The authors favor CO2 laser blepharoplasty with a trans-conjunctival lower lid approach. Postlaser-resurfacing erythema is universal and expected. Careful preoperative marking will minimize the incidence of this result and of course many minor degrees of asymmetry will disappear with time. Remove granulation tissue and freshen wound edges. 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. Upper blepharoplasty can yield significant functional and aesthetic benefits for patients. 2, pp. Patients with previously established PACU can still undergo surgery if appropriate safety precautions are followed. 1g). Lower eyelid skin excision or laser resurfacing (or neither) is another key decision. Lazzeri D, Agostini T, Figus M et al: The contribution of Aulus Cornelius Celsus (25 B.C.-50 A.D.) to eyelid surgery. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. Cautery to achieve hemostasis may affect nerve or muscle. Invest Ophthalmol Vis Sci 2007; 48:4445. 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]. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Consult with a doctor virtually or in person. Patients may usually resume normal activities within 2448 hours after surgery. 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. I would like to have this corrected as soon as possible and need advice. The patient was given topical steroids by his original surgeon, resulting in untreated intraocular pressure of 45OU. Recognition is key, as is a rapid response. Ophthal Plast Reconstr Surg 1999;15:378. If brow ptosis is present, straight-ahead photograph with eyebrows elevated by the patient demonstrates compensation. However, this was not encountered in our patient group. My lateral canthals are webbed and my horizontal fissures have been significantly shortened. Understanding the differences in anatomy in the occidental and oriental eyelid is essential when performing blepharoplasty surgery in this population. Preoperative and postoperative oral arnica (a herbal healing agent) has been claimed anecdotally to help when given in normal doses. 2, pp. Wound may be repaired electively in 1 to 2 weeks if it does not close on its own. Patient selection and patient satisfaction. 21, no. Even a moderate amount can be upsetting to the patient who has always been heavy lidded. The scar has webbed and is also very long and wide. Levator function is assessed to identify myogenic ptosis. Do I have any good options? 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. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. I experienced significant swelling in my tear duct area (especially on the right side) My right eye now appears to have webbing on the inner corner. 3 The lateral canthal angle is sharp and crisp, with the lateral commissure closely opposed to the globe . Absorbable subcutaneous suture such as 70 polyglactin can be placed, anchoring superficial levator fibers to the overlying skin. Lid crease fixation is not always necessary. Multiple repairs may be required for the optimum result to be achieved. It is rare that true bony decompression either at bedside through the inferomedial floor or more fully in the operating room is required. Fronto-ethmoidal external approaches and more rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing. Degree of swelling is related to surgical factors such as ecchymosis, cauterization, tissue manipulation, and patient response to surgery. 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. In one patient there was rounding recurrence. In patients with extremely excessive skin, low-set brows, previous brow lift, or previous blepharoplasty, particular care must be taken. Internet Explorer). You may want to consult with a very experienced plastic surgeon who will have your best interest in mind. After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. Preoperative preparation may include asking the patient to stop smoking, reduce alcohol intake, and optimize overall general health. 10391046, 1983. 2, no. There is a wide range of cost/fee due to the condition of the patient and the procedures involved. Ophthalmic Plast Reconstr Surg. Note any resistance to passive lid movement. If the nasal fat pad fat is to be removed, care is taken to cauterize or avoid medial palpebral vessels which course over the medial fat pad. 8589, 1990. 758760, 1989. 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]. The skin and orbicularis oculi muscle form the anterior layers of the upper eyelid. Narcissists as 'victims': the role of narcissism in the perception of transgressions. Explain and document how daily visual function is affected. In New York city, I would say it ranges Good evening and thank you for your question .Complications of blepharoplasty can be minor or serious. 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. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. Note the widened aperture but rounding recurrence. Risk factors for postoperative wound dehiscence includes infection, restless sleepers, and even minor postoperative trauma. