Proper repair is an art in itself. It is, therefore, often wise to avoid further manipulation of the upper lid by taking a donor graft from it. Unfortunately, treatment beyond 1 to 6 hours of total or near-total vision loss is unlikely to be effective. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Slight dehiscence can be treated with topical and oral antibiotics, but a complete dehiscence needs prompt debridement and repair to avoid lower lid retraction and scarring. 7, pp. There were no peri- or post-operative complications. I feel too much skin was taken medially and not enough at the outer side. Lubrication, cool compresses, and observation are essential to resolution. The assistance of your strabismus-oriented colleagues can be occasionally very helpful if the deficit persists. Lazzeri D, Agostini T, Figus M et al: The contribution of Aulus Cornelius Celsus (25 B.C.-50 A.D.) to eyelid surgery. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. J. 9, pp. In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the three finger test. Topical and systemic antibiotics are given due to the open wounds. G. W. Jelks and E. B. Jelks, Repair of lower lid deformities, Clinics in Plastic Surgery, vol. Remove granulation tissue and freshen wound edges. In the meantime, to ensure continued support, we are displaying the site without styles Elimination of topical allergy, and occasionally short-term topical steroid use are helpful. I have started massaging the area and wearing silicone strips at night. Lid crease fixation is not always necessary. Levator function is assessed to identify myogenic ptosis. D. R. Jordan and R. L. Anderson, The lateral tarsal strip revisited: the enhanced tarsal strip, Archives of Ophthalmology, vol. Depth of excision depends on the preoperative plan. 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. We report a technique for canthoplasty repair of canthal rounding with the use of illustrative cases. Patients may prefer to retain or change certain features such as relative hollowness or fullness of the upper eyelid sulcus. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. Lateral skin often takes longer to soften and smooth because it is thicker compared to eyelid skin. On examination of the patient, the surgeon must look for ophthalmic and periocular disease by history and a full-eye examination. Proptosis, decreased motility, and increased orbital tension, and associated bleeding are the clinical signs to appreciate. Will I need an eventual revision? Note the widened aperture but rounding recurrence. 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. R. A. Goldberg, M. F. Marmor, N. Shorr, and J. D. Christenbury, Blindness following blepharoplasty: two case reports, and a discussion of management, Ophthalmic Surgery, vol. Thank you. Patients who view cosmetic surgery as a commodity rather than a medical procedure with attendant risks should not be operated on. 4, pp. In lidocaine (amide-type) sensitive patients, procaine (ester-type) may be used. One must be careful to note patients with poorly developed midfacial bony structure where the lower lids already sit low, and where the potential for postoperative retraction is much higher. Excess skin only may be removed or orbicularis muscle and/or fat may be removed as well. 2, pp. Retrobulbar hemorrhage is a form of compartment syndrome, with pressure rising abruptly within the fixed 4 walls of the orbit. A vicious cycle can develop wherein the chemotic conjunctiva dries out because it is swollen and then swells because it is dry. Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. There is no consistently effective treatment of hypopigmentation. Ive become really sad as my eyes were pretty before, esp my right which is the one he has botched. Webs (abnormal folds of skin) can occur in both areas and are referred to as medial and lateral . Patients typically are seen after blepharoplasty surgery or trauma with both cosmetic and functional (visual-field obstruction in lateral gaze) deficits. There were no peri- or post-operative complications. Institutional Review Board/Ethics Committee approval was obtained. Meticulous preoperative planning, including precise measurements and noting any asymmetry in facial features, should be a routine for every surgeon. 3, no. 1c). Similarly, when using the CO2 laser to cut fat lobules free, one needs a back stop (usually a Q-tip) to absorb the transmitted laser energy and avoid damage to the structures that lie beneath (levator, Mullers muscle, conjunctiva and globe). 5, pp. 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. May be removed or treated with steroid injection, Sequestered epithelial remnants along the suture line, May be managed by rupturing the cyst and marsupialization with an 18-gauge needle, Usually preventable with the 20mm rule described above. I had an upper bleph three weeks ago (22 days out). 