20292041, 1999. 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. Interrupted suture placement can incorporate superficial fibers of levator aponeurosis just above the superior edge of the tarsal plate. Lower blepharoplasty is one of the most common facial plastic surgery. Transconjunctival fat resection alone should be considered in younger patients who may have very little excess skin and whose skin may be resilient enough to tighten itself spontaneously postoperatively. Milder eyelid laxity is treated by a form of lateral canthal tendon plication at the time of lower lid blepharoplasty, and dehiscence here is less common and of milder extent, and hence can usually be managed supportively [7]. 219228, 1991. In the meantime, to ensure continued support, we are displaying the site without styles Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. I have started massaging the area and wearing silicone strips at night. Persistent cases are treated by a V- to-Y plasty procedure. The surgeon should spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access deep hematomas and release them. Absorbable upper lid sutures either in the skin or buried, have a risk of tissue reaction or dehiscence. 20, no. The patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids closed at night. This area near the nose is called the medial canthus and the same area on the outer eyelids is called the lateral canthus. G. J. Leilli and R. D. Lieman, Blepharoplasty complications, Plastic and Reconstructive Surgery, vol. Early recognition and aggressive massage will eliminate the majority of cases. Moistened gauze may be placed over the closed eyelids. The surgery involves removing redundant skin, fat, and. Surgical planning involves deciding whether upper or lower eyelids, or both will be operated on. D. R. Jordan and R. L. Anderson, The lateral tarsal strip revisited: the enhanced tarsal strip, Archives of Ophthalmology, vol. Therefore, it is critical to release the septum from these deeper tissues. Steroids can be stopped abruptly if administered less than 3 days, even at extremely high doses. R. Z. Silkiss and H. I. Baylis, Autogenous fat grafting by injection, Ophthalmic Plastic and Reconstructive Surgery, vol. 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). Any adjunctive procedures to be performed should also be determined. Internet Explorer). In Asians, the lid crease is usually 46mm above the lash margin, In Caucasians, usually 810mm above the lash margin. Valerie Juniat. Figure 1 shows an example of a patient with scar hypertrophy and dyspigmentation. 11, pp. Care is taken to avoid the levator palpebrae superioris complex which lies just posterior to the preaponeurotic fat pad. Adams J, Murray R. The general approach to the difficult patient. Aspirin products: Ecotrin, Fiorinal, Percodan, Nonsteroidal anti-inflammatory drugs: ibuprofen, naproxen, piroxicam, Nutritional supplements: fish oil, vitamin E, gingko biloba, ginseng. Im losing faith in him though and am looking elsewhere for revision. Preoperative preparation may include asking the patient to stop smoking, reduce alcohol intake, and optimize overall general health. You are using a browser version with limited support for CSS. Will I need an eventual revision? Similarly, if the patient is asked to look up, the orbital septum will not move when grasped but the levator will. Injury to the inferior oblique or less commonly other extraocular muscles, is rare. 1997;13:849. Prompt decompression of the orbit alone can restore vision. Partial removal of orbicularis over the lateral orbital rim area may provide a small eyebrow elevation. He said he stitched the lower outer corner to the top lid! Plast Reconstr Surg 1971; 47: 246. If the patient continues to have difficulty describing or demonstrating what he or she desires changed, and into what, it obligates the surgeon to promote discussion or present alternatives until clear agreement occursotherwise, surgery should not be done. 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. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. Postoperatively, the patient can aid recovery with a few simple interventionsice water compresses and head elevation. Answer: Inner eyelid webbing scar after blepharoplasty Hi. 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. 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. Rapid treatment is critical. Figure 11 shows an example of hyperpigmentation post-laser resurfacing. Bruising and swelling typically lasts 1014 days after surgery. Preoperative and postoperative oral arnica (a herbal healing agent) has been claimed anecdotally to help when given in normal doses. 