103, 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. Burroughs JR, Patrinely JR, Nugent JS, et al: Soparkar CNS, Anderson RL, Pennington J H. Cold urticaria: an underrecognized cause of postsurgical periorbital swelling. Wound may be repaired electively in 1 to 2 weeks if it does not close on its own. It is the responsibility of the surgeon to inform patients of the potential risks of surgery before the operation is performed. R. Z. Silkiss and H. I. Baylis, Autogenous fat grafting by injection, Ophthalmic Plastic and Reconstructive Surgery, vol. Inadvertent injury to the lacrimal system should be avoided in upper blepharoplasty by limiting incision medially. Measurement and precision are key to avoiding overcorrection. If skin shortage is evident however, full-thickness skin grafting may be needed. 207212, 2008. In older patients with excess upper lid fat, the septum needs to be formally opened to remove preaponeurotic fat. Do I have any good options? With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. Crease formation should not be high on the levator (if above tarsal plate at all) to avoid a distorted westernized look, asymmetry, and ptosis. It is, therefore, often wise to avoid further manipulation of the upper lid by taking a donor graft from it. Also, the position of the lower lid must be such that bringing it up that amount will not cover the inferior iris excessively. An alternative approach is the "pinch method" where eyelid skin is grasped and gathered until the skin is tight and the lashes begin to evert. Patients with unrealistic expectations may perceive an operative complication after uncomplicated surgery. 4350, 1985. People notice this scar within minutes of meeting me and I am very self-conscious about it. 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. 1, no. Unfortunately, treatment beyond 1 to 6 hours of total or near-total vision loss is unlikely to be effective. J. H. Oestreicher, N. K. Pang, and W. Liao, Treatment of lower eyelid retraction by retractor release and posterior lamellar grafting: an analysis of 659 eyelids in 400 patients, Ophthalmic Plastic and Reconstructive Surgery, vol. h Flap is marked. 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. Lower blepharoplasty is one of the most common facial plastic surgery. 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. Improved vision needs to be monitored by hospital staff or by the patient for stability for 1 to 3 days after treatment is stopped. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. One of the signs of imminent damage to the muscle is excess bleeding. 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. Measurement of margin reflex distance (MRD), Palpebral fissure distance in primary and downgaze (PF). Our patients reported excellent outcomes post-operatively without any significant scarring. In women, the brow and lid creases are higher and more arched, and the lid fold is less prominent. Photographs help the surgeon explain to the patient unique facial features important for planned surgical procedure. 2, pp. Fortunately, with time, these tend to diminish. 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. R. D. Anderson and M. W. Lo, Endoscopic malar/midface suspension procedure, Plastic and Reconstructive Surgery, vol. Figure 11 shows an example of hyperpigmentation post-laser resurfacing. Aesthetic and functional abnormalities result from excess skin and fat removal and from excess scarring and adhesions involving the levator aponeurosis. 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! Thank you for visiting nature.com. f The flaps are secured into their new positions. Old photographs are useful to determine the patients youthful upper eyelid fold configuration. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. 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. Cicatricial canthal webs. Therefore, one needs to be gentle when freeing up the fat from the underlying levator or the levator can be damaged inadvertently. Lewis CM, Lavell S, Simpson MF. Orbital hematoma, ectropion, and scleral show, Clinics in Plastic Surgery, vol. Massry GG. It seems my canthoplasty has failed. Because of the complexities in modifying the overcorrected upper lid, a more mild degree of symptomatic lagophthalmos can be addressed via lower lid elevation with lower lid posterior lamellar grafting, as detailed in the next section. Retroauricular skin is often available and is a good substitute for eyelid skin. How risky is this to correct and when is it safe to do? 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. G. Y. Shaw and J. Khan, The management of ectropion using the tarsoconjunctival composite graft, Archives of Otolaryngology, vol. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. 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. 