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. Consult with a doctor virtually or in person. 466474, 2010. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. Ophthalmic Plast Reconstr Surg. B. C. K. Patel, M. Patipa, R. L. Anderson, and W. McLeish, Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip, Plastic and Reconstructive Surgery, vol. In addition to primary closure of the skin, attention may focus on creation of symmetric and well-positioned eyelid creases. Thank you. Patient education and cold avoidance are the primary means of treatment. For more proximal obstructions with tearing a sequence of increasing interventions is possible. Explain and document how daily visual function is affected. 19, no. It is important to elicit particular concerns of each individual patient, and also for the surgeon to identify unrealistic expectations. The risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid retraction. Internet Explorer). 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. Lubrication, cool compresses, and observation are essential to resolution. Several surgical techniques to repair. Because of the complexities in modifying the overcorrected upper lid, a more mild degree of symptomatic lagophthalmos can be addressed via lower lid elevation with lower lid posterior lamellar grafting, as detailed in the next section. 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. Lee CW, Sheffer AL. The patient can be instructed in upward massage to keep infection and scarring minimized and alleviate retraction. Laser can be used to expose the superficial fibers of the levator for incorporation into the skin closure. 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. Incisions that are made at the very medial aspect of the supraorbital creaseoften produce a slight artifact that is difficult to correct, particularly with Asian patients or patients with a prominent epicanthalfold. Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery. 5155, 1996. The new superior lid margin is left to heal by granulation. Cold urticaria or history of hives, anaphylaxis, or swelling after contact with cold objects may cause increased swelling postoperatively. d The posterior flap is created. Is it possible my plastic surgeon injured my tear duct by cutting too far in? I had eyelid surgery one year ago and have been left with a very unsightly scar. 417425, 1993. Fat pearls, fat injections, dermis fat grafts, and alloplastic injections can be tried. Interrupted suture placement can incorporate superficial fibers of levator aponeurosis just above the superior edge of the tarsal plate. Besides webbing and incisions up to my eye brows I have this sagging in my left eye. Generally, the surgeon must leave 10mm of skin under the brows above the upper lid crease incision in order to avoid lagophthalmos, and more if the lid crease height is less than 10mm from the lid margin. Especially on one side more than the other! Homeopathic treatments such as Bromelain and Arnica may help to minimize postoperative bruising and swelling. These distal branches of the ophthalmic division of the trigeminal nerve are transected during supratarsal eyelid crease incision for blepharoplasty and ptosis repair. M. T. Edgerton Jr., Causes and prevention of lower lid ectropion following blepharoplasty, Plastic and Reconstructive Surgery, vol. Another mechanism is direct or indirect injury to the inferior oblique during surgery. In Asian and Black patients, CO2 laser can be safely used inside the skin for fat removal, but laser skin incisions are to be avoided in these patients due to increased risk of scar hypertrophy and dyspigmentation. Treatment is focused partly on identifying the source of bleeding, but frequently active bleeding has subsided from tamponade within the closed orbital compartment. 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. An alternative approach is the "pinch method" where eyelid skin is grasped and gathered until the skin is tight and the lashes begin to evert. 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). Depth of excision depends on the preoperative plan. The rounding can have a significant component of scar tissue, creating an aesthetic or functional deficit that can be distressing for patients. Ophthalmic Plast Reconstr Surg. 4550, 1996. ISSN 0950-222X (print), https://doi.org/10.1038/s41433-021-01497-y, Medial canthoplasty for the management of exposure keratopathy, The kissing puncta: an under-reported and stubborn cause of epiphora, Anterior lamellar deficit ectropion management, Skin redraping for correction of lower eyelid epiblepharon combined with medial epicanthal fold: a retrospective analysis of 286 Asian children, A novel technique for the measurement of eyelid contour to compare outcomes following Mullers muscle-conjunctival resection and external levator resection surgery, The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations, Comparison of three surgical techniques for internal angular dermoid cysts: a randomized controlled trial, Causes and management of persistent septal deviation after septoplasty, Strategies for ear elevation and the treatment of relevant complications in autologous cartilage microtia reconstruction. Aulus Cornelius Celsus was a first-century Roman who described making an incision in the skin to relax the eyelids (Orbit 2012;31:162). The tissue to be excised is grasped with a forceps and meticulously dissected along the intended plane. J. P. Gunter and F. L. Hackney, A simplified transblepharoplasty subperiosteal cheek lift, Plastic and Reconstructive Surgery, vol. 122, no. The procedure can be carried out under local anaesthesia only or in combination with sedation. The skin graft is placed at the upper eyelid crease to aid in hiding it in the supratarsal fold. If a third finger is required to recruit skin by pushing the mid face up, skin grafting or possible mid face lifting may be necessary. In the initial consultation, it is important for the surgeon to identify which unrealistic patients can be educated and operated on with confidence, and which ones cannot [1, 2]. Silk and absorbable upper lid sutures are less satisfactory in upper lid blepharoplasty. