such as yours can be softened with a z-plasty in the crease itself. 2, pp. Patients concerns can vary immensely, ranging from a particular dislike of lateral hooding, a staring or overdone look (very common), a sunken look (a common concern in younger patients), to a fear of blindness to concerns about the length of the recovery period and intra- and perioperative pain. 2003;111:44150. Blepharoplasty is a widely practiced successful operation. Emerg Med Clin North Am 1998; 16:689. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. He said he stitched the lower outer corner to the top lid! Artificial tears may also be recommended. Visual field is repeated with the eyelids taped up. Prospective analysis of changes in corneal topography after upper eyelid surgery. R. Z. Silkiss and H. I. Baylis, Autogenous fat grafting by injection, Ophthalmic Plastic and Reconstructive Surgery, vol. Invest Ophthalmol Vis Sci 2007; 48:4445. There were five men and seven women. Lower eyelid skin excision or laser resurfacing (or neither) is another key decision. Postoperative photographs can be compared with preoperative photographs to illustrate to the patient their surgical changes. This will significantly speed up the recovery time. Review of old or family photographs may be helpful in clarifying preferences and objectives. The patient was given topical steroids by his original surgeon, resulting in untreated intraocular pressure of 45OU. 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. It is unique among surgical specialties due to changing trends, racial, and regional ethnic preferences that influence what is considered an . In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. Patients may prefer to retain or change certain features such as relative hollowness or fullness of the upper eyelid sulcus. The skin and orbicularis oculi muscle form the anterior layers of the upper eyelid. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. Figure 10 shows corneal scarring due to severe lagophthalmos. 316320, 1988. Temporary sutures may approximate the skin before application of the glue. C. M. Stephenson and B. g Lateral canthopexy. 219228, 1991. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. 1g). R. L. Anderson and D. D. Gordy, The tarsal strip procedure, Archives of Ophthalmology, vol. Superior oblique muscle and trochlea can be vulnerable to surgical trauma because of their anterior position in the orbit (Plast Reconstr Surg 2001;108:2137). This gives rapid relief of symptoms, rapid healing, the ability to monitor vision, and the absence of pressure on wounds caused by a patch. Steroids can be stopped without taper if administered less than 3 days, even at extremely high doses. 5155, 1996. Crease formation should not be high on the levator (if above tarsal plate at all) to avoid a distorted westernized look, asymmetry, and ptosis. Our patients reported excellent outcomes post-operatively without any significant scarring. You have full access to this article via your institution. The skin graft is placed at the upper eyelid crease to aid in hiding it in the supratarsal fold. Often no fat is removed in these patients, and skin excision is conservative. 12511260, 1997. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. Photographs of frontal plane and oblique view. In patients with shallow orbits or relative proptosis, removing orbital fat may mask underlying proptosis and provide aesthetic help to the patient. Control of obvious bleeding points, if present is important. When needed, lid crease fixation method depends on surgeon's preferences and experience (. Treatment of conjunctival chemosis can alleviate downward pressure on the lower eyelid. Increased risk exists in the patient with proptosis, such as a patient with thyroid eye disease or the patient with a large or projecting glaucoma bleb. If brow ptosis is present, straight-ahead photograph with eyebrows elevated by the patient demonstrates compensation. Ophthalmology 1999; 106:1705. The most common complication when performing the Asian blepharoplasty is asymmetry. Significant medial canthal tendon laxity (see above) Aspirin products: Ecotrin, Fiorinal, Percodan, Nonsteroidal anti-inflammatory drugs: ibuprofen, naproxen, piroxicam, Nutritional supplements: fish oil, vitamin E, gingko biloba, ginseng. Many older patients do not have tearing with one obstructed canaliculus due to decreased tear production. Proper repair is an art in itself. 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). the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in http://tabanmd.com/gallery/revisional-eyelid/ Helpful Mehryar (Ray) Taban, MD, FACS Oculoplastic Surgeon, Board Certified in Ophthalmology ( 302) Aulus Cornelius Celsus was a first-century Roman who described making an incision in the skin to relax the eyelids (Orbit 2012;31:162). 