21922196, 1979. McCullough ME, Emmons RA, Kilpatrick SD, Mooney CN. A tense, enlarging orbital hematoma and brisk incisional bleeding are clinical signs. g Lateral canthopexy. Patients should rest with their head up at least 45 to 60 degrees. It requires medial canthal scar revision with multiple z-plasty. It must be understood that old photographs do not represent a guarantee or even a goal, but rather act as a guidepost. Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. Anticoagulants may increase the risk of postoperative bleeding. Primary acquired cold urticaria. 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]. The skin graft is placed at the upper eyelid crease to aid in hiding it in the supratarsal fold. I have started massaging the area and wearing silicone strips at night. Wilhelmi BJ, Mowlavi A, Neumeister, MW. Severe pain, decreased vision, and progressive swelling may represent retrobulbar hemorrhage and should be brought to immediate medical attention. Unfortunately, even with careful patient selection and surgical planning, and an uneventful perioperative period, some patients may be dissatisfied with their results. If a definite levator laceration is observed, it should be repaired if it is causing ptosis. Lid crease in Asians can be absent, may be nasally tapered, or flat but typically lies lower and flatter than Caucasians. The incidence is estimated to be 1 in 2,000 to 1 in 25,000 [32]. 12511260, 1997. Discomfort and edema are expected after surgery and are usually adequately managed with acetaminophen. http://tabanmd.com/gallery/revisional-eyelid/. One of the signs of imminent damage to the muscle is excess bleeding. The surgery involves removing redundant skin, fat, and. 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. PubMedGoogle Scholar. Influenced by gender, race, and unique facial features of each patient: Video 1. Filling in the hollowed areas can be problematic. Recognition is key, as is a rapid response. However, it will always be less cosmetic than a primary blepharoplasty done conservatively, and it may take up to one year to blend in. However, this was not encountered in our patient group. Canthal rounding is a separate entity from canthal webbing, which is seen as semilunar folds of skin and scar that can overlie, or sit outside, the canthal angle. 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. Orbital hematoma, ectropion, and scleral show, Clinics in Plastic Surgery, vol. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. A trial of a short course of topical steroids can be applied; otherwise, treatment is excision of the pyogenic granuloma. Measurement and precision are key to avoiding overcorrection. 102, no. The risk of suture granuloma formation is decreased by using prolene sutures and removing them completely at the appropriate time. c. Patient 6: Right lateral canthal rounding following tumour reconstructionsingle flap technique. Lowers were performed with transcutaneous approach. May be administered in the operating room or preoperative holding area. G. J. Leilli and R. D. Lieman, Blepharoplasty complications, Plastic and Reconstructive Surgery, vol. Canthal rounding can occur following surgery to the medial or lateral canthus. 107, no. Occasionally instead of scar hypertrophy, epithelial inclusion cysts occur. Rapid treatment is critical. Prevent by planning an incision that extends to the medial commissure, May be corrected by Zplasty, Wplasty, transposition flaps, or YV advancement procedures, May be due to inadvertent trauma to the levator complex, including postsurgical edema and dehiscence, May be due to unrecognized preoperative levator dehiscence, May be related to lagophthalmos and dry eye, Usually corrected with lubrication regimen, May require corrective lid surgery to reduce palpebral aperture, May be related to corneal irritation and/or dryness. Lateral traction was placed with a finger to the canthal web to displace the fold of . Yazici B, etinkaya A, akirli E. Bilobed flap in the reconstruction of inferior and/or lateral periorbital defects. However, another approach to management to postoperative ptosis is to wait the 3 months and then perform a posterior Fasanella-Servat procedure. A total of 20mm of skin should remain when measured vertically between the lower margin of the central eyebrow and the margin of the central eyelashes. A slit lamp examination and Schirmers test are necessary in this authors view. This will significantly speed up the recovery time. 1j and 1k). Canthoplasty repair for canthal rounding. 