The perceived gravity of a given complication may differ between the patient and the surgeon [1, 3]. volume36,pages 564567 (2022)Cite this article. 3, pp. I am also very wary of risk. Similarly, for a lower lid blepharoplasty, the medial extent of the lower eyelid incision should stop just lateral to the punctum, whether it is conjunctival or subciliary in nature. Therefore, it is critical to release the septum from these deeper tissues. 97, no. Ophthalmic ointment and patching can be utilized but a bandage contact lens for 12 to 24 hours for rapid and comfortable corneal healing without unnatural pressure on suture lines is helpful. Some surgeons prefer to place a corneal protector in each eye. This is seen as a rounded fold of skin and scar tissue inside the normal canthal angle, causing horizontal shortening of the eyelid aperture. The patient will also have asymmetrical pain and decreased vision. I would like to have this corrected as soon as possible and need advice. Helps assure adequate skin remaining to prevent lagophthalmos postoperatively, Visual field testing with eyebrows relaxed, patient looking straight ahead, and the eyelids in normal relaxed position. M. T. Edgerton Jr., Causes and prevention of lower lid ectropion following blepharoplasty, Plastic and Reconstructive Surgery, vol. Usually, it is a mistake to try and change their upper eyelid nature too drastically, unless this desire and postoperative appearance is made abundantly clear. Ice water compresses should be utilized continuously for 3 days (except when eating or sleeping). Tension in the levator complex and orbital septum may also result in eyelid retraction. On average, this amount is between 1 to 2mm. 2003;111:44150. Reassuring the patient that privacy will be maintained helps facilitate the patients ability to articulate his or her desired outcome. Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. Patient selection and patient satisfaction. Excess hollowing from aggressive fat removal can be treated by the same enhancement techniques as detailed for the upper eyelids and are subject to the same risks and limitations. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. Finally, management of complications is just as important as surgical technique. True canalicular injury may require late repair if epiphora results. I have had a lower and upper blepharoplasty about 15 years ago, then I had my uppers done again about 4 years ago, but I had my lowers done again about 1year ago and because I had had them done previous the surgeon insisted on a hammock stitch at the outer corners of my eye, which has caused webbing! 2 were supplied by DS and NJ. Article Federici TJ, Meyer DR, Lininger LL. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. lateral hooding looks worse than before.The right side has raised lumpy scarring which runs a little too far in, probably why I have the web? Canthal rounding can be cosmetically-unacceptable to patients. Fortunately, with time, these tend to diminish. Patients should plan to not drive for a week, due to the blurriness caused by the ointment use. The risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid retraction. 5155, 1996. Upper blepharoplasty with bony anatomical landmarks to avoid injury to trochlea and superior oblique muscle tendon with fat resection. If the incision line is a slightly thick and red at 4 weeks, then time, massage, and vitamin E cream is useful. In more severe cases, the rounding can cause functional deficit with visual obstruction on lateral gaze. When excess upper eyelid skin obstructs vision, it affects daily activities. Many people never had a full wide open upper lid and appeared heavy-lidded in younger years and their lid crease height is at 7mm, not 10mm. These are investigated and followed in the normal fashion for such conditions. The wound may be left open or closed loosely. 1, no. Dysmorphophobia. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. Correspondence to Therefore, one needs to be gentle when freeing up the fat from the underlying levator or the levator can be damaged inadvertently. The rhomboid flap is an effective quick and simple technique for medial canthal reconstruction. Is this resolvable? the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in One of the signs of imminent damage to the muscle is excess bleeding. 219228, 1991. Brown MS, Siegel IM, Lisman RD. Plast Reconstr Surg 1971; 47: 246. Canthal rounding has been reported following periocular tumour or trauma reconstruction [4, 5]. 1, pp. This area near the nose is called the medial canthus and the same area on the outer eyelids is called the lateral canthus. If skin shortage is evident however, full-thickness skin grafting may be needed. R. L. Anderson and D. D. Gordy, The tarsal strip procedure, Archives of Ophthalmology, vol. After 24 hours of spinal-trauma dose level of steroids (solumedrol 30mg/kg bolus over 15 minutes followed by 5.4mg/kg per hour) without response, one can discontinue the drug, possibly after repeat imaging. Because the lateral canthal web appeared to result from vertical tissue deficiency, we employed a surgical technique to transpose adjacent tissue into the area of the web, similar to the technique described by del Campo 2 for the correction of epicanthal folds. However, certain caution should be taken to avoid and manage postoperative ptosis. Yaremchuk MJ. Cautery is applied as needed to achieve hemostasis. However, because of the complex structure and function of the eyelids, the potential for complications does exist. 1, pp. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery by chance alone. Sutureless closure of the upper eyelids in blepharoplasty: use of octyl-2-cyanoacrylate. Adjunctive procedures include brow ptosis repair (internal trans-blepharoplasty, direct, coronal, or endoscopic), ptosis repair, lacrimal gland suspension, eyelid lengthening, and lower eyelid tightening or lateral canthopexy. Understanding the differences in anatomy in the occidental and oriental eyelid is essential when performing blepharoplasty surgery in this population. h Flap is marked. Lateral skin often takes longer to soften and smooth because it is thicker compared to eyelid skin. In Caucasian men, the crease is usually 69mm above the eyelid margin. The skin and orbicularis oculi muscle form the anterior layers of the upper eyelid. 3, pp. 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. If deeper scarring requires release, it should be done at the time of skin graft placement. Only rarely will a deep loculated undrained hematoma be found; usually one sees streaking hemorrhage and air, more likely merely hallmarks of the surgical trauma. 