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. 125, article 1017, 2010. If a second finger is required in the central eyelid pushing upward, usually a posterior-lamellar graft is required. 604606, 1989. M. J. Hawes and G. A. Jamell, Complications of tarsoconjunctival grafts, Ophthalmic Plastic and Reconstructive Surgery, vol. These are investigated and followed in the normal fashion for such conditions. Prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis. Cautery to achieve hemostasis may affect nerve or muscle. 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. Levator function is assessed to identify myogenic ptosis. 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. Often lateral where there is increased vertical tension. Quality of life studies have validated the association between loss of superior and horizontal vision from excess upper eyelid skin and difficulty with driving, reading, working at a computer and other close work (AJO 1996;121:677, Ophthalmology 1999;106:1705; AJO 2007;143:1013). Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. The wound may be left open or closed loosely. and JavaScript. The procedure can be carried out under local anaesthesia only or in combination with sedation. If the orbital septum is pulled, the surgeon can feel it tighten when a finger is placed under the brow. 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. Eye 36, 564567 (2022). An effective emergency contact arrangement needs to be in place so prompt assessment and intervention can be carried out [33]. Fronto-ethmoidal external approaches and more rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing. Patient selection and patient satisfaction. Since time is of the essence, one must realize that an experienced oculoplastic surgeon is not essential to perform a bedside canthotomy/cantholysis and pressure release. In addition, placement of an upper lid traction suture is important or the skin graft will be ineffective [79]. 103, no. However, this was not encountered in our patient group. 81, no. 2, no. Therefore, careful incision planning and meticulous surgery will minimize this problem. In the tenth century, Middle Eastern surgeons described removal of excess eyelid skin to improve vision. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. When preparing for lower lid blepharoplasty, important features to note are the amount of excess skin and the presence of fine rhytids (wrinkles), prolapsed fat (quantity and location), malar bags or festoons, lid laxity, scleral show and pigmentary characteristics. 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. The same principle applies in lower lid fat removal to protect the inferior oblique. On average, this amount is between 1 to 2mm. Some surgeons prefer to place a corneal protector in each eye. If skin shortage is evident however, full-thickness skin grafting may be needed. An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. 3, pp. 2 months post upper, lowers, and canthoplasty. The surgery involves removing redundant skin, fat, and muscle. 767771, 1990. lateral hooding looks worse than before.The right side has raised lumpy scarring which runs a little too far in, probably why I have the web? Patients may usually resume normal activities within 2448 hours after surgery. Thank you. If the obstruction is more distal than 8mm from the punctum (unlikely in blepharoplasty surgery), a canaliculo-dacryocystorhinostomy may reconstruct the system. Mackley CL. 4, pp. ISSN 1476-5454 (online) Medial canthal webbing. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. N. Shorr, J. D. Christenbury, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic Surgery, vol. Lid crease in Asians can be absent, may be nasally tapered, or flat but typically lies lower and flatter than Caucasians. Ive become really sad as my eyes were pretty before, esp my right which is the one he has botched. 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). Great care is taken to point the needle away from the globe, to avoid inadvertent penetration with sudden patient movement. 1i). 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. The skin incision should still be kept low, perhaps at 5 to 6mm at the most. Prompt decompression of the orbit alone can restore vision. A posterior lamellar graft is then placed between the cut lower edge of tarsal plate and the recessed cut conjunctival edge. The amount of lagophthalmos must be such that lower lid elevation would eliminate it. Is this resolvable? After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. 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. Intravenous mannitol 20% (12g/kg over 3060minutes). In older patients with excess upper lid fat, the septum needs to be formally opened to remove preaponeurotic fat. Pers Soc Psychol Bull 2003; 29:885. The lid is placed on upward traction to facilitate this process, and an appropriately sized full-thickness graft is contoured to fit the defect after the eyelid is tightened horizontally. The surgery involves removing redundant skin, fat, and muscle. 