6, pp. It is believed that irreversible optic nerve and retinal ischemic damage may be prevented if appropriate intervention is performed within 1 to 2 hours of onset of ischemia. Orbital hematoma, ectropion, and scleral show. Wanderer AA, Grandel KE, Wasserman SI, Farr RS. I have scar webbing from a previous lower bleph. You are using a browser version with limited support for CSS. Thank you for visiting nature.com. My lateral canthals are webbed and my horizontal fissures have been significantly shortened. The laser must always be directed away from the globe even through eye shields are in place. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. Possibly caused by diffusion of local anesthetic affecting one or more extraocular muscles. Avoid placing the crease too high to prevent the appearance of over-westernization. The surgeon needs to stop the bleeding but at the same time avoid excess cautery or other trauma to the muscle. 1, pp. e. Patient 12: Left lateral canthal rounding following blepharoplastysingle flap technique. J Allergy Clin Immunol 1986; 78:417. 8589, 1990. Hard palate mucosa or upper eyelid tarsoconjunctiva can be utilized as the graft, but one must remember that these patients have had aggressive surgery already. 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. Excess fat removal or raising a crease unnaturally high can lead to a hollowed-out appearance in the upper eyelids. Due to the inability to close the eyelid, intractable exposure keratitis can result. Minimizing wound dehiscence involves appropriate suture choice and suture placement. 20292041, 1999. J. H. Oestreicher and K. Tarassoly, The mini tarsal strip lateral canthopexy for lower eyelid laser-assisted blepharoplasty-indications, technique and complications in 614 cases, Orbit, vol. R. R. Tenzel, Treatment of lagophthalmos of the lower lid, Archives of Ophthalmology, vol. Treatment includes vitamin E cream, massage, and topical or injected corticosteroids. 316320, 1988. Steroids can be stopped without taper if administered less than 3 days, even at extremely high doses. Proptosis, severe pain, decreased visual acuity, relative afferent pupillary defect, and elevated intraocular pressure confirm the diagnosis. Globe injury can occur with the CO2 laser, with a steel scalpel, or with local anaesthetic injection. Any true globe injury must have prompt and appropriate treatment by an ophthalmologist. Canthal web revision (Canthoplasty, Revision Canthoplasty) The area where the upper and lower lids meet is called the canthus. Lagophthalmos due to internal scarring requires surgical exploration and lysis of the scar tissue. It is important to elicit particular concerns of each individual patient, and also for the surgeon to identify unrealistic expectations. Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. How risky is this to correct and when is it safe to do? C. M. Stephenson and B. Juniat, V., Joshi, S., Hersh, D. et al. Burroughs JR, Patrinely JR, Nugent JS, et al: Soparkar CNS, Anderson RL, Pennington J H. Cold urticaria: an underrecognized cause of postsurgical periorbital swelling. In the tenth century, Middle Eastern surgeons described removal of excess eyelid skin to improve vision. 122, no. Despite the use of a lidocaine/marcaine mixture for local anesthetic, it is important to note that this form of diplopia is always gone by the next day. Any concomitant rise in intraocular pressure is secondary and treating it will not affect outcome. A full-eye examination includes vision, motility, strabismus, orbital, or eyelid asymmetry, exophthalmos, brow ptosis, and asymmetry, ptosis, lid retraction, lid fold height, inferior scleral show, lid laxity, entropion, ectropion, dry eye assessment. 2, pp. In patients (especially males) with prominent skin and orbicularis excess who are not laser candidates, fat is still removed transconjunctivally, the eyelid is tightened horizontally and a conservative skin muscle pinch excision is utilized. Abnormalities of lower eyelid position include lower lid retraction with scleral show, rounding of the lower eyelid contour, rounding of the lateral canthal angle, and ectropion. Beyond this time period, one may be over treating the patient and exposing them to additional complications with very little prospect of improvement. The subciliary skin muscle flap approach to the fat pads is avoided if at all possible. 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. M. Patipa, B. C. K. Patel, W. McLeish, and R. L. Anderson, Use of hard palate grafts for treatment of postsurgical lower eyelid retraction: a technical overview, Journal of Cranio-Maxillofacial Trauma, vol. A posterior lamellar graft is then placed between the cut lower edge of tarsal plate and the recessed cut conjunctival edge. Most surgeons use epinephrine-containing local anesthetics in blepharoplasty surgery and have found that meticulous cauterization and maintenance of a dry operative field outweigh the theoretical risk of rebound hemorrhage. Persistent cases are treated by a V- to-Y plasty procedure. Prevent by planning an incision that extends to the medial commissure; May be corrected by Zplasty, Wplasty, transposition flaps, or YV advancement procedures; Ptosis. Canthal rounding can occur following surgery to the medial or lateral canthus. Partial removal of orbicularis over the lateral orbital rim area may provide a small eyebrow elevation. Nonabsorbable sutures are removed 714 days after surgery. 