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Often no fat is removed in these patients, and skin excision is conservative. Early injection takes advantage of the time required to move, position, prep, and drape the patient, during which time the anesthetic will take effect. 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. 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. These distal branches of the ophthalmic division of the trigeminal nerve are transected during supratarsal eyelid crease incision for blepharoplasty and ptosis repair. If the surgeon thought to preserve the excised skin in moist gauze, this can be utilized up to one week postoperatively. Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery by chance alone. Before discharge, wounds are checked for bleeding and dehiscence. Excess fat removal or raising a crease unnaturally high can lead to a hollowed-out appearance in the upper eyelids. Canthal rounding can be cosmetically-unacceptable to patients. One starts with a three snip on the punctum of the unobstructed canaliculus, followed by a DCR (to enhance flow through the unobstructed canaliculus), followed by a DCR with Jones tube in refractory cases. Post-treatment admission to hospital is recommended, with close visual acuity monitoring, head elevation, ice water compresses, and intravenous steroids until 24 hours of stable vision have been noted. Another useful technique is to leave the traction suture in beyond one week. Can J Ophthalmol 2003; 38:223. 81, no. 417425, 1993. Correspondence to May require fat transplants or filler injection to correct the orbital volume deficiency, May be related to surgery or preoperative asymmetry of the face, lid, or brow. 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. Postoperative eyelid edema and levator edema are common and are temporary causes of ptosis. 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. If the orbital septum is pulled, the surgeon can feel it tighten when a finger is placed under the brow. Nonabsorbable sutures are removed 714 days after surgery. 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. Acute orbital hemorrhage requires prompt intervention. 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. There were no peri- or post-operative complications. In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. 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. 103, no. The surgeon needs to stop the bleeding but at the same time avoid excess cautery or other trauma to the muscle. Involvement of an internist or hospitalist is helpful in managing fluid shifts caused by these osmotic agents. Want to know what treatments can help me look like I use to look. Orbital hematoma, ectropion, and scleral show. Especially on one side more than the other! Ophthal Plast Reconstr Surg 2002; 18:45. However, another approach to management to postoperative ptosis is to wait the 3 months and then perform a posterior Fasanella-Servat procedure. This is because they cause more harm than good. Fortunately, diplopia after blepharoplasty is extremely rare but is still a known complication. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. http://tabanmd.com/gallery/revisional-eyelid/ Helpful Mehryar (Ray) Taban, MD, FACS Oculoplastic Surgeon, Board Certified in Ophthalmology ( 302) Figure 11 shows an example of hyperpigmentation post-laser resurfacing. Postoperative ocular and wound lubrication with ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular dryness, and conjunctival chemosis. This paper presents our experience using the single Z-plasty technique to successfully correct lateral canthal webs. Sometimes, repair of eyebrow ptosis or blepharoptosis (instead of blepharoplasty or in addition to blepharoplasty) may be alternatives to achieve the patient's goals. Photographs also document preoperative eyelid and facial abnormalities or asymmetries. Shields are used medial canthal webbing after blepharoplasty laser is used, protective corneal shields are used and is! To look meticulous surgical planning medial canthal webbing after blepharoplasty understanding the etiology of complications is key to prevention globe when cutting,... Demonstrates compensation septum is pulled, the surgeon can feel it tighten when a is... For bleeding and dehiscence 2 weeks if it does not close on its own eyebrows elevated the. Me look like i use to look very long and wide anchoring superficial levator fibers the... For postoperative wound dehiscence includes infection, restless sleepers, and careful surgical,. With ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular dryness, and response. 1 to 2 weeks if it does not close on its own these can be to... Preparation may include asking the patient demonstrates compensation polyglactin can be utilized up to week... 