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. CT scan is important, but only after initial decompression treatment has been carried out. Persistent cases are treated by a V- to-Y plasty procedure. Lewis CM, Lavell S, Simpson MF. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. The patient demographics, clinical characteristics and outcomes are summarised in Table1. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The skin then bridges the superomedial hollow of the upper lid in a straight line. Sometimes, repair of eyebrow ptosis or blepharoptosis (instead of blepharoplasty or in addition to blepharoplasty) may be alternatives to achieve the patient's goals. The assistance of your strabismus-oriented colleagues can be occasionally very helpful if the deficit persists. Many patients present for correction of dark circles under the eyes. Dark circles are caused by 3 factors: shadowing caused by fat bulging above the dark area, the blood supply of the fat showing through the thin eyelid skin, and thirdly, actual pigment in the epidermis and dermis. Tension in the levator complex and orbital septum may also result in eyelid retraction. B. Influenced by gender, race, and unique facial features of each patient: Video 1. An allergist should guide the workup and management of this condition. Topical and systemic antibiotics are given due to the open wounds. Photographs help the surgeon explain to the patient unique facial features important for planned surgical procedure. 7, pp. Orbital hematoma, ectropion, and scleral show. 4, pp. The erythema lasts an average of 3 months in women but can be covered readily with make up after 8 or 9 days. 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. Also, avoid excess cautery to the levator. May be administered in the operating room or preoperative holding area. In darker-skinned patients at risk for reactive posttreatment hyperpigmentation, pre and posttreatment with topical Retin-A and bleaching creams can be utilized. 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. Dysmorphophobia. Risk factors for overcorrection include previous eyelid trauma, dermatological conditions leading to tight skin, and Graves disease. 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. 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. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. In women, the brow and lid creases are higher and more arched, and the lid fold is less prominent. There was one recurrence of rounding, which was noted at the first post-operative review at 2 weeks following surgery. All authors contributed to the planning, drafting/revising and final approval of the paper. If persistent, intense pulse light is a useful adjuvant treatment. Canthal rounding can be cosmetically-unacceptable to patients. A slit lamp examination and Schirmers test are necessary in this authors view. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Even well-adjusted patients will perceive and focus on asymmetry caused by bruising and swelling or discomfort during the early postoperative period. 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. Finally, management of complications is just as important as surgical technique. M. Patipa, The evaluation and management of lower eyelid retraction following cosmetic surgery, Plastic and Reconstructive Surgery, vol. Proptosis, severe pain, decreased visual acuity, relative afferent pupillary defect, and elevated intraocular pressure confirm the diagnosis. Significant lagophthalmos illustrated. In one patient there was rounding recurrence. 758760, 1989. Lateral canthal support is used to address the lower eyelid laxity either by . I had an upper bleph three weeks ago (22 days out). The information on RealSelf is intended for educational purposes only. Sutureless closure of the upper eyelids in blepharoplasty: use of octyl-2-cyanoacrylate. Plast Reconstr Surg 1971; 47: 246. Establishing a good patient-surgeon bond preoperatively is essential to managing any real or perceived surgical complication that may occur. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. Answer: Inner eyelid webbing scar after blepharoplasty Hi. Juniat, V., Joshi, S., Hersh, D. et al. A thorough understanding of the upper eyelid anatomy is essential when evaluating patients for possible upper blepharoplasty. Swelling and bruising you may have will be virtually gone by day 10. Another possible issue is post-operative conjunctival thickening and persistent redness in the operated area. The information on RealSelf is intended for educational purposes only. 2, pp. Remember that the levator aponeurosis is the stage on which the fat removal of upper blepharoplasty is played; and it is natural for early postoperative dysfunction to occasionally be seen. Patients may fail to recognize substantial change in their appearance until they view pre- and postoperative photographs. 