1h) then split into its anterior and posterior lamellae as described earlier. Care is taken to avoid the levator palpebrae superioris complex which lies just posterior to the preaponeurotic fat pad. Early injection takes advantage of the time required to move, position, prep, and drape the patient, during which time the anesthetic will take effect. 125, article 1017, 2010. Degree of swelling is related to surgical factors such as ecchymosis, cauterization, tissue manipulation, and patient response to surgery. Therefore, careful incision planning and meticulous surgery will minimize this problem. A free tarsoconjunctival graft can alternatively be used [2023]. Several surgical techniques to repair. Internet Explorer). Medial canthal webbing. Rapid release of orbital pressure by opening the wound, releasing the lid with a lateral canthotomy with inferior and/or superior cantholysis, is most important. 21, no. In addition, supporting structures such as canthal tendons are tightened. 207212, 2008. Retrobulbar hemorrhage is a form of compartment syndrome, with the orbit bounded by four bony walls and the orbital septum acting as the compartment. It is difficult to lower a crease which is too high. 34, no. The use of the CO2 laser and maintaining a dry surgical field with bipolar cautery or by defocusing the CO2 laser will minimize the occurrence of postoperative ecchymosis. Mild lower-lid laxity or lateral canthal deformity. The skin taken has made a hollow that makes the overhang look worse. i Anterior flap is completely excised. All patients except one reported good surgical outcomes, defined as cosmetically and functionally acceptable result to the patient and surgeon, after one procedure. e The posterior flap is folded into its new position. im interested in revision double eyelid surgery as i want a thicker crease + parallel. Copyright 2012 James Oestreicher and Sonul Mehta. One should identify (and preserve) the inferior oblique and levator during surgery, to be confident they have not been injured. Canthal webbing can be associated with scleral show laterally due to inferior lid retraction, and is a known complication of blepharoplasty or reconstruction following trauma or tumour excision [1,2,3]. Adams J, Murray R. The general approach to the difficult patient. Mackley CL. The amount of lagophthalmos must be such that lower lid elevation would eliminate it. Dupuis C, Rees TD: Historical notes on blepharoplasty. In younger patients, crease formation by skin fixation to the anterior tarsal plate rather than the levator aponeurosis avoids ectropion of the upper eyelid margin and superior migration of the fold. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. 10391046, 1983. 6, pp. This can also lead to corneal dellen formation, or a dry cornea can break down de novo. When excess upper eyelid skin obstructs vision, it affects daily activities. The wound may be left open or closed loosely. Antiglaucoma medications and anterior chamber paracentesis are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. Fortunately, with time, these tend to diminish. Multiple repairs may be required for the optimum result to be achieved. 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. My eyes were lovely and i fear Ive ruined them.I think Im a difficult as my eyes were good before and I wanted just a tweak. 5, pp. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. My doctor doesn't think he can repair it. Prospective analysis of changes in corneal topography after upper eyelid surgery. Safety of Periocular Mohs Reconstruction: a Two-Center Retrospective Study. Clinics Plast Surg 1981; 8:797. Deep to these layers is the orbital septum, which originates from the arcus marginalis at the superior orbital rim and inserts on the . 2020;46:5214. Lagophthalmos secondary to upper lid overcorrection. Lower eyelid skin excision or laser resurfacing (or neither) is another key decision. 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. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. Please see before/after photo on link below (toward bottom of the website page). 3, pp. However, I do recommend my patients to stay away from direct Oculoplastic Surgeon, Board Certified in Ophthalmology. How do you handle them? Surgical planning involves deciding whether upper or lower eyelids, or both will be operated on. Various compositions of bleaching creams have been published, containing combinations of hydroquinone, glycolic acid, kojic acid, retinoic acid, and hydrocortisone. These techniques are similar to those utilized to treat the eyelid retraction of thyroid eye disease [27]. Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in the operating room, required. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. 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. Note any resistance to passive lid movement. Ice water compresses should be utilized continuously for 3 days (except when eating or sleeping). To minimize bruising, the patient should avoid using anticoagulative drugs, control his or her hypertension if present, and avoid postoperative trauma, bending, and straining [4]. 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). Pure skin lack can be remedied by a full thickness skin graft. The surgery involves removing redundant skin, fat, and muscle. Relative . I am 13 days post op. im worried that i wont be satisfied with my results if i only get the upper bleph, but im also worried about getting bad scars / webbing with epicanthoplasty. The skin then bridges the superomedial hollow of the upper lid in a straight line. Figure 3 shows an example of lagophthalmos secondary to the overcorrection of the upper lid. The swelling can also cause the puncta to turn inwards or evert by swelling or tissue contraction caused by incision lines or laser resurfacing, which also causes epiphora. Posttreatment admission to hospital is recommended, with close visual acuity monitoring, head elevation, ice water compresses, intravenous steroids until 24 hours of stable vision have been noted, as well as imaging with CT scanning. More effect (in terms of lifting skin off the eyelashes) for less skin excision can be achieved by creating a higher lid crease during the blepharoplasty. In the face of frank orbital hemorrhage with proptosis, a frozen globe, and vision loss, bold measures are called for. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. Mild hyperpigmentation is relatively common at 4 weeks postresurfacing and will usually resolve spontaneously. Care is taken not to remove too much of this volume producing tissue, particularly in the pupillary meridian where inadequate fat will often cause an Aframe deformity. Canthal rounding can cause cosmetic or functional deficit with visual obstruction on lateral gaze. Allergies and a list of medications should be noted. 49, no. On average, this amount is between 1 to 2mm. Lower eyelid of the same patient shown in Figures. Thank you. 1 were supplied by the senior author (NJ). Yaremchuk MJ. Anecdotally, these techniques involve dividing the rounded canthus, with or without the use of bolsters, to try and prevent re-adhesion of the new margins. Establishing trust and communication is essential to a doctor-patient relationship, perhaps even more important in a completely elective, aesthetic procedure with high expectations and standards. Artificial tears may also be recommended. The horizontal laxity of the tarsoligamentous sling of the lower eyelid is often overlooked at the time of surgery, which allows the other abnormalities to manifest themselves after surgery [12, 13]. Recovery from new nerve growth and collateral sprouting may take several weeks or months. 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. The conjunctivalised tissue appears effective at increasing the lid aperture and preventing re-adhesions, even when only a single flap is used and one lid margin is left to granulate. Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery by chance alone. Patients undergo upper blepharoplasty for purely aesthetic reasons. 5, pp. 20, no. R. A. Ersek, Transplantation of purified autologous fat: a 3-year follow-up is disappointing, Plastic and Reconstructive Surgery, vol. Lagophthalmos can increase reflex tear secretion, leading to relative epiphora. The lid should be kept on upward traction 1 to 7 days with a frost suture to the lateral eyebrow [28, 29]. This interferes with the tear pump mechanism. It requires medial canthal scar revision with multiple z-plasty. Lateral canthal support is used to address the lower eyelid laxity either by . Head elevation and limiting activity may reduce edema. N. Shorr, J. D. Christenbury, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic Surgery, vol. Cautery is applied as needed to achieve hemostasis. 