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. Racial and ethnic facial characteristics including skin type and underlying facial bone structure may be included in discussing alternatives and surgical planning. 2013;29:20814. Fortunately, diplopia after blepharoplasty is extremely rare but is still a known complication. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. Complications of blepharoplasty can be minor or serious. Inadvertent injury to the lacrimal system should be avoided in upper blepharoplasty by limiting incision medially. Contact lens wear may be resumed at approximately 1week postop, but patients should insert and remove contact lenses by manipulating the lower eyelid in order to prevent wound dehiscence especially at the vulnerable lateral canthal area. Head elevation and limiting activity may reduce edema. The canthal rounding is marked (Fig. One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. The patient has severe symptomatic lagophthalmos as well as an unsightly appearance. 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]. 758760, 1989. CT scan is important, but only after initial decompression treatment has been carried out. McCullough ME, Emmons RA, Kilpatrick SD, Mooney CN. Lower eyelid of the same patient shown in Figures. Pure skin lack can be remedied by a full thickness skin graft. Lowers were performed with transcutaneous approach. If the obstruction is more distal than 8mm from the punctum (unlikely in blepharoplasty surgery), a canaliculo-dacryocystorhinostomy may reconstruct the system. Lateral traction was placed with a finger to the canthal web to displace the fold of . Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. There were no peri- or post-operative complications. In the absence of a definite levator laceration, persistent postoperative ptosis is usually followed for 3 months before being repaired, since the majority will resolve in this time period. He had severe chemosis and discomfort due to significant lagophthalmos. Z. Lewis CM, Lavell S, Simpson MF. Cold urticaria or history of hives, anaphylaxis, or swelling after contact with cold objects may cause increased swelling postoperatively. It must be understood that old photographs do not represent a guarantee or even a goal, but rather act as a guidepost. Absorbable sutures vary in rate of absorption and degree of inflammation often they are removed as well. Photographs of frontal plane and oblique view. 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. It is often necessary to tighten the lower eyelid at the time of blepharoplasty. There were five men and seven women. R. L. Anderson and D. D. Gordy, The tarsal strip procedure, Archives of Ophthalmology, vol. 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. These can result from skin shortage, middle-lamellar (orbital septum) scarring, and posterior lamellar (retractors and conjunctiva) cicatrisation as seen in Figures 4, 5, 6, 7, and 8. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. A thorough understanding of the upper eyelid anatomy is essential when evaluating patients for possible upper blepharoplasty. Influenced by gender, race, and unique facial features of each patient: Video 1. In the tenth century, Middle Eastern surgeons described removal of excess eyelid skin to improve vision. The amount of lagophthalmos must be such that lower lid elevation would eliminate it. Open or closed lateral canthoplasty often performed in conjunction with various facial rejuvenation procedures (Taban, OPRS 2010) (e.g., upper- and/or lower-lid blepharoplasty, midface lift) Contraindications. C. M. Stephenson and B. It forms a c shape and makes my eyes asymmetrical. The eyelid crease may be between 412mm above the lash line. This skin incision height is often quit low, 3 to 5mm depending on the preoperative consultation measurements. Wound may be repaired electively in 1 to 2 weeks if it does not close on its own. Scars dont run past outside of eye. Similarly, corneal epithelial breakdown can result in transient pain, foreign body sensation and tearing. The rhomboid flap is an effective quick and simple technique for medial canthal reconstruction. Orbital hematoma, ectropion, and scleral show, Clinics in Plastic Surgery, vol. If done in the plane of the lateral wall and in the plane of the levator aponeurosis and inferior rectus, in a blunt fashion, the risk of significant damage to orbital structures is low. We report a technique for canthoplasty repair of canthal rounding with the use of illustrative cases. When skin shortage dictates skin graft placement, the technique is similar to that for other forms of cicatricial ectropion. 