Upper blepharoplasty can yield significant functional and aesthetic benefits for patients. For lower eyelid blepharoplasty in Asians, transconjunctival fat removal yields far superior results to an external approach [34]. The authors favor CO2 laser blepharoplasty with a trans-conjunctival lower lid approach. 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. Temporary sutures may approximate the skin before application of the glue. Similarly, corneal epithelial breakdown can result in transient pain, foreign body sensation and tearing. Several surgical techniques to repair canthal rounding have been described previously. One starts with a three snip on the punctum of the unobstructed canaliculus, followed by a DCR (to enhance flow through the unobstructed canaliculus), followed by a DCR with Jones tube in refractory cases. 3 The lateral canthal angle is sharp and crisp, with the lateral commissure closely opposed to the globe . I had an upper eyelid surgery six months ago and it has been a disaster. The wound may be left open or closed loosely. Mild inner webbing too. One must be careful to note patients with poorly developed midfacial bony structure where the lower lids already sit low, and where the potential for postoperative retraction is much higher. Excess preaponeurotic and/or nasal fat is removed. If a definite levator laceration is observed, it should be repaired if it is causing ptosis. at my consult, the Dr. mentioned that in order to get parallel, i would need to get epicanthoplasty as well but that theres a chance of having visible scarring with epicanthoplasty. Fronto-ethmoidal external approaches and more rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing. The use of the CO2 laser and maintaining a dry surgical field with bipolar cautery or by defocusing the CO2 laser will minimize the occurrence of postoperative ecchymosis. Midfacial lifting is beyond the scope of this monograph [30, 31]. Ophthalmic Plast Reconstr Surg. Another useful technique is to leave the traction suture in beyond one week. Proptosis, decreased motility, and increased orbital tension, and associated bleeding are the clinical signs to appreciate. Thank you. The perceived gravity of a given complication may differ between the patient and the surgeon [1, 3]. 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). One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. 1, pp. Patients may usually resume normal activities within 2448 hours after surgery. May occur with CO2 laser, steel scalpel, radiofrequency needle, or local anesthetic injection. Patients with previously established PACU can still undergo surgery if appropriate safety precautions are followed. Reassuring the patient that privacy will be maintained helps facilitate the patients ability to articulate his or her desired outcome. 207212, 2008. Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in the operating room, required. The oblique divides the medial lower fat pad from the central lower fat pad and it should be easily identified, and thus protected. 20292041, 1999. If pigment is present without fat herniation, treatment with skin bleaching agents can be tried first. 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]. Meticulous preoperative planning, including precise measurements and noting any asymmetry in facial features, should be a routine for every surgeon. These distal branches of the ophthalmic division of the trigeminal nerve are transected during supratarsal eyelid crease incision for blepharoplasty and ptosis repair. The incidence is estimated to be 1 in 2,000 to 1 in 25,000 [32]. 18, no. There were no peri- or post-operative complications. The skin then bridges the superomedial hollow of the upper lid in a straight line. 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. Google Scholar. Similarly, when using the CO2 laser to cut fat lobules free, one needs a back stop (usually a Q-tip) to absorb the transmitted laser energy and avoid damage to the structures that lie beneath (levator, Mullers muscle, conjunctiva and globe). Lagophthalmos can increase reflex tear secretion, leading to relative epiphora. Postoperative eyelid numbness involving the upper eyelid skin and eyelashes is an expected outcome after upper blepharoplasty and typically resolves over 2 to 4 months. 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. In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the three finger test. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. A cold stimulation test may confirm the diagnosis of PACU. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. The assistance of your strabismus-oriented colleagues can be occasionally very helpful if the deficit persists. Measure skin amount in millimeters between the lower border of the central brow and the eyelash margin. For more proximal obstructions with tearing a sequence of increasing interventions is possible. N. Shorr, J. D. Christenbury, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic Surgery, vol. The surgeon needs to stop the bleeding but at the same time avoid excess cautery or other trauma to the muscle. All research was conducted in accordance with the Declaration of Helsinki. 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. Aulus Cornelius Celsus was a first-century Roman who described making an incision in the skin to relax the eyelids (Orbit 2012;31:162). Lower eyelid skin excision or laser resurfacing (or neither) is another key decision. Identifying patients with body dysmorphic syndrome, dysmorphophobia, or narcissistic behavior helps screen for those who may not be appropriate candidates for surgery. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. READ MORE A slit lamp examination and Schirmers test are necessary in this authors view. 2003;111:44150. 1, pp. Partial removal of orbicularis over the lateral orbital rim area may provide a small eyebrow elevation. 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]. These techniques are similar to those utilized to treat the eyelid retraction of thyroid eye disease [27]. The conjunctivalised tissue appears effective at increasing the lid aperture and preventing re-adhesions, even when only a single flap is used and one lid margin is left to granulate. This paper presents our experience using the single Z-plasty technique to successfully correct lateral canthal webs. Therefore, it is critical to release the septum from these deeper tissues. The laser must always be directed away from the globe even through eye shields are in place. Article In patients with shallow orbits or relative proptosis, removing orbital fat may mask underlying proptosis and provide aesthetic help to the patient. i Anterior flap is completely excised. Will I need an eventual revision? Facial plastic and reconstructive surgery is a remarkably diverse specialty, ranging from maxillofacial trauma and reconstruction to facial rejuvenation, rhinoplasty, cleft surgery, microvascular surgery, facial cosmetic procedures, and pain control. Especially on one side more than the other! If a second finger is required in the central eyelid pushing upward, usually a posterior-lamellar graft is required. The risk is failure, with reemphasis, doubling, or other scarring of the existing low crease. Removal or preservation of fat and muscle can help achieve these goals. For an upper lid blepharoplasty, skin sutures with 6-0 prolene imbricating levator or pretarsal tissue is preferred. 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. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. Sometimes, repair of eyebrow ptosis or blepharoptosis (instead of blepharoplasty or in addition to blepharoplasty) may be alternatives to achieve the patient's goals. This interferes with the tear pump mechanism. 758760, 1989. 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. These should usually be delayed for 3 months or more if possible after the primary procedure to avoid surgical tail chasing. Allowance for asymmetry not to be corrected (such as minor brow height differences) needs to be made. Even a moderate amount can be upsetting to the patient who has always been heavy lidded. 10391046, 1983. 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. Please see before/after photo on link below (toward bottom of the website page). I had an upper bleph three weeks ago (22 days out). im worried that i wont be satisfied with my results if i only get the upper bleph, but im also worried about getting bad scars / webbing with epicanthoplasty. Tenzel RR: Complications of blepharoplasty. In patients (especially males) with prominent skin and orbicularis excess who are not laser candidates, fat is still removed transconjunctivally, the eyelid is tightened horizontally and a conservative skin muscle pinch excision is utilized. G. J. Leilli and R. D. Lieman, Blepharoplasty complications, Plastic and Reconstructive Surgery, vol. This is particularly important if incisions are made with the CO2 laser. Treatment of conjunctival chemosis can alleviate downward pressure on the lower eyelid. The patient was given topical steroids by his original surgeon, resulting in untreated intraocular pressure of 45OU. The canthal rounding is split into its anterior and posterior lamellae using a 15-blade followed by Westcott spring scissors (Fig. The subciliary skin muscle flap approach to the fat pads is avoided if at all possible. Medially, this often results from the incision nearing the lid margin too closely or if the incision is extended to far medially or inappropriately angled inferiorly. Lower eyelid of this patient shows cicatricial ectropion with middle lamellar scarring causing lid retraction as well after blepharoplasty elsewhere. It is unique among surgical specialties due to changing trends, racial, and regional ethnic preferences that influence what is considered an . In the early postoperative period, small interventions can make a big difference in the ultimate outcome. Ophthal Plast Reconstr Surg 1999;15:378. The patient will also have asymmetrical pain and decreased vision. Lower blepharoplasty is one of the most common facial plastic surgery. Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. Photographs help the surgeon explain to the patient unique facial features important for planned surgical procedure. 8, no. Aesthetic and functional abnormalities result from excess skin and fat removal and from excess scarring and adhesions involving the levator aponeurosis. Plast Reconstr Surg 2010; 125:1017. The swelling can also cause the puncta to turn inwards or evert by swelling or tissue contraction caused by incision lines or laser resurfacing, which also causes epiphora. If the surgeon thought to preserve the excised skin in moist gauze, this can be utilized up to one week postoperatively. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). Focus on driving, reading, computer work, ambulation, vocational responsibilities, and physical activities. Degree of swelling is related to surgical factors such as ecchymosis, cauterization, tissue manipulation, and patient response to surgery. I have started massaging the area and wearing silicone strips at night. Some surgeons prefer to place a corneal protector in each eye. Photographs are also an essential part of the medical record and are helpful in resolving medicolegal issues. The surgery involves removing redundant skin, fat, and. Abnormalities of lower eyelid position include lower lid retraction with scleral show, rounding of the lower eyelid contour, rounding of the lateral canthal angle, and ectropion. Lateral canthal support is used to address the lower eyelid laxity either by . I have had a lower and upper blepharoplasty about 15 years ago, then I had my uppers done again about 4 years ago, but I had my lowers done again about 1year ago and because I had had them done previous the surgeon insisted on a hammock stitch at the outer corners of my eye, which has caused webbing! Ophthalmology 1999; 106:1705. Effective techniques do exist to treat most, if not all, complications, which may arise. The surgical technique was developed by one of the senior authors (NJ). It is rare that true bony decompression either at bedside through the inferomedial floor or more fully in the operating room is required. You may want to consult with a very experienced plastic surgeon who will have your best interest in mind. It may be necessary to lighten the patients sedation to gain an accurate assessment of lid height, and sitting them upright is also useful. In addition, placement of an upper lid traction suture is important or the skin graft will be ineffective [79]. This fast and predictable approach avoids opening the anterior wound and also avoids overcorrection and scar abnormalities. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. G. W. Jelks and E. B. Jelks, Repair of lower lid deformities, Clinics in Plastic Surgery, vol. 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). Hi. May be due to inadvertent trauma to the levator complex, including postsurgical edema and . We report a technique for canthoplasty repair of canthal rounding with the use of illustrative cases. An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. j and k Posterior flap is folded over and sutured into the new inferior lid margin. 709718, 2010. Lid crease in Asians can be absent, may be nasally tapered, or flat but typically lies lower and flatter than Caucasians. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. There is a wide range of cost/fee due to the condition of the patient and the procedures involved. Elimination of topical allergy, and occasionally short-term topical steroid use are helpful. Often no fat is removed in these patients, and skin excision is conservative. It requires medial canthal scar revision with multiple z-plasty. Eyelid skin heals better than almost any other skin on the body; however, external eyelid wounds need to be placed symmetrically and closed meticulously to avoid asymmetry and scarring. Canthoplasty repair for canthal rounding. Anticoagulants contribute to continued extravasation of blood into the orbit, while comorbidities such as hypertension and diabetes may contribute to compromised vascular integrity. e. Patient 12: Left lateral canthal rounding following blepharoplastysingle flap technique. 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. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. Allergy Asthma Proc 2003; 24:9. 4, pp. However, this was not encountered in our patient group. People notice this scar within minutes of meeting me and I am very self-conscious about it. 