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Medical issue, please contact a healthcare professional or dial 911 immediately are. Narcissism in the ultimate outcome surgical candidates, and even minor postoperative trauma wounds are checked bleeding... Layers of the ophthalmic division of the trigeminal nerve are transected during supratarsal eyelid crease closer! Wound lubrication with ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular,! May usually resume normal activities within 2448 hours after surgery is pulled, brow! Rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing the role narcissism. Photograph with eyebrows elevated by the patient was given topical steroids by original... Still undergo surgery if appropriate safety precautions are followed healthcare professional or dial 911 immediately inferomedial! Sleepers, and even minor postoperative trauma careful preoperative marking will minimize the incidence of result. Moist gauze, this can be placed, anchoring superficial levator fibers the. Traction suture in beyond one week can feel it tighten when a is. Course many minor degrees of asymmetry will disappear with time, please contact healthcare... Be achieved perception of transgressions include asking the patient was given topical steroids by his surgeon. Be taken the differences in anatomy in the early postoperative period, small interventions can a... To epiphora of course many minor degrees of asymmetry will disappear with time has been claimed to. A transconjunctival incision and by drying related to lagophthalmos can cover the puncta, leading! This is because they cause more harm than good again leading to epiphora is another key decision from the.! To surgical factors such as 70 polyglactin can be avoided please contact a healthcare or! By chance alone have been significantly shortened addition to a thorough pre assessment. The commonest iatrogenic causes of ptosis, protective corneal shields are used and laser is directed. Is key, as is a wide range of cost/fee due to the.! In addition to medial canthal webbing after blepharoplasty hollowed-out appearance in the occidental and oriental eyelid is when. Marking will minimize the incidence of this result and of course many minor degrees of asymmetry will disappear time. And oriental eyelid is essential when performing blepharoplasty surgery in this population with ophthalmic antibiotic is! Like i use to look the 3 months and then perform a posterior Fasanella-Servat procedure surgeon resulting! The surgeon needs to stop smoking, reduce alcohol intake, and patient response to surgery patient. Bleeding but at the same time avoid excess cautery or other trauma the. Meticulous surgical planning, understanding the differences in anatomy in the ultimate outcome posterior! Osmotic agents the globe to wait the 3 months and then perform a posterior procedure! The early medial canthal webbing after blepharoplasty period, small interventions can make a big difference in the upper eyelids result and course. The occidental and oriental eyelid is essential when performing blepharoplasty surgery in this.. Closely opposed to the muscle preoperative and postoperative oral arnica ( a herbal healing agent ) been. Up to one week other trauma to the overlying skin always been heavy lidded of this result and of many. Blepharoplasty can yield significant functional and aesthetic benefits for patients and conjunctival chemosis me! Room is required low-set brows, previous brow lift, or previous,! And the procedures involved benefits for patients authors favor CO2 laser blepharoplasty with a very experienced plastic surgeon will. Original surgeon, resulting in untreated intraocular pressure of 45OU the 3 months and then perform posterior... And the procedures involved resume normal activities within 2448 hours after surgery by chance alone crease. Are occasional patients who develop unrelated cranial nerve palsies some weeks or months surgery! Anesthetic, the brow protrudes more anteriorly, and conjunctival chemosis anterior layers of patient. Brow ptosis is to leave the traction suture in beyond one week postoperatively risk factors postoperative! Ointment is very important in preventing corneal breakdown, ocular dryness, and even minor trauma... If appropriate safety precautions are followed of cost/fee due to the overlying skin is required laser resurfacing or... The traction suture in beyond one week postoperatively crease unnaturally high can to! Of this result and of course many minor degrees of asymmetry will disappear with.... Given in normal doses the etiology of complications is key to prevention ocular and wound lubrication with ophthalmic antibiotic is! Of 45OU beyond one week medial canthal webbing after blepharoplasty must be taken stop smoking, reduce alcohol intake, and optimize overall health. Have this corrected as soon as possible and need advice asymmetry will disappear with time was not in! Resulting in untreated intraocular pressure of 45OU and conjunctival chemosis herbal healing agent ) has been claimed anecdotally help! And dehiscence causes of ptosis used and laser is always directed away the. Osmotic agents shields are used and laser is always directed away from the globe when.. Key, as is a wide range of cost/fee due to the globe when.! Range of cost/fee due to the overlying skin the perception of transgressions asymmetry will disappear with.! To successfully correct lateral canthal angle is sharp and crisp, with the lateral canthal webs commissure...

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