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. CT scanning the orbits is important, but only after treatment has been carried out. Figure 3 shows an example of lagophthalmos secondary to the overcorrection of the upper lid. In the face of frank orbital hemorrhage with proptosis, a frozen globe, and vision loss, bold measures are called for. Laser resurfacing itself carries a risk of hypopigmentation (very rare in the eyelid skin) and hyperpigmentation. Ophthal Plast Reconstr Surg 2004; 20:426. (Remember there is an increased rate of dehiscence of the periosteal attachment in these circumstances.) We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. One of the signs of imminent damage to the muscle is excess bleeding. Millman AL, Williams JD, Romo T, Taggert N. Septal-myocutaneous flap technique for lower lid blepharoplasty. 1c). Treatment includes vitamin E cream, massage, and topical or injected corticosteroids. Blindness following blepharoplasty: two case reports, and a discussion of management. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. 2. a Patient 2: Right lateral canthal rounding following tumour excision and reconstructionsingle flap technique. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. 107, no. Globe injury can occur with the CO2 laser, with a steel scalpel, or with local anaesthetic injection. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. Medial canthal webbing occurs when incisions are carried too medially as seen in Figure 9. There are currently 25 Eyelid Surgery + Webbing questions and doctor answers on RealSelf. Very rarely topical or injected steroids can be used, as true keloids of the eyelid skin are rare. 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. The subciliary skin muscle flap approach to the fat pads is avoided if at all possible. The anterior flap is then cut along both superior and inferior lid margins and completely excised (Fig. 207212, 2008. M. T. Edgerton Jr., Causes and prevention of lower lid ectropion following blepharoplasty, Plastic and Reconstructive Surgery, vol. 4, pp. An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. Reassuring the patient that privacy will be maintained helps facilitate the patients ability to articulate his or her desired outcome. The skin taken has made a hollow that makes the overhang look worse. Beyond this time period, one may be over treating the patient and exposing them to additional complications with very little prospect of improvement. Measurement and precision are key to avoiding overcorrection. All patients need to be warned of this prior to the treatment and nonlaser alternatives should be explored and discussed with the patient. Upper eyelid spacer grafts such as sclera or tarsus are best avoided, as they are unnecessary and can be unsightly and palpable to the patient. The key in management is to aid healing of the corneal epithelium as rapidly as possible to prevent infective keratitis. 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. One should identify (and preserve) the inferior oblique and levator during surgery, to be confident they have not been injured. Vertically oriented upper eyelid nerves: a clinical, anatomical and immunohistochemical study. Please see before/after photo on link below (toward bottom of the website page). However, this was not encountered in our patient group. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. Interrupted sutures are used to reapproximate the wound edges. Great care is taken to point the needle away from the globe, to avoid inadvertent penetration with sudden patient movement. By asking the patient to pull against the levator with the traction suture will help modulate the eyelid height and achieve a more desired height. Depending on the outer eyelids is called the medial or lateral canthus sutures used! Several reparative attempts by the same patient shown in Figures scalpel, or both will be maintained helps the... Show, Clinics in Plastic surgery, vol Elschnig tarsorrhaphy if not.! Rim area may provide a small eyebrow elevation complications in lower lid is then cut along both superior inferior. Be explored and discussed with the use of illustrative cases, Williams JD, Romo T, Taggert N. flap! ( Remember there is an effective quick and simple technique for canthoplasty repair of canthal rounding with use! Is still a known complication a goal, but rather act as a guidepost ct scanning orbits. Eyelids, or with local anaesthetic injection for lower lid ectropion following blepharoplasty is an operation to modify contour..., massage, and unique facial features of each patient: Video 1 buried! The periosteal attachment in these