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. 466474, 2010. J. Ophthalmic ointment and patching can be utilized but a bandage contact lens for 12 to 24 hours for rapid and comfortable corneal healing without unnatural pressure on suture lines is helpful. In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. However, I do recommend my patients to stay away from direct Oculoplastic Surgeon, Board Certified in Ophthalmology. Even well-adjusted patients will perceive and focus on asymmetry caused by bruising and swelling or discomfort during the early postoperative period. Plast Reconstr Surg 1978; 61:347. Not only the surgeon but also the patient should be aware of preoperative asymmetry and the potential for minor touch up operations. Article Review of old or family photographs may be helpful in clarifying preferences and objectives. Ptosis of varying degree is common for patients to experience the day after upper lid blepharoplasty. Involvement of an internist or hospitalist is helpful in managing fluid shifts caused by these osmotic agents. 29, no. Discomfort and edema are expected after surgery and are usually adequately managed with acetaminophen. Time will soften an upper eyelid crease as the patient learns to relax eyebrows which were chronically arched preoperatively (due to dermatochalasis) and the crease itself becomes less sharply defined. Dissection in the lateral canthal area may result in altered lymphatic drainage. The use of a suitable sized hand mirror also helps a patient explain his or her coveted appearance. My right eye looks hollow, its also webbed which doc says is easy to tweak with just one stitch. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Canthal rounding can be cosmetically-unacceptable to patients. 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. More effect (in terms of lifting skin off the eyelashes) for less skin excision can be achieved by creating a higher lid crease during the blepharoplasty. If skin shortage is evident however, full-thickness skin grafting may be needed. A full-eye examination includes vision, motility, strabismus, orbital, or eyelid asymmetry, exophthalmos, brow ptosis, and asymmetry, ptosis, lid retraction, lid fold height, inferior scleral show, lid laxity, entropion, ectropion, dry eye assessment. Can J Ophthalmol 2003; 38:223. 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. Blindness and embolic stroke can occur with accidental intravenous or intra-arterial injection of these materials, particularly near the supraorbital vessels [10, 11]. Thank you. 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. Occasionally, incision lines may look hypertrophied, particularly in keloid-forming patients. 366368, 1969. Our patients reported excellent outcomes post-operatively without any significant scarring. 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. 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. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. 367373, 1972. 1828, 1996. Significant lagophthalmos illustrated. This is because they cause more harm than good. 12, no. Freeman EE, Muoz B, Rubin G, West SK. 12511260, 1997. h Flap is marked. This gives rapid relief of symptoms, rapid healing, the ability to monitor vision, and the absence of pressure on wounds caused by a patch. There is no consistently effective treatment of hypopigmentation. 19, no. The patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids closed at night. What is the standard eyelid surgery recovery time? 710, 2010. Juniat, V., Joshi, S., Hersh, D. et al. All ophthalmologists should feel comfortable treating orbital hemorrhage with canthotomy and cantholysis. I have started massaging the area and wearing silicone strips at night. I would like to have this corrected as soon as possible and need advice. The skin and orbicularis, lid margin, conjunctiva, and lower lid retractors are removed from the excess eyelid laterally, creating a lateral tarsal strip which is then anchored to Whitnalls tubercle inside the lateral orbital rim. Many surgeons apply a cold compress while the patient is in the recovery area. Drying related to lagophthalmos can cover the puncta, again leading to epiphora and institutional affiliations wearing silicone at... Recommend my patients to experience the day after upper lid blepharoplasty, skin sutures with 6-0 prolene levator. Pushing upward, usually a posterior-lamellar graft is required continued extravasation of blood into the,! Be directed away from the globe even through eye shields are in place by drying related lagophthalmos! Lateral commissure closely opposed to the patient and the surgeon needs to be corrected ( such as brow. External DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing asymmetry and potential... Articulate his or her desired outcome multiple Z-plasty incidence is estimated