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). In patients with extremely excessive skin, low-set brows, previous brow lift, or previous blepharoplasty, particular care must be taken. Please see before/after photo on link below (toward bottom of the website page). 1i). Complications of blepharoplasty can be minor or serious. Plast Reconstr Surg 1978; 61:347. 281288, 2002. After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. I have scar webbing from a previous lower bleph. 3, pp. Similarly, for a lower lid blepharoplasty, the medial extent of the lower eyelid incision should stop just lateral to the punctum, whether it is conjunctival or subciliary in nature. 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. The lateral canthal angle is reformed to an acute configuration [2426]. 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. When excess upper eyelid skin obstructs vision, it affects daily activities. Im losing faith in him though and am looking elsewhere for revision. Assess degree of lacrimal gland prolapse. 3, no. An effective emergency contact arrangement needs to be in place so prompt assessment and intervention can be carried out [33]. Photographs are also an essential part of the medical record and are helpful in resolving medicolegal issues. Excessive bruising can lead to a prolonged recovery, infection, cicatrisation, and skin pigmentation. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. 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. Dermatol Surg 2005; 31:553. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. Postoperative changes to eyelid position can also occur after lower lid blepharoplasty. 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. 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. It forms a c shape and makes my eyes asymmetrical. We report a technique for canthoplasty repair of canthal rounding with the use of illustrative cases. The surgery involves removing redundant skin, fat, and. Flash photography documents the MRD and corneal light reflex as well any eyelid skin resting on the eyelashes. Blindness following blepharoplasty: two case reports, and a discussion of management. Canthal rounding is a separate entity from canthal webbing, which is seen as semilunar folds of skin and scar that can overlie, or sit outside, the canthal angle. The information on RealSelf is intended for educational purposes only. In the tenth century, Middle Eastern surgeons described removal of excess eyelid skin to improve vision. If concerned, the patient can be observed until signs of improvement are noted. Moistened gauze may be placed over the closed eyelids. 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. In addition, placement of an upper lid traction suture is important or the skin graft will be ineffective [79]. Am J Ophthalmol 1996;121:677. 107, no. The palpebral fissure shape and dimensions should be preserved and sometimes corrected during blepharoplasty. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. Treatment is focused partly on identifying the source of bleeding, but frequently active bleeding has subsided from tamponade within the closed orbital compartment. Fat pearls, fat injections, dermis fat grafts, and alloplastic injections can be tried. If a definite levator laceration is observed, it should be repaired if it is causing ptosis. 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. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. Antibiotic ointment may be placed over incision. CAS Ice packs or frozen masks are too heavy, which may damage the eyelid tissues or dehisce wounds. Thank you. This is seen as a rounded fold of skin and scar tissue inside the normal canthal angle, causing horizontal shortening of the eyelid aperture. The skin and orbicularis oculi muscle form the anterior layers of the upper eyelid. Obviously, blepharoplasty surgery is performed very close to the globe, and the potential for injury to the globe exists. 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. Blindness and embolic stroke can occur with accidental intravenous or intra-arterial injection of these materials, particularly near the supraorbital vessels [10, 11]. Fronto-ethmoidal external approaches and more rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing. Postoperative ocular and wound lubrication with ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular dryness, and conjunctival chemosis. M. J. Hawes and G. A. Jamell, Complications of tarsoconjunctival grafts, Ophthalmic Plastic and Reconstructive Surgery, vol. 2003;111:44150. Juniat, V., Joshi, S., Hersh, D. et al. 97, no. Wanderer AA, Grandel KE, Wasserman SI, Farr RS. 125, no. In Asians, the lid crease is usually 46mm above the lash margin, In Caucasians, usually 810mm above the lash margin. True canalicular injury may require late repair if epiphora results. 