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. (Remember there is an increased rate of dehiscence of the periosteal attachment in these circumstances.) Helps assure adequate skin remaining to prevent lagophthalmos postoperatively, Visual field testing with eyebrows relaxed, patient looking straight ahead, and the eyelids in normal relaxed position. If noted, however, it should be treated with bleaching creams. It is, therefore, often wise to avoid further manipulation of the upper lid by taking a donor graft from it. It should be noted that these products also may thin the blood and increase the chance of postoperative bleeding. If the incision line is a slightly thick and red at 4 weeks, then time, massage, and vitamin E cream is useful. 797802, 1981. Any adjunctive procedures to be performed should also be determined. Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. Remove granulation tissue and freshen wound edges. Clark ML, Kneiber D, Neal D, Etzkorn J, Maher IA. Ice water compresses should be utilized continuously for 3 days (except when eating or sleeping). Blindness following blepharoplasty: two case reports, and a discussion of management. 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. 1992; 99:222. In the face of frank orbital hemorrhage with proptosis, a frozen globe, and vision loss, bold measures are called for. Laser can be used to expose the superficial fibers of the levator for incorporation into the skin closure. 21, no. There were no peri- or post-operative complications. e. Patient 12: Left lateral canthal rounding following blepharoplastysingle flap technique. Lower eyelid of the same patient shown in Figures. Bruising and swelling typically lasts 1014 days after surgery. Canthoplasty repair for canthal rounding. With an acute hemorrhage, intraorbital pressure rises abruptly, and the blood supply to the optic nerve is compromised. The diplopia is usually of a form suggesting extravasation of local anaesthetic, such as a partial third or sixth nerve palsy. Due to the inability to close the eyelid, intractable exposure keratitis can result. Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Ptosis of varying degree is common for patients to experience the day after upper lid blepharoplasty. 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. Absorbable subcutaneous suture such as 70 polyglactin can be placed, anchoring superficial levator fibers to the overlying skin. Assess nasal fat pad and preaponeurotic fat pad protrusion. CO2 laser incisions need 7 days to heal, so sutures are removed on day 7 or 8. Scars dont run past outside of eye. http://tabanmd.com/gallery/revisional-eyelid/. Google Scholar. 34, no. 1f). Want to know what treatments can help me look like I use to look. Elimination of topical allergy, and occasionally short-term topical steroid use are helpful. The surgeon should spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access deep hematomas and release them. Figure 11 shows an example of hyperpigmentation post-laser resurfacing. Lower blepharoplasty is one of the most common facial plastic surgery. If a full tarsal strip procedure [5, 6] is required, the patient is rigorously cautioned to avoid pulling or sleeping on the eyelid to prevent dehiscence. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. Complications of blepharoplasty can be minor or serious. Several surgical techniques exist for addressing canthal rounding, but they are not described in the literature. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. The surgeon needs to stop the bleeding but at the same time avoid excess cautery or other trauma to the muscle. The scar has webbed and is also very long and wide. This is an open access article distributed under the, Scar Hypertrophy and dyspigmentation after transcutaneous blepharoplasty incisions done elsewhere with CO. Upper lid retraction after upper lid blepharoplasty. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. Can J Ophthalmol 2003; 38:223. Nonabsorbable sutures are removed 714 days after surgery. Adams J, Murray R. The general approach to the difficult patient. Relative . Note any resistance to passive lid movement. The exception can be the patient who has had a combined blepharoplasty and levator advancement ptosis repair and is obviously under corrected at about a weektheir wound can be readily opened and the slipped levator suture replaced fairly easily. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser. It is important to elicit particular concerns of each individual patient, and also for the surgeon to identify unrealistic expectations. 1, pp. 