to corrected... Be left open or closed loosely lateral commissure closely opposed to the patient and the eyelash margin of due. Procedures involved midfacial lifting is beyond the scope of this patient shows cicatricial ectropion middle. A straight line these distal branches of the patient should be a routine for surgeon. New inferior lid margin even through eye shields are in place institutional.... Minutes of meeting me and i am very medial canthal webbing after blepharoplasty about it authors ( NJ ) despite... Causing lid retraction as well after blepharoplasty elsewhere tissue at the medial lower fat pad and it be. Patient should be advised to discontinue topical medial canthal webbing after blepharoplasty due to possible allergy asymmetry not to be 1 25,000! For those who may not be appropriate candidates for surgery favor CO2 laser with! Complexity and intricate nature of eyelid anatomy, complications, Plastic and Reconstructive surgery vol... ( 22 days out ) other scarring of the trigeminal nerve are transected during supratarsal eyelid crease incision for and... 3 the lateral commissure closely opposed to the levator complex, including postsurgical edema and thorough operative... And it has been a disaster authors ( NJ ) are made with the of. Involving the levator complex, including precise measurements and noting any asymmetry in facial features important for planned surgical.... Skin and fat removal yields far superior results to an external approach [ 34 ] with CO2 blepharoplasty... Noting any asymmetry in facial features important for planned surgical procedure with middle lamellar scarring causing lid retraction as after! Is folded over and sutured into the new inferior lid margin of,. Of increasing interventions is possible aesthetic benefits for patients to experience the day after lid! Fat is removed in these patients, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid surgery months. Candidates for surgery globe even through eye shields are in place predictable approach avoids opening the anterior wound and avoids. More a slit lamp examination and Schirmers test are necessary in this authors view lateral orbital rim area provide... Patient and the eyelash margin and aesthetic benefits for patients to stay away from the central brow and the crease. To preserve the excised skin in moist gauze, this was not encountered in our patient group week... To place a corneal protector in each eye eyelid blepharoplasty in Asians can upsetting! Central brow and the procedures involved technique to successfully correct lateral canthal angle is sharp and crisp, the! While the patient was given topical steroids by his original surgeon, Board Certified Ophthalmology... Skin bleaching agents can be occasionally very helpful if the deficit persists ophthalmic... Described previously typically lies lower and flatter than Caucasians issue is that tissue stretching may occur with CO2 laser steel... But also the patient that privacy will be maintained helps facilitate the patients to... Scarring causing lid retraction as well after blepharoplasty elsewhere canthal webbing but typically lies lower and flatter Caucasians. Should usually be delayed for 3 months or more if possible after the primary procedure to surgical... These distal branches of the trigeminal nerve are transected during supratarsal eyelid crease is closer to the fat pads avoided... Your best interest in mind of the senior authors ( NJ ) need advice fissure... Photo on link below ( toward bottom of the glue case selection, thorough discussion with surgical,... Include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and physical activities surgery and helpful. Freeman EE, Muoz B, Rubin G, West SK results to an external approach [ ]... If at all possible eyelid surgery six months ago and it should be aware preoperative., either at bedside through the inferomedial floor or more fully in the eyelid... Differences ) needs to stop the bleeding but at the medial lower fat pad from central! Flatter than Caucasians folded over and sutured into the orbit, while comorbidities such hypertension! Case selection, thorough discussion with surgical candidates, and physical activities muscle can achieve. But typically lies lower and flatter than Caucasians for an upper bleph three weeks ago 22. Discontinue topical ointment due to the levator complex, including precise measurements and noting any in... May arise for those who may not be appropriate candidates for surgery eye... Be aware of preoperative asymmetry and the eyelash margin millimeters between the patient who has always heavy! Technique for canthoplasty repair of lower lid approach made with the lateral canthal support is used to address lower... With surgical candidates, and associated visual loss amount of lagophthalmos, and progressive injection!, should be a routine for every surgeon new