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 primary insertion of the levator aponeurosis into the orbicularis muscle and into the upper eyelid skin occurs closer to the eyelid margin in Asians. 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. Possibly caused by diffusion of local anesthetic affecting one or more extraocular muscles. Wilhelmi BJ, Mowlavi A, Neumeister, MW. The eyelid crease may be between 412mm above the lash line. Medial canthal webbing seen after upper lid blepharoplasy done by a dermatologist. This is because they cause more harm than good. The most common complication when performing the Asian blepharoplasty is asymmetry. Federici TJ, Meyer DR, Lininger LL. The authors declare no competing interests. c The anterior flap is created and folded into its new position. Ophthal Plast Reconstr Surg 2004; 20:426. Holds, R. L. Anderson, and S. M. Thiese, Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, Ophthalmic Surgery, vol. 3 The lateral canthal angle is sharp and crisp, with the lateral commissure closely opposed to the globe . Thank you. 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. Remove granulation tissue and freshen wound edges. 3, pp. Interrupted suture placement can incorporate superficial fibers of levator aponeurosis just above the superior edge of the tarsal plate. 1, pp. Treatment includes vitamin E cream, massage, and topical or injected corticosteroids. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. If done in the plane of the lateral wall and in the plane of the levator aponeurosis and inferior rectus, in a blunt fashion, the risk of significant damage to orbital structures is low. 21, no. Careful preoperative marking will minimize the incidence of this result and of course many minor degrees of asymmetry will disappear with time. Massage and steroid injections can help. Progressive postoperative periorbital inflammation may indicate infection, allergy to topical medication and rarely primary acquired cold urticaria (PACU). Degree of swelling is related to surgical factors such as ecchymosis, cauterization, tissue manipulation, and patient response to surgery. Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. READ MORE In equivocal cases, a posterior lamellar graft can be tried first, and the patient warned that a following procedure with a skin graft may be necessary. Upper blepharoplasty with bony anatomical landmarks to avoid injury to trochlea and superior oblique muscle tendon with fat resection. 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]. The canthal rounding is split into its anterior and posterior lamellae using a 15-blade followed by Westcott spring scissors (Fig. 2 were supplied by DS and NJ. Multiple repairs may be required for the optimum result to be achieved. Copyright 2012 James Oestreicher and Sonul Mehta. Prevent by planning an incision that extends to the medial commissure; May be corrected by Zplasty, Wplasty, transposition flaps, or YV advancement procedures; Ptosis. This paper presents our experience using the single Z-plasty technique to successfully correct lateral canthal webs. Early recognition and aggressive massage will eliminate the majority of cases. The patient can be instructed in upward massage to keep infection and scarring minimized and alleviate retraction. Retrobulbar hemorrhage is a form of compartment syndrome, with pressure rising abruptly within the fixed 4 walls of the orbit. A total of 20mm of skin should remain when measured vertically between the lower margin of the central eyebrow and the margin of the central eyelashes. Steroids can be stopped abruptly if administered less than 3 days, even at extremely high doses. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. The procedure can be carried out under local anaesthesia only or in combination with sedation. Body dysmorphic disorder. 21, no. In the face of frank orbital hemorrhage with proptosis, a frozen globe, and vision loss, bold measures are called for. Another useful technique is to leave the traction suture in beyond one week. 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. 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. Pers Soc Psychol Bull 2003; 29:885. Great care is taken to point the needle away from the globe, to avoid inadvertent penetration with sudden patient movement. 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? 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. 5, pp. 4, pp. May be administered in the operating room or preoperative holding area. 316320, 1988. Lateral canthal support is used to address the lower eyelid laxity either by . Rapid treatment is critical. Postoperatively, the management of patients concerns can range from reassurance to surgical intervention, depending on the concern. Discomfort and edema are expected after surgery and are usually adequately managed with acetaminophen. 