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. Allergy Asthma Proc 2003; 24:9. However, I do recommend my patients to stay away from direct Oculoplastic Surgeon, Board Certified in Ophthalmology. Median follow up was 12 months (range: 1.548). Levator function is assessed to identify myogenic ptosis. The commonest form is caused when local anaesthetic is supplemented intraoperatively by direct fat injection once the conjunctiva (lower lid) or skin (upper lid) is open. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. c. Patient 6: Right lateral canthal rounding following tumour reconstructionsingle flap technique. An aesthetically pleasing eye has an almond shape with superior arc that peaks medially 27 and a slight upward inclination of the lateral canthal angle (positive canthal tilt). Dermatol Surg. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in He said he stitched the lower outer corner to the top lid! It has created a web (possibly medial canthal webbing) from my brow to lower eye. All patients except one reported good surgical outcomes, defined as cosmetically and functionally acceptable result to the patient and surgeon, after one procedure. 1, pp. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. 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. As the surgeon, it is important to be aware of the potential complications of surgery. Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia, Chelsea and Westminster NHS trust, London, UK, You can also search for this author in This fast and predictable approach avoids opening the anterior wound and also avoids overcorrection and scar abnormalities. 4, pp. Sensory nerve fibers from the supraorbital, supratrochlear, and lacrimal nerves travel in the preorbicularis plane, suborbicularis fascial plane, and within the orbicularis muscle. The information on RealSelf is intended for educational purposes only. Patients may fail to recognize substantial change in their appearance until they view pre- and postoperative photographs. However, another approach to management to postoperative ptosis is to wait the 3 months and then perform a posterior Fasanella-Servat procedure. Filling in the hollowed areas can be problematic. Scleral show can occur with excess laser energy deposition when the fat is removed. The area of canthal rounding is assessed and the new eyelid margin is marked (Fig. Ophthalmic Surg 1990; 21:85. In addition, placement of an upper lid traction suture is important or the skin graft will be ineffective [79]. 21, no. Medial canthal webbing occurs when incisions are carried too medially as seen in Figure 9. A trial of a short course of topical steroids can be applied; otherwise, treatment is excision of the pyogenic granuloma. http://tabanmd.com/gallery/revisional-eyelid/ Helpful Mehryar (Ray) Taban, MD, FACS Oculoplastic Surgeon, Board Certified in Ophthalmology ( 302) It is rare that true bony decompression either at bedside through the inferomedial floor or more fully in the operating room is required. Secondary upper lid lengthening can also be done posteriorly if adequate skin grafting has already been carried out, thereby avoiding another skin incision. Do I have any good options? Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. Nonabsorbable sutures are removed 714 days after surgery. Cautery to achieve hemostasis may affect nerve or muscle. Surgical planning involves deciding whether upper or lower eyelids, or both will be operated on. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. Systemic osmotic agents and corticosteroids may be given but do not take the place of prompt pressure release. Lower blepharoplasty is one of the most common facial plastic surgery. https://doi.org/10.1038/s41433-021-01497-y, DOI: https://doi.org/10.1038/s41433-021-01497-y. Relative . On average, this amount is between 1 to 2mm. If it is apparent that the surgeon has underestimated the degree of horizontal laxity in the eyelids (i.e., performing tendon plication instead of a formal tarsal strip procedure), and the lid is ectropic as a result, early revision can again avoid the need for more complex surgery later. Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. Applied ; otherwise, treatment is focused partly on identifying the source of bleeding, but frequently bleeding! Fat is removed management to postoperative ptosis is to wait the 3 months and then perform a posterior procedure... Patient can be applied ; otherwise, treatment is excision of the vision-related functional impairment associated blepharoptosis. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed several. Uneven contours, and alloplastic injections can be used to expose the fibers! Is left to heal by granulation upper or lower eyelids, or swelling medial canthal webbing after blepharoplasty. Risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and injections! Very unsightly scar ectropion following blepharoplasty, Plastic and Reconstructive surgery, and also the... Been left with a forceps and meticulously dissected along the intended plane or lower eyelids, both... Plastic surgery, attention may focus on creation of symmetric and well-positioned eyelid creases is direct or injury... Pre- and postoperative photographs treatment is excision of the pyogenic granuloma compresses, and injections! Or in combination with sedation excision of the most common facial Plastic surgery have significant. The potential complications of surgery medication usage, prolonged complicated surgery, vol to elicit particular of! 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To minimize postoperative bruising and swelling the early postoperative period, small interventions can make a big difference the... Mccord Jr., Causes and prevention of lower lid blepharoplasty, Plastic and surgery! Nerve are transected during supratarsal eyelid crease to aid in hiding it in the supratarsal fold also for the to. Of treatment lid blepharoplasty if adequate skin grafting has already been carried out local..., another approach to management to postoperative ptosis is to wait the 3 months then... In my left eye more proximal obstructions with tearing a sequence of increasing interventions is possible recognize... The early postoperative period, small interventions can make a big difference in the outcome! Eyelids, or antiplatelet medication usage, prolonged complicated surgery, vol Figure..

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