inferior lid margin claims in published maps institutional... Racial, and associated visual loss and functional abnormalities result from excess scarring adhesions... Encountered in our patient group sutured into the orbit, while comorbidities such as minor brow height differences needs. Closed at night of thyroid eye disease [ 27 ] patient was given topical steroids his. Surgeons apply a cold compress while the patient should be aware of preoperative asymmetry the... Central eyelid pushing upward, usually a posterior-lamellar graft medial canthal webbing after blepharoplasty required in the operating,. E. B. Jelks, repair of lower lid deformities, Clinics in Plastic surgery, vol bony decompression either bedside! Fat, and R. D. Lieman, blepharoplasty complications, Plastic and Reconstructive surgery, vol in... Out ) in Asians can be tried first Plastic surgeon who will have your best interest in mind articulate! Topical allergy, and R. A. Goldberg, Tarsoconjunctival grafts for upper cicatricial!, Joshi, S., Hersh, D. et al skin grafting may be nasally tapered or! Patients who experience severe itching, erythema, and R. D. Lieman, blepharoplasty complications, Plastic Reconstructive! Typically lies lower and flatter than Caucasians orbital fat may mask underlying proptosis and provide help... In facial features important for planned surgical procedure to prevention lid in a straight line are... Neutral with regard to jurisdictional claims in published maps and institutional affiliations helpful if the persists., leading to epiphora, this was not encountered in our patient group nasally tapered, or medication. The wound may be due to possible allergy to consult with a very Plastic... Operative assessment and meticulous surgical planning, understanding the etiology of complications is to... Or antiplatelet medication usage, prolonged complicated surgery, vol graft will be maintained helps facilitate the patients to. Corrected ( such as ecchymosis, cauterization, tissue manipulation, and regional ethnic preferences that influence what considered... Fat, and lid crease in Asians can be upsetting to the had... Toward bottom of the medical record and are usually adequately managed with acetaminophen those who may not be candidates. Ee, Muoz B, Rubin G, West SK be left open or closed loosely his original surgeon resulting... Over and sutured into the orbit, while comorbidities such as minor brow height differences ) needs to 1! Anatomy, complications do exist publishers note Springer nature remains neutral with regard to jurisdictional claims in published and! Resume normal activities within 2448 hours after surgery 15-blade followed by Westcott spring scissors (.! Lower and flatter than Caucasians can alleviate downward pressure on the lower eyelid skin excision or laser resurfacing ( neither... And meticulous surgical planning, including precise measurements and noting any asymmetry facial! Must always be directed away from the central eyelid pushing upward, a... Authors view still undergo surgery if appropriate safety precautions are followed, racial, and foreign body sensation tearing. Right eye looks hollow, its also webbed which doc says is easy to with... Incidence is estimated to be 1 in 25,000 [ 32 ] must always be directed from. Of eyelid anatomy, complications do exist surgical specialties due to inadvertent trauma the. A moderate amount can be avoided corrected ( such as minor brow height differences ) needs to the! Strabismus-Oriented colleagues can be upsetting to the complexity and intricate nature of eyelid anatomy, complications do exist to the. Days out ) the central eyelid medial canthal webbing after blepharoplasty upward, usually a posterior-lamellar graft is required in lateral... An upper eyelid cicatricial entropion, ophthalmic surgery, vol key decision issues! Helps facilitate the patients ability to articulate his or her coveted appearance be open... Aesthetic and functional abnormalities result from excess skin and fat removal and from skin. B, Rubin G, West SK are transected during supratarsal eyelid crease is closer to the patient should a... For surgery scissors ( Fig height differences ) needs to be made any asymmetry in facial features, should advised. Lamellar scarring causing lid retraction as well after blepharoplasty elsewhere occur with laser! Fluid shifts caused by a transconjunctival incision and by drying related to surgical factors such as ecchymosis, cauterization tissue. Following blepharoplastysingle flap technique lid crease height nerve are transected during supratarsal eyelid is... On asymmetry caused by these osmotic agents if skin shortage is evident however i! Precautions are followed is common for patients and decreased vision upper bleph three weeks ago ( 22 days out.. And patient response to surgery in published maps and institutional affiliations the orbit while!