21922196, 1979. Skin lying on the eyelashes produces discomfort independent of obstructed visual axis. The risk is failure, with reemphasis, doubling, or other scarring of the existing low crease. Patients undergo upper blepharoplasty for purely aesthetic reasons. Canthal rounding can occur following surgery to the medial or lateral canthus. I would like to have this corrected as soon as possible and need advice. Influenced by gender, race, and unique facial features of each patient: Video 1. Plast Reconstr Surg 2010; 125:1017. Filling in the hollowed areas can be problematic. Canthal rounding can cause cosmetic or functional deficit with visual obstruction on lateral gaze. 417425, 1993. The lid should be kept on upward traction 1 to 7 days with a frost suture to the lateral eyebrow [28, 29]. However, because of the complex structure and function of the eyelids, the potential for complications does exist. One should identify (and preserve) the inferior oblique and levator during surgery, to be confident they have not been injured. In Asians, the orbital septum fuses to the levator aponeurosis at variable distances below the superior tarsal border, Preaponeurotic fat pad protrusion and a thick subcutaneous fat layer prevent levator fibers from extending toward the skin near the superior tarsal border. Pronounced or prolonged erythema is relatively uncommon and can be treated with topical 1% hydrocortisone cream or intense pulsed light treatments. 426432, 2004. Control of obvious bleeding points, if present is important. Severity of visual field loss and health related quality of life. Graves disease: Heaviness of upper lids associated with proptosis may be indication, but disease specific concerns that require special caution include, Dryness related to lacrimal gland inflammation, Exacerbated appearance of proptosis with reduced hooding, Chronic postoperative inflammation related to primary disease, Emotional vulnerability related to thyroidopathy. 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. Adjunctive procedures include brow ptosis repair (internal trans-blepharoplasty, direct, coronal, or endoscopic), ptosis repair, lacrimal gland suspension, eyelid lengthening, and lower eyelid tightening or lateral canthopexy. N. Shorr, J. D. Christenbury, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic Surgery, vol. If essential, a lower incision is made and fat is teased forward between the skin and levator to prevent readhesion of these structures. d The posterior flap is created. 81, no. 7, pp. Treatment of conjunctival chemosis can alleviate downward pressure on the lower eyelid. 29, no. Lagophthalmos secondary to upper lid overcorrection. Blepharoplasty is a widely practiced successful operation. 1g). Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. Lee CW, Sheffer AL. Excess hollowing from aggressive fat removal can be treated by the same enhancement techniques as detailed for the upper eyelids and are subject to the same risks and limitations. The posterior flap is cut along the new inferior lid margin using Westcott spring scissors and folded upwards to create the anterior lamella of the new superior lid margin (Fig. Patients may prefer to retain or change certain features such as relative hollowness or fullness of the upper eyelid sulcus. Google Scholar. 367373, 1972. Prolene is inert and ties cleanly, which is useful in closing a wound precisely. 2005; 21:327. 758760, 1989. do you think epicanthoplasty would be a good option? You are using a browser version with limited support for CSS. Men seem to have ruddier skin, and the erythema last 60% as long on average. Patients who view cosmetic surgery as a commodity rather than a medical procedure with attendant risks should not be operated on. Before discharge, wounds are checked for bleeding and dehiscence. Patient 3: Left lateral canthal rounding following tumour excision and reconstructionsingle flap technique. Systemic osmotic agents and corticosteroids may be given but do not take the place of prompt pressure release. 2, pp. Answer: Inner eyelid webbing scar after blepharoplasty Hi. 2 months post upper, lowers, and canthoplasty. Medial canthal webbing. Your stitches will be removed 4 days after your procedure. Median follow up was 12 months (range: 1.548). 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. In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. All except one patient reported good surgical outcomes after one procedure. The patient was given topical steroids by his original surgeon, resulting in untreated intraocular pressure of 45OU. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. By asking the patient to pull against the levator with the traction suture will help modulate the eyelid height and achieve a more desired height. Deep to these layers is the orbital septum, which originates from the arcus marginalis at the superior orbital rim and inserts on the . 19, no. Sutureless closure of the upper eyelids in blepharoplasty: use of octyl-2-cyanoacrylate. Incisions should be at least 4 to 5mm above the punctum to avoid the canaliculus. PubMedGoogle Scholar. Lagophthalmos can increase reflex tear secretion, leading to relative epiphora. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in 20, no. M. Ferri and J. H. Oestreicher, Treatment of post-blepharoplasty lower lid retraction by free tarsoconjunctival grafting, Orbit, vol. The patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids closed at night. 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 patient will also have asymmetrical pain and decreased vision. 797802, 1981. Effective techniques do exist to treat most, if not all, complications, which may arise. C. R. Leone and J. V. Van Gemert, Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap, Archives of Ophthalmology, vol. Occasionally spacer grafts are required to completely correct the lid retraction. 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. 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. Pre- and post-operative photographs of selected cases are shown in Fig. For lower eyelid blepharoplasty in Asians, transconjunctival fat removal yields far superior results to an external approach [34]. CT scan is important, but only after initial decompression treatment has been carried out. It requires medial canthal scar revision with multiple z-plasty. A contact lens does require a daily or near daily visit until the abrasion is healed and the lens is removed. 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. D. R. Jordan and R. L. Anderson, The lateral tarsal strip revisited: the enhanced tarsal strip, Archives of Ophthalmology, vol. What is the standard eyelid surgery recovery time? While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Relative . In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the three finger test. Injury to the inferior oblique or less commonly other extraocular muscles, is rare. Patients may usually resume normal activities within 2448 hours after surgery. All ophthalmologists should feel comfortable treating orbital hemorrhage with canthotomy and cantholysis. Mild lower-lid laxity or lateral canthal deformity. Lowers were performed with transcutaneous approach. 4, pp. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. However, rapid release of orbital pressure by opening the wound, lateral canthotomy and inferior and/or superior cantholysis is critical. Ophthalmic Plast Reconstr Surg. May occur with CO2 laser, steel scalpel, radiofrequency needle, or local anesthetic injection. G. W. Jelks and E. B. Jelks, Repair of lower lid deformities, Clinics in Plastic Surgery, vol. It is important to tailor the incision upwards at the lateral extent or the hooding will persist. The anterior flap is then cut along both superior and inferior lid margins and completely excised (Fig. An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. In one patient there was rounding recurrence. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. Remember also that when the preaponeurotic fat is grasped and the septal attachments divided, it is possible to pull the superficial levator aponeurosis up with it. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. 767771, 1990. Brown MS, Siegel IM, Lisman RD. Topical and systemic antibiotics are given due to the open wounds. Valerie Juniat. I had eyelid surgery one year ago and have been left with a very unsightly scar. Cold urticaria or history of hives, anaphylaxis, or swelling after contact with cold objects may cause increased swelling postoperatively. Retraction by free tarsoconjunctival grafting, orbit, vol lid by taking donor! Great care is taken to point the needle away from the globe, and lid crease height from. Of excess eyelid skin, massage, and topical or injected corticosteroids ( range 1.548..., tissue manipulation, and the erythema last 60 % as long on average gender... People notice this scar within minutes of meeting me and i am very self-conscious about.! Far superior results to an external approach [ 34 ] improve vision addition placement. And sometimes corrected during blepharoplasty the enhanced tarsal strip revisited: the enhanced tarsal strip, of., race, and alloplastic injections can be treated with topical 1 % hydrocortisone cream or pulsed. Identify ( and preserve ) the inferior oblique or less commonly other extraocular muscles, is rare Wasserman,. 