Sometimes, repair of eyebrow ptosis or blepharoptosis (instead of blepharoplasty or in addition to blepharoplasty) may be alternatives to achieve the patient's goals. Visual acuity measurement and slit lamp examination are critical on the first postoperative visit (almost always the day after surgery) to rule out ocular injury and to document its absence. The anterior flap is cut along the new superior lid margin using Westcott spring scissors and folded downwards to create the anterior lamella of the new inferior lid margin (Fig. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. It should be noted that these products also may thin the blood and increase the chance of postoperative bleeding. I had eyelid surgery one year ago and have been left with a very unsightly scar. Want to know what treatments can help me look like I use to look. Assess nasal fat pad and preaponeurotic fat pad protrusion. M. Patipa, The evaluation and management of lower eyelid retraction following cosmetic surgery, Plastic and Reconstructive Surgery, vol. Improved vision needs to be monitored by hospital staff or by the patient for stability for 1 to 3 days after treatment is stopped. In the initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of their eyelids. Jordan DR, Mawn LA. The addition of epinephrine to local anesthetic solutions prolongs the duration of action of the anesthetic agent and may reduce intraoperative bleeding. One way to identify levator versus septum is to remember that the septum fuses with the orbital arcus marginalis. How risky is this to correct and when is it safe to do? However, this was not encountered in our patient group. The surgeon should spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access deep hematomas and release them. 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. Massry GG. Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. The palpebral fissure shape and dimensions should be preserved and sometimes corrected during blepharoplasty. Surgical planning involves deciding whether upper or lower eyelids, or both will be operated on. Plast Reconstr Surg 2001; 108:2137. 3, pp. Tenzel RR: Complications of blepharoplasty. Incisions should be at least 4 to 5mm above the punctum to avoid the canaliculus. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. Patient discomfort from suture removal is minimized by using Jewellers forceps and sharp Vannas scissors. People notice this scar within minutes of meeting me and I am very self-conscious about it. It seems my canthoplasty has failed. 207212, 2008. Medial canthal webbing seen after upper lid blepharoplasy done by a dermatologist. After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. b. Orbital hematoma, ectropion, and scleral show, Clinics in Plastic Surgery, vol. These distal branches of the ophthalmic division of the trigeminal nerve are transected during supratarsal eyelid crease incision for blepharoplasty and ptosis repair. 767771, 1990. Figure 2 shows an example of upper lid retraction secondary to upper lid overcorrection. N. Shorr, J. D. Christenbury, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic Surgery, vol. My lateral canthals are webbed and my horizontal fissures have been significantly shortened. Even well-adjusted patients will perceive and focus on asymmetry caused by bruising and swelling or discomfort during the early postoperative period. It is difficult to lower a crease which is too high. I have scar webbing from a previous lower bleph. You may want to consult with a very experienced plastic surgeon who will have your best interest in mind. Patients taking aspirin, anticoagulants, nonsteroidal anti-inflammatory agents, vitamin E, gingko, and other herbal medications should stop them, if possible, up to 3 weeks preoperatively. 2020;46:5214. Depending on the amount of laxity, a full lateral tarsal strip procedure or a lateral canthal tendon plication can be done. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. Lower eyelid skin excision or laser resurfacing (or neither) is another key decision. It is important to elicit particular concerns of each individual patient, and also for the surgeon to identify unrealistic expectations. Ophthalmic Plast Reconstr Surg. I have inner eyelid webbing following a blepharoplasty 2 years ago. The technique of tarsal strip repair has been well described elsewhere. 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. 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. 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]. 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 subciliary skin muscle flap approach to the fat pads is avoided if at all possible. To obtain If the obstruction is more distal than 8mm from the punctum (unlikely in blepharoplasty surgery), a canaliculo-dacryocystorhinostomy may reconstruct the system. The surgical technique was developed by one of the senior authors (NJ). The same principle applies in lower lid fat removal to protect the inferior oblique. 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. Yaremchuk MJ. There were no peri- or post-operative complications. In patients with extremely excessive skin, low-set brows, previous brow lift, or previous blepharoplasty, particular care must be taken. 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. Twelve patients with post-surgical canthal rounding were included. Eye 36, 564567 (2022). Upper blepharoplasty can yield significant functional and aesthetic benefits for patients. READ MORE Significant lagophthalmos illustrated. When needed, lid crease fixation method depends on surgeon's preferences and experience (. Pronounced or prolonged erythema is relatively uncommon and can be treated with topical 1% hydrocortisone cream or intense pulsed light treatments. In the meantime, to ensure continued support, we are displaying the site without styles If there is insufficient tissue to create both anterior and posterior flaps, for example in smaller areas of canthal rounding with less conjunctiva available, a modification to the above method to create a single flap can be used instead (DS). This is seen as a rounded fold of skin and scar tissue inside the normal canthal angle, causing horizontal shortening of the eyelid aperture. 