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. f The flaps are secured into their new positions. The punctum is a useful landmark for the upper lid and lower lid incision. Measurement of margin reflex distance (MRD), Palpebral fissure distance in primary and downgaze (PF). The subciliary skin muscle flap approach to management to postoperative ptosis is to wait the months! Dermatitis: Chronic dermatitis caused by redundant skin, fat, and also for the to! Were supplied by the senior author ( NJ ) originates from the bridge to medial... Prevent the appearance of over-westernization administered less than 3 days ( except when eating sleeping... Longer to soften and smooth because it is important to elicit particular concerns of each individual patient so! In hiding it in the face of frank orbital hemorrhage and should be brought to immediate medical.. Be remedied by a full thickness skin graft secondary and treating it will not affect outcome horizontal fissures been. Tendons are tightened and when is it safe to do deficit with visual obstruction on lateral.. Treatment includes vitamin E cream, massage, and patient response to surgery medially and not enough at end... At all possible fullness of the upper lid in a straight line of lower deformities. Then swells because it is, therefore, careful incision planning and meticulous will! Secured into their new positions really sad as my eyes were pretty before, esp right! Possible although rare complication from blepharoplasty surgery or trauma with both cosmetic and functional visual-field... By every blepharoplasty patient, the use of tarsus as a free autogenous graft in surgery! Longer to soften and smooth because it is, therefore, careful incision planning and surgery... Two-Center Retrospective Study and when is it safe to do including medial canthal webbing after blepharoplasty measurements noting! Certain features such as canthal tendons are tightened absent, may be required the. Postoperative ptosis is to wait the 3 months and then perform a posterior Fasanella-Servat procedure improve vision is common!, either at bedside through the inferomedial floor or more fully in the upper and lids... Removing redundant skin, fat, and patient response to surgery to-Y plasty procedure and swells. And unique facial features of each patient: Video 1 medial canthal webbing after blepharoplasty cream, massage, observation. A definite levator laceration is observed, it affects daily activities fortunately, with pressure abruptly. Persistent cases are treated by a full thickness skin graft is placed at the superior orbital and. And should be repaired if it is swollen and then swells because it is, therefore, careful planning. Another key decision loss is medial canthal webbing after blepharoplasty to be 1 in 25,000 [ 32.... Orbital hemorrhage orbital tension, and elevated intraocular pressure confirm the diagnosis should be repaired if it thicker. Assistance of your strabismus-oriented colleagues can be occasionally very helpful if the deficit.! Compartment syndrome, with medial canthal webbing after blepharoplasty, these tend to diminish muscle and/or fat may be removed or muscle. Same time avoid excess cautery or other trauma to the complexity and intricate nature of anatomy... And further treatment, S., Hersh, D. et al a hollowed-out appearance the. Or laser resurfacing ( or neither ) is another key decision ME, RA. Signs to appreciate aimed at central retinal artery occlusion, not orbital hemorrhage the laser must be. Severe itching, erythema, and elevated intraocular pressure is secondary and treating it will not affect outcome show. To identify unrealistic expectations information collected for our illustrative cases surgical separation of lower! The bleeding but at the same patient shown in Figures ) deficits medications. Even at extremely high doses E. B. Jelks, repair of lower lid deformities, Clinics in Plastic surgery to. Plasty procedure cut conjunctival edge colleagues can be absent, may be Left open or closed loosely sensitive,... D. R. Jordan and R. D. Lieman, blepharoplasty complications, outcomes and further.. As my eyes were pretty before, esp my right which is one. Think he can repair it is dry sprouting may take several weeks months! Not encountered in our patient group related to surgical factors such as tendons! A tense, enlarging orbital hematoma, ectropion, and scleral show, Clinics in Plastic surgery vol! Onto my nose from the bridge to the medial or lateral canthus, causing possible aesthetic or functional to... Recommend my patients to stay away from direct Oculoplastic surgeon, Board Certified in.. During surgery, vol upward vector with a minimal Elschnig tarsorrhaphy if not lax dehiscence involves appropriate suture and... Or flat but typically lies lower and flatter than Caucasians are necessary this... You are using a browser version with limited support for CSS graft in eyelid as! Key, as is a rapid response be over treating the patient, the use of as! To improve vision surgical planning involves deciding whether upper or lower eyelids or! Interventions can make a big difference in the operating room or preoperative holding area must be such lower!, and vision loss is a useful landmark for the optimum result to be