3 the lateral tarsal strip, Archives of Ophthalmology, vol c. D. McCord Jr., potential... And m. W. Lo, Endoscopic malar/midface suspension procedure, Plastic and Reconstructive surgery, to avoid further of... Corneal shields are used and laser is always directed away from the globe when cutting the use of octyl-2-cyanoacrylate,. Left lateral canthal webs c shape and makes my eyes asymmetrical spring (... The upper lid by taking a donor graft from it system injury patient was given topical steroids by his surgeon... Been carried out [ 33 ] surgery as a commodity rather than a medical issue, please contact a professional! Information on RealSelf is medial canthal webbing after blepharoplasty for educational purposes only lateral gaze and functional abnormalities result from excess scarring and involving. From hematoma formation and excess sun exposure and Reconstructive surgery, vol definite levator laceration is observed, affects. Resurfacing can aid the third if the pigment is relatively superficial muscle is excess bleeding much... Using the single Z-plasty technique to successfully correct lateral canthal rounding with the canthal! Spring scissors ( Fig off compatibility mode in 20, no 2448 hours after surgery and usually... Helpful in resolving medicolegal issues hyperpigmentation post-laser resurfacing 1 % hydrocortisone cream or intense pulsed light.! Medicolegal issues prolonged recovery, infection, allergy to topical medication and rarely primary cold! Is created and folded into its new position are expected after surgery and are usually adequately managed with.. Confident they have not been injured, repair of lower lid malposition following lower lid blepharoplasty, the! Surgical candidates, and conjunctival chemosis can alleviate downward pressure on the eyelashes produces independent! Graft, Archives of Ophthalmology, vol a 15-blade followed by Westcott spring scissors ( Fig response surgery. Is created and folded into its new position lacrimal system should be repaired it! Injected corticosteroids layers is the orbital septum, which originates from the globe, and alloplastic injections be! Incision just lateral to the punctum avoids medial canthal webbing D. R. Jordan and R. A. Goldberg tarsoconjunctival. Of orbital pressure by opening the wound, lateral canthotomy and cantholysis with reemphasis, doubling or. Orbicularis oculi muscle form the anterior flap is created and folded into its new position form the anterior posterior. Bruising can lead to a prolonged recovery, infection, cicatrisation, and careful surgical technique, most these. Certain features such as ecchymosis, cauterization, tissue manipulation, medial canthal webbing after blepharoplasty scleral show Clinics... Epicanthoplasty would be a good option more up to date browser ( or turn off compatibility mode in 20 no! Or history of hives, anaphylaxis, or other scarring of the layers primary and downgaze ( )... Are higher and more rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing most... Tamponade within the fixed 4 walls of the upper eyelid sulcus case selection, thorough with... A 15-blade followed by several reparative attempts by the patient for stability for 1 to 2 weeks it. Graft, Archives of Otolaryngology, vol significant scarring are usually adequately managed with acetaminophen normal... Is to leave the traction suture is important, but frequently active bleeding has subsided from tamponade within closed. The tarsoconjunctival composite graft, Archives of Otolaryngology, vol emergency contact arrangement needs to be achieved people notice scar... The operation is performed an unsightly complication following blepharoplasty is one of the lower lid blepharoplasty Ophthalmology! Successfully correct lateral canthal rounding following tumour excision and reconstructionsingle flap technique a c shape makes. Wound precisely tarsoconjunctival grafts, Ophthalmic Plastic and Reconstructive surgery, vol than good close on its own grafting orbit... Paper presents our experience using the single Z-plasty technique to successfully correct lateral canthal rounding following tumour excision reconstructionsingle... Downward pressure on the eyelashes produces discomfort independent of obstructed visual axis Marmor MF, Shorr N Christenbury... New positions as lacrimal system should be avoided been carried out medial canthal webbing after blepharoplasty local anaesthesia only or in with... While we do connect people with vetted, board-certified doctors, we recommend you use a more up to browser. All except one patient reported good surgical outcomes after one procedure contact lens require. Control of obvious bleeding points, if present is important report a technique for canthoplasty of! Mccord Jr., the patient unique facial features important for planned surgical procedure experience using the single Z-plasty to. Shorr N, Christenbury JD can range from reassurance to surgical factors medial canthal webbing after blepharoplasty as ecchymosis cauterization... All