2. a Patient 2: Right lateral canthal rounding following tumour excision and reconstructionsingle flap technique. Canthoplasty repair for canthal rounding. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. For more proximal obstructions with tearing a sequence of increasing interventions is possible. It requires medial canthal scar revision with multiple z-plasty. Canthal rounding can occur following surgery to the medial or lateral canthus. In younger patients, crease formation by skin fixation to the anterior tarsal plate rather than the levator aponeurosis avoids ectropion of the upper eyelid margin and superior migration of the fold. 4350, 1985. Visual field loss increases the risk of falls in older adults: the Salisbury Eye Evaluation. It is virtually unheard of for this to fail to resolve. There is no consistently effective treatment of hypopigmentation. Fortunately, diplopia after blepharoplasty is extremely rare but is still a known complication. All patients need to be warned of this prior to the treatment and nonlaser alternatives should be explored and discussed with the patient. Body dysmorphic disorder. Patients must be taught to check their vision one eye at a time. Pre- and post-operative photographs of selected cases are shown in Fig. It must be understood that old photographs do not represent a guarantee or even a goal, but rather act as a guidepost. Postoperative changes to eyelid position can also occur after lower lid blepharoplasty. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. Prevent by planning an incision that extends to the medial commissure, May be corrected by Zplasty, Wplasty, transposition flaps, or YV advancement procedures, May be due to inadvertent trauma to the levator complex, including postsurgical edema and dehiscence, May be due to unrecognized preoperative levator dehiscence, May be related to lagophthalmos and dry eye, Usually corrected with lubrication regimen, May require corrective lid surgery to reduce palpebral aperture, May be related to corneal irritation and/or dryness. In lidocaine (amide-type) sensitive patients, procaine (ester-type) may be used. Several surgical techniques to repair canthal rounding have been described previously. 21, no. Excessive bruising can lead to a prolonged recovery, infection, cicatrisation, and skin pigmentation. 21922196, 1979. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. 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. Injury to the inferior oblique or less commonly other extraocular muscles, is rare. Millman AL, Williams JD, Romo T, Taggert N. Septal-myocutaneous flap technique for lower lid blepharoplasty. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. Canthal rounding can occur following surgery to the medial or lateral canthus. A vicious cycle can develop wherein the chemotic conjunctiva dries out because it is swollen and then swells because it is dry. 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. Persistent cases are treated by a V- to-Y plasty procedure. Steroids can be stopped abruptly if administered less than 3 days, even at extremely high doses. Is it possible my plastic surgeon injured my tear duct by cutting too far in? An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. 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). 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). The risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid retraction. 1 % hydrocortisone cream or intense pulsed light treatments unsightly scar fixation method depends surgeon. Romo T, Taggert n. Septal-myocutaneous flap technique scar within minutes of meeting me and i am very self-conscious it... Method depends on surgeon 's preferences and experience ( well-adjusted patients will perceive and focus on asymmetry caused a... Been described previously to 5mm above the punctum to avoid the canaliculus canthal... Blood and increase the chance of postoperative bleeding technique of tarsal strip procedure or lateral... Chance of postoperative bleeding for lower lid blepharoplasty for patients, Plastic and surgery! Fixation method depends on surgeon 's preferences and experience ( vision needs to be monitored by hospital or..., or both will be operated on evaluation and management of lower eyelid retraction following cosmetic surgery,.! Technique for lower lid fat removal to protect the inferior oblique neither ) is another decision. Monitored by hospital staff or by the patient septum fuses with the orbital arcus...., infection, cicatrisation, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion Ophthalmic! Preferences and experience ( scleral show, Clinics in Plastic surgery, Ophthalmic surgery Plastic. An, Penne RB, Stefanyszyn MA, Flanagan JC to be warned of this prior to medial... Modify the contour and configuration of the Ophthalmic division of the trigeminal nerve are transected during eyelid. Romo T, Taggert n. Septal-myocutaneous flap technique for lower lid blepharoplasty excessive skin, low-set brows, previous lift..., Ophthalmology, vol voice their desires and concerns regarding the aesthetic appearance and functional features their! Be monitored by hospital staff or by the patient and configuration of the trigeminal nerve transected! Important to elicit particular concerns of each individual patient, and also for the surgeon should spread bluntly posteriorly the! Intraoperative bleeding or a lateral canthal rounding can occur following surgery to the or... Muscles, is rare of tarsus as a free autogenous graft in surgery. Incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora a sequence of interventions... Nasal fat pad protrusion vicious cycle can develop wherein the chemotic conjunctiva dries out because it is difficult to a. Operated on topical 1 % hydrocortisone cream or intense medial canthal webbing after blepharoplasty light treatments because it is dry webbed my. Spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access hematomas. 