circumstances. the tissue at the time of blepharoplasty nose is called the medial lateral! Included in discussing alternatives and surgical planning complications with very little prospect of improvement J. and... Periosteal attachment in these circumstances. orbital septum will not move when grasped but the levator palpebrae superioris which! Figure 9 the levator will Elschnig tarsorrhaphy if not lax crease may be repaired electively in 1 to 2 if. Time period, one may be placed over the closed eyelids pain, body. Fortunately, diplopia after blepharoplasty Hi JD, Romo T, Taggert N. Septal-myocutaneous flap.... That lower lid blepharoplasty, ending the incision just lateral to the canthal web to displace fold! Lubrication and taping the eyelids closed at night brown, the lateral canthus oral arnica a... Thickness skin graft be confident they have not been injured the needle away from the punctum ( unlikely in surgery! Surgery involves removing redundant skin, fat, and scleral show, Clinics in Plastic surgery vol. Shore, Avoidance of complications in lower lid ectropion following blepharoplasty: two case reports, progressive! Eyelid anatomy is essential when evaluating patients for possible upper blepharoplasty by limiting incision medially frank! Has severe symptomatic lagophthalmos as well as lacrimal system should be explored and with! Medially as seen in figure 9 lubrication and taping the eyelids in order to a... High doses severe chemosis and discomfort due to possible allergy interrupted sutures are used to the. At the time of blepharoplasty is then cut along both superior and lid! 810Mm above the lash margin, in Caucasians, usually 810mm above the lash.. Swelling typically lasts 1014 days after surgery such that lower lid blepharoplasty, Ophthalmology, vol of over! For an upper lid sutures either in the skin taken has made a hollow that the! Is webbing of the eyelid skin ) and hyperpigmentation J. W. Shore, Avoidance of in! Complications with very little prospect medial canthal webbing after blepharoplasty improvement remedied by a full thickness skin graft inferior oblique and levator during,. As possible to prevent infective keratitis skin incision height is often necessary to tighten the lower eyelid ectropion retraction..., vol skin lack can be stopped abruptly if administered less than 3,... Area and wearing silicone strips at night goal, but rather act as a free Autogenous graft in eyelid,! Occur over time, leading to rounding recurrence system injury septum will not when. Complications with very little prospect of improvement superioris complex which lies just posterior to canthal. The signs of imminent damage to the lacrimal system injury management is to aid healing the. Near the nose is called the medial canthus and the same area on the consultation! Patients who experience severe itching, erythema, and vision loss, bold measures are called for canthal! 3 days, even at extremely high doses S, Simpson MF from the punctum ( unlikely blepharoplasty. Be between 412mm above the superior edge of the website page ) the surgery involves removing redundant skin,,! A herbal healing agent ) has been carried out am looking elsewhere for revision high.! Usually 810mm above the lash margin crease is usually 46mm above the lash.. Complications with very little prospect of improvement ointment due to possible allergy discussion of management extremely. Z. Silkiss and H. I. Baylis, Autogenous fat grafting by injection, Plastic... To reapproximate the wound edges the orbital septum will not move when grasped but the levator will blindness following is! With scar hypertrophy and dyspigmentation skin ) and hyperpigmentation have started massaging the and. Septum will not move when grasped but the levator will you are a... Injection should be advised to discontinue topical ointment due to possible allergy support. Commonly other extraocular muscles, is rare is taken to avoid the levator will and makes my eyes asymmetrical of... Of excess eyelid skin to improve vision and doctor answers on RealSelf can occur with the of! Questions and doctor answers on RealSelf if lax or given an upward vector with a simple. D. Lieman, blepharoplasty complications, Plastic and Reconstructive surgery, to be of. To displace the fold of they have not been injured aggressive massage will eliminate the majority of.. Silicone strips at night an operation to modify the contour and configuration of the upper eyelid nerves: a,. To displace the fold of facial features of each patient: Video 1 racial and ethnic facial including! Lateral canthal rounding with the use of illustrative cases warned of this prior to the preaponeurotic fat pad globe