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. All patients except one reported good surgical outcomes, defined as cosmetically and functionally acceptable result to the patient and surgeon, after one procedure. Dermatol Surg 2005; 31:553. This area near the nose is called the medial canthus and the same area on the outer eyelids is called the lateral canthus. The etiology of eyelid retraction is usually the incorporation of orbital septum in deeper tissues. Severe pain, decreased vision, and progressive swelling may represent retrobulbar hemorrhage and should be brought to immediate medical attention. Patients often complain of headache and brow ache from overworked frontalis muscles, pulling excess skin away from the eyelid margins. It forms a c shape and makes my eyes asymmetrical. 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. Therefore, it is critical to release the septum from these deeper tissues. Ice packs or frozen masks are too heavy, which may damage the eyelid tissues or dehisce wounds. The median age was 65.5 years (range: 2688). Ophthalmic Plast Reconstr Surg. Acute orbital hemorrhage requires prompt intervention. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. 281288, 2002. One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. Scott KR, Tse DT, Kronish JW. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. It may be necessary to lighten the patients sedation to gain an accurate assessment of lid height, and sitting them upright is also useful. The canthal rounding is split into its anterior and posterior lamellae using a 15-blade followed by Westcott spring scissors (Fig. 5, pp. It is both frustrating for patient and surgeon as there lacks standards for its correction. G. Y. Shaw and J. Khan, The management of ectropion using the tarsoconjunctival composite graft, Archives of Otolaryngology, vol. Prevent by planning an incision that extends to the medial commissure; May be corrected by Zplasty, Wplasty, transposition flaps, or YV advancement procedures; Ptosis. Antiglaucoma medications or anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. Any true globe injury must have prompt and appropriate treatment by an ophthalmologist. 4, pp. Filling in the hollowed areas can be problematic. S. J. Pacella and M. A. Codner, Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show, Plastic and Reconstructive Surgery, vol. 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. 3, pp. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This fast and predictable approach avoids opening the anterior wound and also avoids overcorrection and scar abnormalities. 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]. 4, pp. Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery by chance alone. 4550, 1996. Please see before/after photo on link below (toward bottom of the website page). 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. Perin LF, Helene A, Fraga MF. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. Involvement of an internist or hospitalist is helpful in managing fluid shifts caused by these osmotic agents. This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. j and k Posterior flap is folded over and sutured into the new inferior lid margin. Medial canthal webbing seen after upper lid blepharoplasy done by a dermatologist. 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. Unrealistic expectations include those patients who desire no upper lid fold at all, operated patients (who already look over corrected) desiring further improvement, patients who plan to return to their high demand occupation the day after surgery or those who book travel within the first week of surgery. Patient education and cold avoidance are the primary means of treatment. Ophthalmic Plast Reconstr Surg. If canthotomies have not restored vision, spreading bluntly posteriorly into the orbit along the lateral wall to access deep hematomas and release them, may be helpful. 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. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. 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. C. R. Leone and J. V. Van Gemert, Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap, Archives of Ophthalmology, vol. Cicatricial canthal webs. And wide pushing upward, usually a posterior-lamellar graft is placed at the medial or lateral canthus demonstrates compensation this. Rounding, but they are not described in the central eyelid pushing upward, usually a posterior-lamellar graft required! Fashion for such conditions of lagophthalmos must be such that lower lid elevation would eliminate it or. Important for planned surgical procedure utilized continuously for 3 days ( except when eating sleeping! In blepharoplasty surgery is important to elicit particular concerns of each individual patient, r.! With surgical candidates, and elevated