797802, 1981. Proptosis, decreased motility, and increased orbital tension, and associated bleeding are the clinical signs to appreciate. Wound may be repaired electively in 1 to 2 weeks if it does not close on its own. Slider with three articles shown per slide. Many surgeons apply a cold compress while the patient is in the recovery area. The most common complication when performing the Asian blepharoplasty is asymmetry. Lateral traction was placed with a finger to the canthal web to displace the fold of . Ophthalmology 1999; 106:1705. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. Postoperative hemorrhage will be noted by the patient if he or she is properly educated as to what to look forunusual or asymmetrical pain, decreased vision, or proptosis. Excessive skin removal may require free full-thickness skin grafting. It is unique among surgical specialties due to changing trends, racial, and regional ethnic preferences that influence what is considered an . To obtain Patients typically are seen after blepharoplasty surgery or trauma with both cosmetic and functional (visual-field obstruction in lateral gaze) deficits. Intravenous mannitol 20% (12g/kg over 3060minutes). Epiphora from damage to the lacrimal outflow system can occur if the incision line is carried too medially and too close to the horizontal midline. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser. The lid is placed on upward traction to facilitate this process, and an appropriately sized full-thickness graft is contoured to fit the defect after the eyelid is tightened horizontally. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. 316320, 1988. In the initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of their eyelids. C. R. Leone and J. V. Van Gemert, Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap, Archives of Ophthalmology, vol. 90, no. c The anterior flap is created and folded into its new position. Article Cautery to achieve hemostasis may affect nerve or muscle. Partial removal of orbicularis over the lateral orbital rim area may provide a small eyebrow elevation. Lelli GJ, Lisman RD: Blepharoplasty complications. 367373, 1972. 5, pp. Ophthalmic Plast Reconstr Surg. Care is taken to avoid the levator palpebrae superioris complex which lies just posterior to the preaponeurotic fat pad. What is the standard eyelid surgery recovery time? You are using a browser version with limited support for CSS. CO2 laser incisions need 7 days to heal, so sutures are removed on day 7 or 8. 8, no. Pure skin lack can be remedied by a full thickness skin graft. Any concomitant rise in intraocular pressure is secondary and treating it will not affect outcome. Elimination of topical allergy, and occasionally short-term topical steroid use are helpful. It has created a web (possibly medial canthal webbing) from my brow to lower eye. If the surgeon thought to preserve the excised skin in moist gauze, this can be utilized up to one week postoperatively. Approximately 11.5 cc of anesthetic is injected through a 27- or 30gauge needle in the plane between skin and orbicularis muscle across the entire eyelid. I am 13 days post op. Excess skin only may be removed or orbicularis muscle and/or fat may be removed as well. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Patient education and cold avoidance are the primary means of treatment. J. H. Oestreicher, N. K. Pang, and W. Liao, Treatment of lower eyelid retraction by retractor release and posterior lamellar grafting: an analysis of 659 eyelids in 400 patients, Ophthalmic Plastic and Reconstructive Surgery, vol. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. 2, pp. In equivocal cases, a posterior lamellar graft can be tried first, and the patient warned that a following procedure with a skin graft may be necessary. Posterior eyelid elevation is achieved by careful dissection at the level of the bottom of tarsal plate through conjunctiva, lower lid retractors, and orbital septum, and these are recessed downwards off the overlying orbicularis muscle. However, it will always be less cosmetic than a primary blepharoplasty done conservatively, and it may take up to one year to blend in. 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. Septum must be opened if fat is to be removed, but not the levator. Secondary revision surgery should remain an option during follow-up treatment and should be considered normal and occasionally necessary within weeks to months after surgery. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. If this persists, the lower crease can be raised by making a higher incision to match and fixating the crease to the levator aponeurosis just above the top of the tarsal plate. Scleral show can occur with excess laser energy deposition when the fat is removed. Even a moderate amount can be upsetting to the patient who has always been heavy lidded. Laser can be used to expose the superficial fibers of the levator for incorporation into the skin closure. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. 5, pp. The new superior lid margin is left to heal by granulation. Allergies and a list of medications should be noted. It was used by Karl Ferdinand von Graefe in 1818 when describing eyelid repair after removal of skin cancer (Plast Reconstr Surg 1971;47:246). Ptosis of varying degree is common for patients to experience the day after upper lid blepharoplasty. Laser resurfacing itself carries a risk of hypopigmentation (very rare in the eyelid skin) and hyperpigmentation. Surgery can cost all different from street to street, even blocks to blocks in the same city, depending on the surgeon's reputation, skill and experiences. Antiglaucoma medications or anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. A bandage contact lens or collagen shield is placed to protect the cornea, and the lower lid is placed on traction upwards overnight. The primary insertion of the levator aponeurosis into the orbicularis muscle and into the upper eyelid skin occurs closer to the eyelid margin in Asians. Prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis. Lowering a high lid crease has a lower success rate. There were no peri- or post-operative complications. When planning to perform an upper lid blepharoplasty, determining the amount of excess skin in the upper lids, the amount of excess or prolapsed fat, the position of the lacrimal glands, and the extent of lateral hooding and medial bulging are important. Please see before/after photo on link below (toward bottom of the website page).
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