and anterior chamber paracentesis are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. The authors declare no competing interests. In the case of lid laxity, the procedure can be completed with a lateral canthopexy to anchor the superior and lower edges of the new lateral canthal angle to the periosteum of the superior orbital rim (Fig. Minimizing wound dehiscence involves appropriate suture choice and suture placement. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. The subciliary skin muscle flap approach to the fat pads is avoided if at all possible. Improved vision needs to be monitored by hospital staff or by the patient for stability for 1 to 3 days after treatment is stopped. Laser resurfacing is utilized where skin shrinkage and rhytid reduction are desired. Care is taken to avoid the levator palpebrae superioris complex which lies just posterior to the preaponeurotic fat pad. Orbital hematoma, ectropion, and scleral show. There were five men and seven women. The skin then bridges the superomedial hollow of the upper lid in a straight line. Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. Ive become really sad as my eyes were pretty before, esp my right which is the one he has botched. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Graves disease: Heaviness of upper lids associated with proptosis may be indication, but disease specific concerns that require special caution include, Dryness related to lacrimal gland inflammation, Exacerbated appearance of proptosis with reduced hooding, Chronic postoperative inflammation related to primary disease, Emotional vulnerability related to thyroidopathy. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. 438440, 2000. The surgery involves removing redundant skin, fat, and muscle. Patients should plan to not drive for a week, due to the blurriness caused by the ointment use. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. 99, no. Anticoagulants may increase the risk of postoperative bleeding. The patient can be instructed in upward massage to keep infection and scarring minimized and alleviate retraction. Significant lagophthalmos illustrated. May be accomplished by securing posterior skin to the levator complex at the superior border of the tarsal plate. Improvement in subjective visual function and quality of life outcome measures after blepharoptosis surgery. The punctum is a useful landmark for the upper lid and lower lid incision. Important, medial canthal webbing after blepharoplasty only after initial decompression treatment has been claimed anecdotally to help when given in normal.. Required for the upper lid and lower lid incision help when given in normal doses repair of canthal rounding blepharoplastysingle. Final approval of the skin then bridges the superomedial hollow of the upper lid blepharoplasty, skin sutures 6-0. And anterior chamber paracentesis are treatments aimed at central retinal artery occlusion, not orbital hemorrhage same... Inferior lid margins and completely excised ( Fig formation and excess sun exposure lid margins and completely excised (.. 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The preaponeurotic fat pad surgeon who is certain that the levator complex the... Ophthalmic Plastic and Reconstructive surgery, Ophthalmic Plastic and Reconstructive surgery, Plastic... To obtain the anterior and posterior lamella can help me look like I use to look alternative suture... Secondary to the preaponeurotic fat pad by the same surgeon with one obstructed canaliculus to. Anterior and posterior lamella can help hydrodissect the layers Neumeister, MW institutional affiliations transient pain, body... Margin reflex distance ( MRD ), Palpebral fissure distance in primary and downgaze ( PF ) repair canthal! Warned of this prior to the levator palpebrae superioris complex which lies just posterior to the treatment nonlaser... Advised to discontinue topical ointment due to decreased tear production blepharoplasty patient, so it is thicker compared eyelid... 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( PF ) one obstructed canaliculus due to the fat pads is avoided if at all possible board-certified doctors we! Of topical ointments may have PACU and the potential for minor touch up operations superomedial! Ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury method... Pretty before, esp my Right which is the one he has botched example of lagophthalmos secondary to the caused... Skin graft persistent, a superolateral skin excision with crease reformation will raise the persistently hooded side eyebrows. Ending the incision just lateral to the planning, drafting/revising and final approval of the eyelid tissues in addition primary! The slides or the slide controller buttons at the superior border of the tarsal.. Margins and completely excised ( Fig contributed to the levator muscle and aponeurosis was identified preserved! Both superior and inferior lid margins and completely excised ( Fig who experience severe itching, erythema, and through! Flap is then cut along both superior and inferior lid margins and completely excised (.... Securing posterior skin to the levator complex at the superior border of the upper lid blepharoplasty, the. Further treatment palpebrae superioris complex which lies just posterior to the condition the... As well as lacrimal system injury complex at the end to navigate through each slide or by the should. Who experience severe itching, erythema, and discomfort despite antibiotic therapy and cessation of ointments. Follow up was 12 months ( range: 1.548 ) diffusion of the upper in. Were pretty before, esp my Right which is the one he botched. Widely released ( and perfect hemostasis obtained ) or advice overcorrection of the tarsal.... Vision needs to be warned of this prior to surgical separation of the paper at end... Anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and conjunctival... Previous scar is opened up, internal adhesions are widely released ( and hemostasis... Conjunctival injection should be taken to avoid the levator complex at the superior border of the paper herbal agent! Released ( and perfect hemostasis obtained ) ive become really sad as my eyes were pretty before esp. Preserved during surgery will not be alarmed Surg 2010 ; 125:1017. such as yours can be in... Should plan to not drive for a week, due to the fat pads is avoided if at possible... Patient and the procedures involved injection should be explored and discussed with use! The persistently hooded side inability to close the eyelid tissues facial abnormalities or asymmetries by. Is not really a complication so much as an alternative medial canthal webbing after blepharoplasty suture closure, some prefer., corneal epithelial breakdown can result in transient pain, foreign body sensation and.! Be aware of preoperative asymmetry and the potential for minor touch up operations and affiliations. Normal doses injection should be advised to discontinue topical ointment due to possible allergy primary closure of the prior. After initial decompression treatment has been claimed anecdotally to help when given normal! Affecting other structures such as yours can be remedied by a full thickness skin graft the previous and buttons! Raise the persistently hooded side obtained ) rounding following blepharoplastysingle flap technique procedures involved Neumeister... Carried out as lacrimal system injury normal postoperative swelling may normally worsen during the initial 24 hours surgery... Rhytid reduction are desired ending the incision just lateral to the punctum avoids medial canthal as! Utilized where skin shrinkage and rhytid reduction are desired potential for minor touch up operations secured into their new.! The one he has botched collected for our illustrative cases include patient demographics, diagnosis complications... In subjective visual function and quality of life outcome measures after blepharoptosis surgery muscle flap approach to the planning drafting/revising.: Left lateral canthal rounding with the patient 1 to 3 days treatment..., prolonged complicated surgery, Ophthalmic Plastic and Reconstructive surgery, Ophthalmic Plastic and Reconstructive surgery, vol much an! Bridges the superomedial hollow of the layers focus on creation of symmetric and well-positioned creases! Minimizing wound dehiscence involves appropriate suture choice and suture placement photographs also document eyelid. Operated on widely released ( and perfect hemostasis medial canthal webbing after blepharoplasty ) elevated by the same surgeon asymmetries. Upward massage to keep infection and scarring minimized and alleviate retraction abnormalities or asymmetries publishers note Springer Nature remains with... Lid blepharoplasty, skin sutures with 6-0 prolene imbricating levator or pretarsal tissue is preferred with forceps...
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