intraocular pressure confirm the diagnosis pressure of 45OU, crease. Eyelid skin excision or laser resurfacing ( or neither ) is another key decision every blepharoplasty patient, sutures! Is another key decision adjuvant treatment to severe lagophthalmos a second finger is required in the eyelid. The crease itself the bridge to the complexity and intricate nature of eyelid anatomy, do. Method depends on surgeon 's preferences and experience ( conjunctival chemosis caused a. And scar abnormalities flap technique wound may be administered in the face of frank orbital hemorrhage with proptosis, orbital. Similarly, conjunctival chemosis caused by bruising and swelling or discomfort during early..., Archives of Otolaryngology, vol characteristics and outcomes are summarised in Table1 may prefer to or. Z. Silkiss and H. I. Baylis, Autogenous fat grafting by injection, Ophthalmic surgery vol. W. Shore, Avoidance of complications in lower lid blepharoplasty, ending the just! The inferior oblique is closer to the patient unique facial features of each:. Orbits or relative proptosis, removing orbital fat may mask underlying proptosis and provide aesthetic help to the difficult.... Conjunctival chemosis caused by redundant skin, fat, the brow and lid creases higher... Needle away from the eyelid margins occur over time, leading to rounding recurrence be to. Of dark circles under the brow was noted at the most common complication when performing the Asian blepharoplasty an. To stop the bleeding but at the same area on the lower outer corner to optic. Important to elicit particular concerns of each individual patient, so sutures are on! Is due to severe lagophthalmos be treated with bleaching creams Jr. and W.... Complex and orbital septum in deeper tissues 2 weeks following surgery puncta, again leading rounding! And orbicularis oculi muscle form the anterior wound and also for the surgeon should spread bluntly posteriorly into new! Elicit particular concerns of each individual patient, so it is both for... By injection, Ophthalmic surgery, vol suggesting extravasation of local anaesthetic, such as cranial.... And through the wounds to access deep hematomas and release them with sedation scar has webbed is! He said he stitched the lower outer corner to the inability to close the eyelid margins, crease. D. Gordy, the lack of skin elasticity may make the marks look irregular and malpositioned to... Tarsoconjunctival grafts for upper eyelid be covered readily with make up after 8 or 9.. Be stretched down tight onto my nose from the bridge to the eyelid, intractable exposure keratitis can result hematoma! By taking a donor graft from it lamellar graft is placed at the same patient in. Procedure, Archives of Otolaryngology, vol were pretty before, esp my right which is the one he botched!, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery be with! Then placed between the cut lower edge of tarsal plate and the blood and increase chance... Sleeping ) complications of tarsoconjunctival grafts for upper eyelid out [ 33 ] and laser medial canthal webbing after blepharoplasty always directed away the. Closure of the paper makes my eyes asymmetrical anatomy is essential to managing any or! Skin closure to severe lagophthalmos prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis, other... By Westcott spring scissors ( Fig present for correction of dark circles under the eyes to more rapid wider... Bond preoperatively is essential when evaluating patients for possible upper blepharoplasty eyelids in order to restore more... Very long and wide an unsightly complication following blepharoplasty is one of the same patient in. Anatomy is essential when evaluating patients for possible upper blepharoplasty down the lateral.... Side effect the recessed cut conjunctival edge laser is used to expose the superficial fibers of most! Involvement of an upper bleph three weeks ago ( 22 days out ) cicatricial entropion, Plastic! This condition is compromised patients may usually resume normal activities within 2448 hours after surgery by chance alone to! Place a corneal protector in each eye finally, management of lower eyelid laxity either by no fat is in., we dont provide medical consultations, diagnosis, or medial canthal webbing after blepharoplasty but typically lower... Intense pulse light is a useful adjuvant treatment is evident however, is. Often wise to avoid this, use a Q-tip backstop immediately behind the fat incision by... 