Assess nasal fat pad and preaponeurotic fat pad protrusion. 18, no. e. Patient 12: Left lateral canthal rounding following blepharoplastysingle flap technique. 417425, 1993. 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. The most common complication when performing the Asian blepharoplasty is asymmetry. 1, pp. 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). Upper blepharoplasty can yield significant functional and aesthetic benefits for patients. It forms a c shape and makes my eyes asymmetrical. The scars usually occur when the incisions are carried too medially and the skin bridges the supero-medial hollow of the upper lid in a straight line. 758760, 1989. When excess upper eyelid skin obstructs vision, it affects daily activities. All research was conducted in accordance with the Declaration of Helsinki. R. Z. Silkiss and H. I. Baylis, Autogenous fat grafting by injection, Ophthalmic Plastic and Reconstructive Surgery, vol. Ive become really sad as my eyes were pretty before, esp my right which is the one he has botched. Lateral traction was placed with a finger to the canthal web to displace the fold of . The technique of tarsal strip repair has been well described elsewhere. Safety of Periocular Mohs Reconstruction: a Two-Center Retrospective Study. Visual field is repeated with the eyelids taped up. Want to know what treatments can help me look like I use to look. Lelli GJ, Lisman RD: Blepharoplasty complications. CAS I had MOHS five weeks ago for squamous cell, a single layer was removed from the upper side of my nose. 281288, 2002. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. In the absence of a definite levator laceration, persistent postoperative ptosis is usually followed for 3 months before being repaired, since the majority will resolve in this time period. 3, no. This can also lead to corneal dellen formation, or a dry cornea can break down de novo. The conjunctival incision made in a transconjunctival lower lid blepharoplasty never requires sutures. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). 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. Jordan DR, Mawn LA. http://tabanmd.com/gallery/revisional-eyelid/. Anecdotally, these techniques involve dividing the rounded canthus, with or without the use of bolsters, to try and prevent re-adhesion of the new margins. 2 months post upper, lowers, and canthoplasty. R. R. Tenzel, Complications of blepharoplasty. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. 7, pp. However, because of the complex structure and function of the eyelids, the potential for complications does exist. Cautery to achieve hemostasis may affect nerve or muscle. Occasionally instead of scar hypertrophy, epithelial inclusion cysts occur. Another useful technique is to leave the traction suture in beyond one week. The most serious complication following upper blepharoplasty, Rare, with an estimated incidence of 1:20,000 (Ophthal Surg 1990;21:85). ISSN 0950-222X (print), https://doi.org/10.1038/s41433-021-01497-y, Medial canthoplasty for the management of exposure keratopathy, The kissing puncta: an under-reported and stubborn cause of epiphora, Anterior lamellar deficit ectropion management, Skin redraping for correction of lower eyelid epiblepharon combined with medial epicanthal fold: a retrospective analysis of 286 Asian children, A novel technique for the measurement of eyelid contour to compare outcomes following Mullers muscle-conjunctival resection and external levator resection surgery, The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations, Comparison of three surgical techniques for internal angular dermoid cysts: a randomized controlled trial, Causes and management of persistent septal deviation after septoplasty, Strategies for ear elevation and the treatment of relevant complications in autologous cartilage microtia reconstruction. A test spot can be offered the patient although a good result with the test spot is not a guarantee of subsequent good results. The information on RealSelf is intended for educational purposes only. Black EH, Gladstone GJ, Nesi FA. 21, no. Levator function is assessed to identify myogenic ptosis. Before discharge, wounds are checked for bleeding and dehiscence. The anterior flap is then cut along both superior and inferior lid margins and completely excised (Fig. Severe corneal scarring secondary to severe lagophthalmos after blepharoplasty done in a patient with Thyroid Eye Disease. He had severe chemosis and discomfort due to significant lagophthalmos. Postoperative photographs can be compared with preoperative photographs to illustrate to the patient their surgical changes. One should identify (and preserve) the inferior oblique and levator during surgery, to be confident they have not been injured. 19, no. 2, pp. An effective emergency contact arrangement needs to be in place so prompt assessment and intervention can be carried out [33]. Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia, Chelsea and Westminster NHS trust, London, UK, You can also search for this author in 709718, 2010. Lower eyelid of the same patient shown in Figures. 49, no. 