Ophthal Plast Reconstr Surg 2004; 20:426. The patient has severe symptomatic lagophthalmos as well as an unsightly appearance. The information on RealSelf is intended for educational purposes only. The skin then bridges the superomedial hollow of the upper lid in a straight line. Twelve patients with post-surgical canthal rounding were included. Find a surgeon who can do this for you but you also have to understand that there is always a risk for scarring that may be visible. The risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid retraction. 4, pp. Review of old or family photographs may be helpful in clarifying preferences and objectives. If suspicious that an orbital hemorrhage has occurred, laser eye protectors (metallic scleral contact lenses) block vision and must be removed to assess the visual acuity. 1g). After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. Excess skin only may be removed or orbicularis muscle and/or fat may be removed as well. Laser can be used to expose the superficial fibers of the levator for incorporation into the skin closure. R. L. Anderson and D. D. Gordy, The tarsal strip procedure, Archives of Ophthalmology, vol. Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. 2, pp. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Please see before/after photo on link below (toward bottom of the website page). 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. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. Rapid treatment is critical. PubMedGoogle Scholar. The technique of tarsal strip repair has been well described elsewhere. Severe corneal scarring secondary to severe lagophthalmos after blepharoplasty done in a patient with Thyroid Eye Disease. Patients must be taught to check their vision one eye at a time. Epiphora from damage to the lacrimal outflow system can occur if the incision line is carried too medially and too close to the horizontal midline. G. W. Jelks and E. B. Jelks, Repair of lower lid deformities, Clinics in Plastic Surgery, vol. On average, this amount is between 1 to 2mm. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. 2, no. Due to the inability to close the eyelid, intractable exposure keratitis can result. It forms a c shape and makes my eyes asymmetrical. Depth of excision depends on the preoperative plan. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. 7175, 1987. One way to identify levator versus septum is to remember that the septum fuses with the orbital arcus marginalis. 8589, 1990. 1b). Minimizing wound dehiscence involves appropriate suture choice and suture placement. The patient demographics, clinical characteristics and outcomes are summarised in Table1. It is, therefore, often wise to avoid further manipulation of the upper lid by taking a donor graft from it. 372376, 1998. 3, pp. b The canthal rounding is split into its anterior and posterior lamellae. Am J Ophthalmol 1996;121:677. A contact lens does require a daily or near daily visit until the abrasion is healed and the lens is removed. 316320, 1988. J Allergy Clin Immunol 1986; 78:417. 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. In Asians, the lid crease is usually 46mm above the lash margin, In Caucasians, usually 810mm above the lash margin. Patient education and cold avoidance are the primary means of treatment. Blindness and embolic stroke can occur with accidental intravenous or intra-arterial injection of these materials, particularly near the supraorbital vessels [10, 11]. This is seen as a rounded fold of skin and scar tissue inside the normal canthal angle, causing horizontal shortening of the eyelid aperture. What complications can come from a blepharoplasty? Patient 3: Left lateral canthal rounding following tumour excision and reconstructionsingle flap technique. 20, no. Patients may fail to recognize substantial change in their appearance until they view pre- and postoperative photographs. Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. 2005; 21:327. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. Answer: Inner eyelid webbing scar after blepharoplasty Hi. Lubrication, cool compresses, and observation are essential to resolution. 5, pp. Sutureless closure of the upper eyelids in blepharoplasty: use of octyl-2-cyanoacrylate. 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. 3, pp. In addition, supporting structures such as canthal tendons are tightened. This can also lead to corneal dellen formation, or a dry cornea can break down de novo. 4350, 1985. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. 19, no. Dermatol Surg. Lateral canthal support is used to address the lower eyelid laxity either by . Postoperatively, the management of patients concerns can range from reassurance to surgical intervention, depending on the concern. Mild inner webbing too. Moistened gauze may be placed over the closed eyelids. In one patient there was rounding recurrence. Patients may usually resume normal activities within 2448 hours after surgery. Patient selection and patient satisfaction. 1f). Orbital hematoma, ectropion, and scleral show, Clinics in Plastic Surgery, vol. Allergies and a list of medications should be noted. Fortunately, diplopia after blepharoplasty is extremely rare but is still a known complication. Temporary sutures may approximate the skin before application of the glue. Finally, conjunctival incisions can occasionally develop pyogenic granulomas. Dermatol Surg 2005; 31:553. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. R. D. Anderson and M. W. Lo, Endoscopic malar/midface suspension procedure, Plastic and Reconstructive Surgery, vol. Postoperative eyelid edema and levator edema are common and are temporary causes of ptosis. Ice packs or frozen masks are too heavy, which may damage the eyelid tissues or dehisce wounds. Therefore, one needs to be gentle when freeing up the fat from the underlying levator or the levator can be damaged inadvertently. R. R. Tenzel, Treatment of lagophthalmos of the lower lid, Archives of Ophthalmology, vol. Patients may prefer to retain or change certain features such as relative hollowness or fullness of the upper eyelid sulcus. Filling in the hollowed areas can be problematic. Most patients only need to take 7 days off work. McKean-Cowdin R, Varma R, Wu J, et al. Systemic osmotic agents (mannitol) and steroids are an adjunct but will not take the place of prompt pressure release. Yazici B, etinkaya A, akirli E. Bilobed flap in the reconstruction of inferior and/or lateral periorbital defects. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. i Anterior flap is completely excised. Medial canthal webbing occurs when incisions are carried too medially as seen in Figure 9. Internet Explorer). Plast Reconstr Surg. 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. Heinze JB, Hueston JT. Postoperative changes to eyelid position can also occur after lower lid blepharoplasty. CO2 laser incisions need 7 days to heal, so sutures are removed on day 7 or 8. Ophthalmic Plast Reconstr Surg. If the surgeon thought to preserve the excised skin in moist gauze, this can be utilized up to one week postoperatively. Lower eyelid of the same patient shown in Figures. Perin LF, Helene A, Fraga MF. Tension in the levator complex and orbital septum may also result in eyelid retraction. The incidence is estimated to be 1 in 2,000 to 1 in 25,000 [32]. Not only the surgeon but also the patient should be aware of preoperative asymmetry and the potential for minor touch up operations. 3, article 3, 1995. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. The patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids closed at night. Several surgical techniques to repair canthal rounding have been described previously. The palpebral fissure shape and dimensions should be preserved and sometimes corrected during blepharoplasty. Steroids can be stopped abruptly if administered less than 3 days, even at extremely high doses. 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). Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery by chance alone. I have scar webbing from a previous lower bleph. May be due to inadvertent trauma, poor wound healing, excessive tension, early suture removal, and infection. Involvement of an internist or hospitalist is helpful in managing fluid shifts caused by these osmotic agents. CT scan is important, but only after initial decompression treatment has been carried out. Consideration can be given to prophylactic lower lid elevation and posterior lamellar grafting at the time of blepharoplasty surgery. Patients should rest with their head up at least 45 to 60 degrees. The patients racial, ethnic, or congenital facial features must be noted and discussion made as to what, if anything, is to be changed. In addition to primary closure of the skin, attention may focus on creation of symmetric and well-positioned eyelid creases. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. 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. Tension in the reconstruction of inferior and/or lateral periorbital defects helpful in clarifying and... Period, small interventions can make a big difference in the early postoperative period, small interventions can make big... System injury strip repair has been carried out common and are temporary causes of ptosis or family may... 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