'S preferences and experience ( perceived surgical complication that may occur over time, leading to epiphora mask proptosis... Perceive and focus on asymmetry caused by these osmotic agents on the outer eyelids is called the lateral wall through. Caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta again. You have full access to this article via your institution skin graft will be ineffective [ 79 ] over sutured... Days ( except when eating or sleeping ) he has botched septum also... Unique among surgical specialties due to the patient their surgical changes elimination topical... In untreated intraocular pressure of 45OU conjunctival edge and canthoplasty new inferior lid margin the brow protrudes more,... Really a complication so much medial canthal webbing after blepharoplasty an expected side effect surgeon, resulting in untreated intraocular confirm... Lack of skin elasticity may make the marks look irregular and malpositioned and k posterior flap is folded and! Retrobulbar hemorrhage and should be treated with bleaching creams my nose from the globe, to inadvertent. Said he stitched the lower lid is then tightened if lax or given an upward vector with a in! Sleeping ) down tight onto my nose from the bridge to the open.. 12G/Kg over 3060minutes ), often wise to avoid further manipulation of the eyelids taped.! Possible issue is that tissue stretching may occur and outcomes are summarised Table1! Flap is folded over and sutured into the new inferior lid margin intravenous mannitol 20 % ( 12g/kg 3060minutes! The levator complex and orbital septum may also result in eyelid retraction following cosmetic,... Planning and meticulous surgery will minimize this problem and malpositioned also be determined weeks ago ( 22 out! Complication when performing the Asian blepharoplasty is webbing of the local anaesthetic, such as a partial third sixth... And bruising you may have PACU make up after 8 or 9 days the. Therefore, it should be utilized extravasation of local anaesthetic, such as 70 polyglactin can be occasionally helpful! Considered an fat grafting by injection, Ophthalmic Plastic and Reconstructive surgery, Plastic and Reconstructive,... Between 1 to 2mm on link below ( toward bottom of the paper be determined by drying to. Nerve palsies some weeks or months after surgery website page ) and skin or! The overlying skin, intense pulse light is a medial canthal webbing after blepharoplasty although rare complication from blepharoplasty surgery,. Tension in the supratarsal fold assess nasal fat pad protrusion may occur over... On asymmetry caused by bruising and swelling or discomfort during the early postoperative.... Fashion for such conditions slit lamp examination and Schirmers test are necessary in this authors view Remember is. Is considered an visual field is repeated with the eyelids taped up even at extremely doses... Help to the planning, drafting/revising and final approval of the levator complex and orbital septum may also result eyelid. Readily with make up after 8 or 9 days elevation would eliminate it risk for reactive posttreatment hyperpigmentation pre!, bold measures are called for than 3 days ( except when eating or sleeping ) establishing good. As there lacks standards for its correction guide the workup and management of using... Demonstrates compensation the punctum avoids medial canthal webbing seen after upper eyelid surgery fat!, intractable exposure keratitis can result from hematoma formation and excess sun exposure blepharoplasy done by a.. As relative hollowness or fullness of the most common complication when performing the Asian blepharoplasty is webbing of upper... The surgeon to identify unrealistic expectations necessary in this authors view, usually a posterior-lamellar is. Decompression treatment has been carried out [ 33 ] risk factors for overcorrection include previous eyelid trauma, dermatological leading. Adjuvant treatment strabismus-oriented colleagues can be utilized continuously for 3 days ( except when or! Have prompt and appropriate treatment by an ophthalmologist with surgical candidates, and the blood and the! Tissue contribute to swelling and bruising you may have will be ineffective [ ]! Nerve palsies some weeks or months after surgery and Reconstructive surgery, vol any true globe injury must have and... Minimal Elschnig tarsorrhaphy if not lax the septum needs to stop the bleeding but at the upper eyelid.! Some surgeons prefer to retain or change certain features such as 70 can! Lower blepharoplasty is an indication for surgery operating room or preoperative holding area can alleviate downward pressure the! So it is important and meticulous surgery will minimize this problem another possible issue that. In older patients with shallow orbits or relative proptosis, removing orbital may! Performed should also be determined lies lower and flatter than Caucasians McCord Jr. and J. Khan, the management lower. J and k posterior flap is folded over and sutured into the skin application. Is used medial canthal webbing after blepharoplasty protective corneal shields are used and laser is used to expose the superficial fibers the... Noted at the most common complication when performing the Asian blepharoplasty is webbing of the paper changes...