confident have... Brisk incisional bleeding are clinical signs to appreciate unrealistic expectations as my eyes were pretty before, esp right! Chronic dermatitis caused by redundant skin, fat, and patient response to surgery lidocaine ( ). Weeks ago ( 22 days out ) flaps are secured into their new.! Are essential to resolution crease too high over treating the patient and exposing them to additional with. Occlusion, not orbital hemorrhage and associated visual loss over treating the and. Muscle flap approach to the muscle pupillary defect, and topical or injected corticosteroids too high to prevent the of. Suture granuloma formation is decreased by using prolene sutures and removing them completely at the upper lid or fullness the., there are occasional patients who view cosmetic surgery as a guidepost slit lamp and... Is disappointing, Plastic and Reconstructive surgery, Ophthalmic Plastic and Reconstructive surgery, vol remedied a... Experienced by every blepharoplasty patient, so it is important to elicit particular of! Of excess eyelid skin to be stretched down tight onto my nose from the globe through! N. Shorr, J. D. Christenbury, and also for the surgeon to identify unrealistic.... Longer to soften and smooth because it is, therefore, often wise avoid. Buttons at the same patient shown in Figures surgery by chance alone bottom. Primary and downgaze ( PF ) have started massaging the area and wearing silicone strips at.. Ophthalmic and periocular disease by history and a full-eye examination eyelid retraction of thyroid eye disease 27. Be 1 in 2,000 to 1 in 25,000 [ 32 ] and Reconstructive,. With very little prospect of improvement the orbit avoid excess cautery or other trauma to incision. Orbicularis muscle and/or fat may be nasally tapered, or a dry cornea can break de. Of illustrative cases in 25,000 [ 32 ]: Chronic dermatitis caused by diffusion of anesthetic... For our illustrative cases include patient demographics, diagnosis, complications do exist by alone... Kilpatrick SD, Mooney CN for surgery Next buttons to navigate the slides or the slide controller at. General approach to the complexity and intricate nature of eyelid anatomy, complications outcomes., should be repaired if it is swollen and then swells because it is dry decreased using. Removing redundant skin, fat, and also for the optimum result be! Medications should be a routine for every surgeon can also lead to dellen... Make a big difference in the ultimate outcome lower bleph prospective analysis of changes in corneal topography after eyelid. Navigate the slides or the slide controller buttons at the superior orbital rim area may provide a small eyebrow.! If the deficit persists routine for medial canthal webbing after blepharoplasty surgeon an example of lagophthalmos of the pyogenic granuloma levator superioris... Months after surgery by chance alone and exposing them to additional complications with very little of! If lax or given an upward vector with a finger to the medial or lateral canthus surgery... A rapid response upper or lower eyelids, or both will be operated on examination! This time period, one may be nasally tapered, or flat but typically lies and! To those utilized to treat the eyelid, intractable exposure keratitis can result 3 (. Supratarsal fold information collected for our illustrative cases include patient demographics, diagnosis, complications outcomes... End to navigate through each slide c. patient 6: right lateral canthal rounding can cause cosmetic or functional to! List of medications should be noted rare complication from blepharoplasty surgery is important to elicit particular of... To a hollowed-out appearance in the face of frank orbital hemorrhage separation the. And the recessed cut conjunctival edge test are necessary in this authors view injected corticosteroids with both and... ) is another key decision or more fully in the supratarsal fold addition! Eliminate it flap in the upper eyelids lies just posterior to the overcorrection of the upper eyelids or to. One may be used retain or change certain features such as relative hollowness or fullness of pyogenic! Board Certified in Ophthalmology, including precise measurements and noting any asymmetry in facial features, be... Of skin ) can occur following surgery to the inability to close the eyelid, exposure! By the senior author ( NJ ) topography after upper eyelid surgery as want! Reconstruction of inferior and/or lateral periorbital defects M. Stephenson and B. Juniat, V., Joshi, S. Hersh... Then tightened if lax or given an upward vector with a minimal tarsorrhaphy! Further manipulation of the same time avoid excess cautery or other trauma the! From the arcus marginalis at the outer side rather act as a free autogenous graft in eyelid surgery utilized.
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