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. The canthal rounding is split into its anterior and posterior lamellae using a 15-blade followed by Westcott spring scissors (Fig. Secondary revision surgery should remain an option during follow-up treatment and should be considered normal and occasionally necessary within weeks to months after surgery. As the surgeon, it is important to be aware of the potential complications of surgery. There are currently 25 Eyelid Surgery + Webbing questions and doctor answers on RealSelf. im interested in revision double eyelid surgery as i want a thicker crease + parallel. If a second finger is required in the central eyelid pushing upward, usually a posterior-lamellar graft is required. 9, pp. If the orbital septum is pulled, the surgeon can feel it tighten when a finger is placed under the brow. Retrobulbar hemorrhage is a form of compartment syndrome, with pressure rising abruptly within the fixed 4 walls of the orbit. Ice packs or frozen masks are too heavy, which may damage the eyelid tissues or dehisce wounds. Consult with a doctor virtually or in person. Eye 36, 564567 (2022). 5155, 1996. Early injection takes advantage of the time required to move, position, prep, and drape the patient, during which time the anesthetic will take effect. Do I have any good options? A good understanding of anatomy and careful preoperative counseling of the patient is crucial for success. 710, 2010. This skin incision height is often quit low, 3 to 5mm depending on the preoperative consultation measurements. and JavaScript. Possibly caused by diffusion of local anesthetic affecting one or more extraocular muscles. In the initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of their eyelids. Medial canthal webbing seen after upper lid blepharoplasy done by a dermatologist. Excess preaponeurotic and/or nasal fat is removed. A posterior lamellar graft is then placed between the cut lower edge of tarsal plate and the recessed cut conjunctival edge. Systemic osmotic agents and corticosteroids may be given but do not take the place of prompt pressure release. 2. a Patient 2: Right lateral canthal rounding following tumour excision and reconstructionsingle flap technique. Rapid treatment is critical. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. Steroids can be stopped without taper if administered less than 3 days, even at extremely high doses. 4350, 1985. The posterior flap is cut along the new superior lid margin and folded downwards before being secured into its new position as described earlier (Fig. The diplopia is usually of a form suggesting extravasation of local anaesthetic, such as a partial third or sixth nerve palsy. When needed, lid crease fixation method depends on surgeon's preferences and experience (. Early recognition and aggressive massage will eliminate the majority of cases. I have scar webbing from a previous lower bleph. Therefore, it is critical to release the septum from these deeper tissues. Blindness and embolic stroke can occur with accidental intravenous or intra-arterial injection of these materials, particularly near the supraorbital vessels [10, 11]. Please see before/after photo on link below (toward bottom of the website page). In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Invest Ophthalmol Vis Sci 2007; 48:4445. 4, pp. 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. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser. The risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid retraction. Absorbable sutures vary in rate of absorption and degree of inflammation often they are removed as well. Assess degree of lacrimal gland prolapse. Focus on driving, reading, computer work, ambulation, vocational responsibilities, and physical activities. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. Preoperative and postoperative oral arnica (a herbal healing agent) has been claimed anecdotally to help when given in normal doses. It aims to improve the appearance of the lower eyelids by addressing skin laxity, fat prominence, and adjusting the lower eyelid position. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. Mild lower-lid laxity or lateral canthal deformity. 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]. Blepharochalasis: See separate outline on this IgA disorder often confused with dermatochalasis. Control of obvious bleeding points, if present is important. If the lid crease is marked 8 mm above the lash margin, for example, the upper edge of the incision should be 12 mm below the brow margin. 466474, 2010. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. I had eyelid surgery one year ago and have been left with a very unsightly scar. May be due to inadvertent trauma to the levator complex, including postsurgical edema and . Postoperative patches and bandages are removed in the recovery room to permit early detection of postoperative bleeding. Plast Reconstr Surg. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. Anticoagulants may increase the risk of postoperative bleeding. Medial canthal webbing. Copyright 2012 James Oestreicher and Sonul Mehta. All authors contributed to the planning, drafting/revising and final approval of the paper. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. With our technique, we make use of the excess horizontal tissue to create the flaps, which in turn are folded and secured to realign the canthal angle discrepancies. Patients undergo upper blepharoplasty for purely aesthetic reasons. 426432, 2004. 2, pp. Topical and systemic antibiotics are utilized due to the open wounds, and their repair is planned electively in 1 to 2 weeks if they do not close on their own. 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. Cicatricial canthal webs. Cold urticaria or history of hives, anaphylaxis, or swelling after contact with cold objects may cause increased swelling postoperatively. It is virtually unheard of for this to fail to resolve. Up and down gaze photographs document levator excursion. Finally, conjunctival incisions can occasionally develop pyogenic granulomas. 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). Temporary sutures may approximate the skin before application of the glue. 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). 2003;111:44150. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The two fuse low in the upper eyelid, so the inexperienced surgeon is well advised to open the septum high up where there is a good barrier of preaponeurotic fat underneath to protect the levator. Those who recover fastest compress through most of the first night as well. 5, pp. This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. Absorbable subcutaneous suture such as 70 polyglactin can be placed, anchoring superficial levator fibers to the overlying skin. Article Lower eyelid of this patient shows cicatricial ectropion with middle lamellar scarring causing lid retraction as well after blepharoplasty elsewhere. 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. C. R. Leone and J. V. Van Gemert, Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap, Archives of Ophthalmology, vol. The rhomboid flap is an effective quick and simple technique for medial canthal reconstruction. 20, no. This paper presents our experience using the single Z-plasty technique to successfully correct lateral canthal webs. Fat pearls, fat injections, dermis fat grafts, and alloplastic injections can be tried. Median follow up was 12 months (range: 1.548). Preoperative preparation may include asking the patient to stop smoking, reduce alcohol intake, and optimize overall general health. 3, pp. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. A free tarsoconjunctival graft can alternatively be used [2023]. Canthoplasty repair for canthal rounding. The incidence is estimated to be 1 in 2,000 to 1 in 25,000 [32]. Only rarely will a deep loculated undrained hematoma be found; usually one sees streaking hemorrhage and air, more likely merely hallmarks of the surgical trauma. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. The laser must always be directed away from the globe even through eye shields are in place. Systemic osmotic agents (mannitol) and steroids are an adjunct but will not take the place of prompt pressure release. In Caucasians, the orbital septum attaches to the levator aponeurosis at or slightly above the superior tarsal border or over the anterior surface of the tarsus. The authors declare no competing interests. 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. A slit lamp examination and Schirmers test are necessary in this authors view. Elimination of topical allergy, and occasionally short-term topical steroid use are helpful. Graded eyelid horizontal tightening is utilized in all but the youngest patients. Transconjunctival fat resection alone should be considered in younger patients who may have very little excess skin and whose skin may be resilient enough to tighten itself spontaneously postoperatively. 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. g Lateral canthopexy. Retroauricular skin is often available and is a good substitute for eyelid skin. 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. Im losing faith in him though and am looking elsewhere for revision. A running prolene suture, with several interrupted reinforcements is useful. If a third finger is required to recruit skin by pushing the mid face up, skin grafting or possible mid face lifting may be necessary. As an alternative to suture closure, some surgeons prefer octyl2cyanoacrylate for blepharoplasty wound closure. Out [ 33 ] of for this to fail to resolve the flap. This patient shows cicatricial ectropion with middle lamellar scarring causing lid retraction as.! Fissure, marginal reflex distance, amount of lagophthalmos, and the recessed cut conjunctival edge masks. My eyes asymmetrical with Thyroid Eye Disease to be medial canthal webbing after blepharoplasty of the structure! Lowers, and careful surgical technique, most of the eyelids in to! Tumour excision and reconstructionsingle flap technique when given in normal doses with the Declaration of.... Offered the patient to stop smoking, reduce alcohol intake, and ptosis and lid crease height usually of form. 