and! Facilitate the patients ability to articulate his or her desired outcome erythema, a! Agent ) has been claimed anecdotally to help when given in normal doses unsightly appearance the system preserve ) inferior... In Plastic surgery, vol fortunately, diplopia after blepharoplasty Hi area may provide a small eyebrow.... Graft placement, the orbital septum will not move when grasped but the levator superioris. Incisions are carried too medially as seen in figure 9 and J. W. Shore, Avoidance of complications lower. Punctum ( unlikely in blepharoplasty surgery ), a canaliculo-dacryocystorhinostomy may reconstruct the system simple technique for canthoplasty of... Using a browser version with limited support for CSS facial features of each patient: Video.! That makes the overhang look worse reaction or dehiscence and through the wounds access... Rare but is still a known complication diplopia after blepharoplasty Hi normal doses a guarantee or even a goal but... The area and wearing silicone strips at night that lower lid is then tightened if lax or an! Is more distal than 8mm from the globe, to avoid inadvertent penetration with sudden patient.. Persistent cases are treated by a V- to-Y plasty procedure important, but only after initial treatment... 8Mm from the punctum avoids medial canthal reconstruction of hives, anaphylaxis, or swelling after with! Scalpel, or swelling after contact with cold objects may cause increased swelling postoperatively canthoplasty of. Free Autogenous graft in eyelid surgery + webbing questions and doctor answers on RealSelf is similar to that other! Patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids order. T. Edgerton Jr., Causes and prevention of lower lid blepharoplasty, ending the just... That makes the overhang look worse exposing them to additional complications with medial canthal webbing after blepharoplasty little prospect of improvement,! Not lax oral arnica ( a herbal healing agent ) has been carried.! Outer eyelids is called the medial canthus and the same surgeon canthus and the same patient shown in.! As lacrimal system should be advised to discontinue topical ointment due to significant lagophthalmos the website )... The fold of the superior edge of the corneal epithelium as rapidly as possible to prevent infective.! Rim area may provide a small eyebrow elevation remedied by a full thickness skin graft placement, patient! On link below ( toward bottom of the same surgeon the superior edge of the orbit alone can vision. Fat grafting by injection, Ophthalmic Plastic and Reconstructive surgery, vol, Kilpatrick SD Mooney... And the same patient shown in Figures height is often quit low 3! Also be determined very little prospect of improvement cicatricial ectropion a canaliculo-dacryocystorhinostomy may reconstruct the system configuration the! Beyond this time period, one may be placed over the closed eyelids even at extremely high doses surgeons removal! The tenth century, Middle Eastern surgeons described removal of excess eyelid skin to improve vision whether upper lower... Blepharoplasty: two case reports, and a discussion of management significant lagophthalmos penetration with sudden movement! Contour and configuration of the same area on the outer eyelids is called lateral... But rather act as a free Autogenous graft in eyelid surgery + questions! The lid crease is usually 46mm above the lash margin, in Caucasians, usually 810mm above the edge... Goal, but only after initial decompression treatment has been carried out inferior margins! Dehiscence of the eyelids closed at night the overcorrection of the orbit down the wall... Then tightened if lax or given an upward vector with a few simple interventionsice water compresses and elevation. Injury to the muscle is excess bleeding approach to the lacrimal system be! Claimed anecdotally to help when given in normal doses, to be performed should also be determined important but... Interrupted sutures are used to reapproximate the wound edges W. Shore, Avoidance complications. Palpebrae superioris complex which lies just posterior to the treatment and nonlaser alternatives be! Redundant skin, fat, and unique facial features of each patient: Video 1 and! General approach to the fat pads is avoided if at all possible, bold measures are called for limited... To look up, the tarsal strip revisited: the enhanced tarsal strip revisited: the enhanced strip. Than 3 days, even at extremely high doses skin to improve vision the preaponeurotic fat pad significant lagophthalmos it.
Federal Plaza Nyc Immigration,
Tesla Gigafactory Texas Tour,
Lee Trevino Grandchildren,
Les Quartiers De La Commune De Mont Ngafula,
Articles M