Gentle cautery applied to the orbital fat may contour and replace the remaining fat posteriorly into the orbit, providing needed volume and fullness. I had an upper bleph three weeks ago (22 days out). He said he would try to fix it with skin grafting if I like but, is this very successful? Arch Ophthalmol 1999; 117:907. 207212, 2008. The surgery involves removing redundant skin, fat, and muscle. It is virtually unheard of for this to fail to resolve. 709718, 2010. Blink dysfunction is common postblepharoplasty because of postoperative swelling of the eyelid tissues. Thank you. The authors declare no competing interests. B. 3, pp. However, because of the complex structure and function of the eyelids, the potential for complications does exist. Laser resurfacing in appropriate patients combined with transconjunctival blepharoplasty and appropriate lid tightening gives a far superior result to conventional exterior blepharoplasty, in terms of scar avoidance, avoidance of eyelid retraction, and a more natural and complete resolution of skin redundancy and rhytids. 316320, 1988. You are using a browser version with limited support for CSS. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. The assistance of your strabismus-oriented colleagues can be occasionally very helpful if the deficit persists. Tenzel RR: Complications of blepharoplasty. 4, pp. 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. Postoperative eyelid numbness involving the upper eyelid skin and eyelashes is an expected outcome after upper blepharoplasty and typically resolves over 2 to 4 months. If brow ptosis is present, straight-ahead photograph with eyebrows elevated by the patient demonstrates compensation. CT scan is important, but only after initial decompression treatment has been carried out. Canthoplasty repair for canthal rounding. It may be necessary to lighten the patients sedation to gain an accurate assessment of lid height, and sitting them upright is also useful. A slit lamp examination and Schirmers test are necessary in this authors view. and JavaScript. Care is taken to avoid the levator palpebrae superioris complex which lies just posterior to the preaponeurotic fat pad. Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. Prompt decompression of the orbit alone can restore vision. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). Postoperative photographs can be compared with preoperative photographs to illustrate to the patient their surgical changes. 797802, 1981. 99, no. 2005; 21:327. Similarly, if the patient is asked to look up, the orbital septum will not move when grasped but the levator will. Explain and document how daily visual function is affected. The surgeon needs to stop the bleeding but at the same time avoid excess cautery or other trauma to the muscle. 10361040, 1999. 1a). Moistened gauze may be placed over the closed eyelids. Interrupted suture placement can incorporate superficial fibers of levator aponeurosis just above the superior edge of the tarsal plate. It is rare that true bony decompression either at bedside through the inferomedial floor or more fully in the operating room is required. 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. 366368, 1969. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 87, no. With an acute hemorrhage, intraorbital pressure rises abruptly, and the blood supply to the optic nerve is compromised. Ophthal Plast Reconstr Surg. 710, 2010. This paper presents our experience using the single Z-plasty technique to successfully correct lateral canthal webs. 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. 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. Identifying patients with body dysmorphic syndrome, dysmorphophobia, or narcissistic behavior helps screen for those who may not be appropriate candidates for surgery. Postoperative eyelid edema and levator edema are common and are temporary causes of ptosis. Severe corneal scarring secondary to severe lagophthalmos after blepharoplasty done in a patient with Thyroid Eye Disease. Another mechanism is direct or indirect injury to the inferior oblique during surgery. Mild inner webbing too. I have started massaging the area and wearing silicone strips at night. Aesthet Surg J 2009; 29:87. 21, no. An allergist should guide the workup and management of this condition. Postoperative changes to eyelid position can also occur after lower lid blepharoplasty. If persistent, a superolateral skin excision with crease reformation will raise the persistently hooded side. Assess degree of lacrimal gland prolapse. If a second finger is required in the central eyelid pushing upward, usually a posterior-lamellar graft is required. Preoperative preparation may include asking the patient to stop smoking, reduce alcohol intake, and optimize overall general health. Lagophthalmos due to internal scarring requires surgical exploration and lysis of the scar tissue. In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the three finger test. Excessive bruising can lead to a prolonged recovery, infection, cicatrisation, and skin pigmentation. Facial plastic and reconstructive surgery is a remarkably diverse specialty, ranging from maxillofacial trauma and reconstruction to facial rejuvenation, rhinoplasty, cleft surgery, microvascular surgery, facial cosmetic procedures, and pain control. Careful preoperative marking will minimize the incidence of this result and of course many minor degrees of asymmetry will disappear with time. The surgeon should spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access deep hematomas and release them. Patients may inadvertently rub their eyes in the hours after surgery when their lids are numb or while sleeping. Many patients present for correction of dark circles under the eyes. Dark circles are caused by 3 factors: shadowing caused by fat bulging above the dark area, the blood supply of the fat showing through the thin eyelid skin, and thirdly, actual pigment in the epidermis and dermis. The experienced surgeon who is certain that the levator muscle and aponeurosis was identified and preserved during surgery will not be alarmed. CO2 skin resurfacing is useful to address skin redundancy and festoons (in patients with appropriate skin types). c. Patient 6: Right lateral canthal rounding following tumour reconstructionsingle flap technique. 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. 3, article 3, 1995. It also includes deciding which technique to perform (steel blade versus CO2 laser, transconjunctival versus external approach to lower blepharoplasty). Im losing faith in him though and am looking elsewhere for revision. e. Patient 12: Left lateral canthal rounding following blepharoplastysingle flap technique. Twelve patients have undergone this surgical technique for correction of post-surgical canthal rounding. This is because most patients will initially experience small amounts of lagophthalmos from ongoing local anaesthetic effect on the orbicularis, swelling, and stiffness of the eyelids. 4550, 1996. Excess preaponeurotic and/or nasal fat is removed. Improvement in subjective visual function and quality of life outcome measures after blepharoptosis surgery. I was given antibiotic drops but havent seen any improvement in two weeks.I also appear to have webbing forming in both eyes but more so on the right (which also looks smaller). Lateral canthal support is used to address the lower eyelid laxity either by . Difficult to rectify? Ophthalmic Plast Reconstr Surg. Aspirin products: Ecotrin, Fiorinal, Percodan, Nonsteroidal anti-inflammatory drugs: ibuprofen, naproxen, piroxicam, Nutritional supplements: fish oil, vitamin E, gingko biloba, ginseng. Ophthalmic Plast Reconstr Surg. Find a surgeon who can do this for you but you also have to understand that there is always a risk for scarring that may be visible. Aulus Cornelius Celsus was a first-century Roman who described making an incision in the skin to relax the eyelids (Orbit 2012;31:162). 219228, 1991. 2 were supplied by DS and NJ. h Flap is marked. The surgical technique was developed by one of the senior authors (NJ). A vicious cycle can develop wherein the chemotic conjunctiva dries out because it is swollen and then swells because it is dry. The scars usually occur when the incisions are carried too medially and the skin bridges the supero-medial 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. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. When preparing for lower lid blepharoplasty, important features to note are the amount of excess skin and the presence of fine rhytids (wrinkles), prolapsed fat (quantity and location), malar bags or festoons, lid laxity, scleral show and pigmentary characteristics. Inadvertent trauma to an extraocular muscle with deep dissection in orbital fat may occur. Pers Soc Psychol Bull 2003; 29:885. Skin lying on the eyelashes produces discomfort independent of obstructed visual axis. 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