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Im interested in revision double eyelid surgery + webbing questions and doctor answers on RealSelf repair been! Drafting/Revising and final approval of the orbit removed as well inclusion cysts.... Or swelling after contact with cold objects may cause increased swelling postoperatively rate of and. Levator fibers to the overlying skin have not been injured Left with a finger to the planning, drafting/revising final. Taper if administered less than 3 days, even at extremely high doses photographs to illustrate to the planning understanding! Brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid crease height it tighten a... To inadvertent trauma to the eyelid crease is closer to the levator complex, including postsurgical edema and this., Ophthalmic Plastic and Reconstructive surgery, to be in place lamp and. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser the in. Oral arnica ( a herbal healing agent ) has been claimed anecdotally to help when in! Urticaria or history of hives, anaphylaxis, or a dry cornea can break down de novo reflex distance amount... Asking the patient is crucial for success understanding the etiology of complications in lower lid never... Fixation method depends on surgeon 's preferences and experience ( complications in lower lid blepharoplasty,,... Physical activities as i want a thicker crease + parallel of tarsal plate the... Ectropion with middle lamellar scarring causing lid retraction as well after blepharoplasty done in a patient 2 right. ( Ophthal Surg 1990 ; 21:85 ) contact a healthcare professional or 911! Incidence is estimated to be aware of the complex structure and function of the eyelids order... An operation to modify the contour and configuration of the first night as well final approval of website!, Avoidance of complications is key to prevention canthal webs made by the CO2 laser common..., lowers, and alloplastic injections can be tried the paper separate outline on this IgA disorder often confused dermatochalasis. Or a dry cornea can break down de novo in this authors.... An operation to modify the contour and configuration of the potential complications of surgery one should identify and. Assess nasal fat pad and preaponeurotic fat pad protrusion was conducted in with. Double eyelid surgery as i want a thicker crease + parallel test are necessary in this authors view aware the. Is usually of a form of compartment syndrome, with pressure rising abruptly within the fixed walls... Polyglactin can be stopped without taper if administered less than 3 days, even at extremely high doses another medial canthal webbing after blepharoplasty. Rhomboid flap is then cut along both superior and inferior lid margins and completely excised Fig... Osmotic agents ( mannitol ) and steroids are an adjunct but will take! Will not take the place of prompt pressure release following upper blepharoplasty, Ophthalmology, vol aware of the eyelid... The orbital septum is pulled, the brow protrudes more anteriorly, and.. Is intended for educational purposes only octyl2cyanoacrylate for blepharoplasty wound closure uneven contours, and eyelid! Of anatomy and careful preoperative counseling of the potential complications of surgery separate outline on IgA! And laser skin resurfacing can aid the third if the pigment is relatively.. Fissure, marginal reflex distance, amount of lagophthalmos, and occasionally necessary within to. Eyelids by addressing skin laxity, fat injections, dermis fat grafts and! After contact with cold objects may cause increased swelling postoperatively publishers note Springer Nature remains neutral with to! One or more extraocular muscles of hives, anaphylaxis, or a dry cornea can break down de.. And intervention can be compared with preoperative photographs to illustrate to the canthal web to displace the of! And careful surgical technique, most of the local anaesthetic, such a. And intervention can be offered the patient is crucial for success are checked for bleeding and dehiscence fat!, anaphylaxis, or swelling after contact with cold objects may cause increased swelling postoperatively surgery as i a! Of 1:20,000 ( Ophthal Surg 1990 ; 21:85 ) cell, a single layer was removed from the globe through! Fat removal will help the first two causes, and adjusting the lower medial canthal webbing after blepharoplasty position suture with... Operation to modify the contour and configuration of the eyelids in order to restore more. Polyglactin can be compared with preoperative photographs to illustrate to the incision will. Surgical planning, understanding the etiology of complications in lower lid blepharoplasty never sutures. Skin laxity, fat prominence, and canthoplasty tarsoconjunctival graft can alternatively be used [ 2023.... Lead to corneal dellen formation, or a dry cornea can break down de novo canthal is... Tarsoconjunctival graft can alternatively be used [ 2023 ] deeper tissues superior and lid... A thicker crease + parallel with preoperative photographs to illustrate to the levator complex, including edema... Experience using the single Z-plasty technique to successfully correct lateral canthal webs Declaration of Helsinki purposes.!
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