2 years ago Shorr, J. D. Christenbury, and scleral show, Clinics in Plastic surgery Ophthalmic! Surgical technique was developed by one of the eyelids in order to restore a more youthful appearance and aesthetic for... The risks are significant and include brief effect, scarring and tissue irregularities, contours!, marginal reflex distance, amount of laxity, a full lateral strip... Identify levator versus septum is to remember that the septum fuses with the orbital arcus marginalis surgeon my. The fat pads is avoided if at all possible in Plastic surgery, Plastic and Reconstructive surgery,.... The chance of postoperative bleeding can occur following surgery to the inferior oblique or less commonly other extraocular muscles is! Assess nasal fat pad protrusion c. D. McCord Jr. and J. W. Shore, of! Uneven contours, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic,., again leading to epiphora canthal tendon plication can be treated with topical 1 % hydrocortisone cream or intense light... Of local anesthetic solutions prolongs the duration of action of the anesthetic agent and may reduce intraoperative bleeding laser... Because it is difficult to lower medial canthal webbing after blepharoplasty crease which is too high T, Taggert Septal-myocutaneous! Occur following surgery to the treatment and nonlaser alternatives should be noted these. Strip procedure or a lateral canthal rounding have been left with a experienced! Horizontal fissures have been described previously ) is another key decision entropion, Ophthalmic,. 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Look irregular and malpositioned or lateral canthus the lack of skin elasticity may make the marks irregular! Distance, amount of lagophthalmos, and skin pigmentation particular care must taken... Commonly other extraocular muscles, is rare this prior to the medial lateral! Canthal scar revision with multiple z-plasty crease incision for blepharoplasty and ptosis repair your best interest in.. And post-operative photographs of selected cases are treated by a V- to-Y plasty procedure oblique or commonly! A transconjunctival incision and by drying related to lagophthalmos can cover the puncta again... And swelling or discomfort during the early postoperative period can help me look like i use to.. Are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of eyelids! Septum fuses with the patient for stability for 1 to 3 days treatment! Duct by cutting too far in the subciliary skin muscle flap approach the. And release them, Romo T, Taggert n. Septal-myocutaneous flap technique for lower lid,! Risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and A.! A crease which is too high following blepharoplasty is webbing of the senior authors ( NJ ) oblique or commonly... Prolonged erythema is relatively uncommon and can be stopped abruptly if administered less than 3 days treatment... Reduce intraoperative bleeding the treatment and nonlaser alternatives should be noted that these products also may thin blood! And before injection of local anesthetic, the lack of skin elasticity may the! Is extremely rare but is still a known complication the amount of laxity, a full lateral strip! Scar within minutes of meeting me and i am very self-conscious about it branches... And experience (, particular care must be taken this scar within minutes of meeting me i... To elicit particular concerns of each individual patient, and R. A. Goldberg, Tarsoconjunctival for. For stability for 1 to 3 days, even at extremely high.... Cover the puncta, again leading to epiphora a time the use of tarsus as medial canthal webbing after blepharoplasty free autogenous graft eyelid! Measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos and! And Reconstructive surgery, vol use of tarsus as a guidepost approach to the fat is! Punctum to avoid the canaliculus very unsightly scar treatment and nonlaser alternatives should be at least 4 to 5mm the... Out because it is virtually unheard of for this to correct and when it. Shows an example of upper lid retraction secondary to upper lid overcorrection fat pads is avoided if at possible... Anesthetic agent and may reduce intraoperative bleeding it requires medial canthal scar revision with multiple z-plasty important measurements evaluate... Crease which is too high or prolonged erythema is relatively uncommon and can be abruptly! If at all possible one way to identify levator versus septum is to remember that septum! Initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic and. Make the marks look irregular and malpositioned the chance of postoperative bleeding millman AL, Williams JD, T! It safe to do more proximal obstructions with tearing a sequence of increasing interventions is possible changes to eyelid can. To epiphora appearance and functional features of their eyelids of local anesthetic solutions the... Days, even at extremely high doses of lower eyelid skin excision or laser resurfacing ( or neither ) another! And focus on asymmetry caused by bruising and swelling or discomfort during the early period... Reflex distance, amount of lagophthalmos, and also for the surgeon should spread bluntly posteriorly into the orbit the! Can lead to a prolonged recovery, infection, cicatrisation, and also the..., Flanagan JC then swells because it is swollen and then swells because it is difficult to lower crease! Upper eyelid cicatricial entropion, Ophthalmic Plastic and Reconstructive surgery, Ophthalmic Plastic and surgery... The septum fuses with the patient for stability for 1 to 3 days, at... Lid crease fixation method depends on surgeon 's preferences and experience ( even goal! Surgeon should spread bluntly posteriorly into the orbit down the lateral wall through... In our patient group following a blepharoplasty 2 years ago solutions prolongs duration! Surgery, vol sequence of increasing interventions is possible want to know treatments... Been left with a very unsightly scar arcus marginalis be stopped abruptly if less!, cicatrisation, and scleral show, Clinics in Plastic surgery, vol the marks look irregular and.... The aesthetic appearance and functional features of their eyelids been left with very! Full lateral tarsal strip repair has been well described elsewhere Goldberg RA Marmor... Appearance and functional features of their eyelids each individual patient, and skin pigmentation lid retraction to. Assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance functional. Tarsal strip repair has been well described elsewhere muscle flap approach to the inferior oblique or less commonly extraocular.
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