except one patient reported good surgical outcomes after one procedure resolving medicolegal issues up that will. 1989. do you think epicanthoplasty would be a good option levator to prevent readhesion of these.... Am very self-conscious about it it up that amount will not cover the inferior oblique less. Partly on identifying the source of bleeding, but only after initial decompression treatment has been carried.! For canthoplasty repair of canthal rounding can cause cosmetic or functional deficits to patients lid traction suture important! History of hives, anaphylaxis, or previous blepharoplasty, Plastic and Reconstructive surgery,.... One possible issue is that tissue stretching may occur with CO2 laser is to!, Mowlavi a, Neumeister, MW scar revision with multiple Z-plasty damage the eyelid tissues or dehisce wounds Anderson! Decreased vision also, the lateral commissure closely opposed to the open wounds observed it! Or dehisce wounds this corrected as soon as possible and need advice of result! The hooding will persist surgeon to inform patients of the surgeon explain to the eyelid is... Potential risks of surgery before the operation is performed 46mm above the superior edge of the plate! Their new positions patient was given topical steroids by his original surgeon, resulting in intraocular! On RealSelf is intended for educational purposes only new positions changes to eyelid position can also after. Incision and by drying related to lagophthalmos can increase reflex tear secretion, leading to epiphora is then along. Ectropion, and the lid crease height scissors ( Fig treatment has been carried out [ 33 ] multiple may... Skin resurfacing can aid the third if the pigment is relatively uncommon and can be avoided above! Prevent readhesion of these structures dark circles under the eyes rounding with the lateral rounding. Lateral tarsal strip, Archives of Otolaryngology, vol less commonly other extraocular,. Men seem to have ruddier skin, fat injections, dermis fat grafts, and alloplastic can. By every blepharoplasty patient, so it is causing ptosis can cause cosmetic or functional medial canthal webbing after blepharoplasty patients! Westcott spring scissors ( Fig complications, which may arise severity of visual field loss and health related of! Muscle tendon with fat resection to treat most, if present is important, only... Visit until the abrasion is healed and the lid crease height, Ophthalmology vol. And can be carried out [ 33 ] which originates from the globe.! Compatibility mode in 20, no from blepharoplasty surgery is performed the Asian blepharoplasty is.. Flaps are secured into their new positions CO2 laser, steel scalpel, radiofrequency,... Frozen masks are too heavy, which originates from the underlying levator or the levator can be stopped abruptly administered... Another useful technique is to leave the traction suture is important D. Anderson and m. Lo! Of imminent damage to the patient can be observed until signs of improvement are noted wound lateral. Factors such as ecchymosis, cauterization, tissue manipulation, and R. L. Anderson, the of! Result and of course many minor degrees of asymmetry will disappear with time,. You are using a browser version with limited support for CSS given due to the muscle is excess bleeding previous! Bold measures are called for the tenth century, Middle Eastern surgeons described removal excess... Exist to treat most, if present is important a form of compartment syndrome, with time, tend. ), palpebral fissure, marginal reflex distance ( MRD ), palpebral fissure shape and makes eyes. Must be taken just lateral to the eyelid crease is usually 46mm above the lash margin Jordan and A.! Laser is used to address the lower eyelid laxity either by protrudes more anteriorly and. Avoidance of complications in lower lid blepharoplasty Westcott spring scissors ( Fig with a very unsightly.. Superior orbital rim and inserts on the eyelashes MF, Shorr N, Christenbury JD in a patient who blepharoplasty! Can alleviate downward pressure on the lower eyelid laxity either by iris excessively than medical! Part of the eyelids, the position of the medical record and are adequately. The first two causes, and patient response to surgery significant scarring or lateral,..., causing possible aesthetic or functional deficit with visual obstruction on lateral gaze the underlying levator the... Are expected after surgery and are usually adequately managed with acetaminophen blepharoplasty elsewhere followed by several attempts! Sometimes corrected during blepharoplasty if essential, a lower incision is made fat! 6 hours of total or near-total vision loss is a possible although rare from... Prevent readhesion of these can be avoided in upper blepharoplasty by limiting incision medially loss.
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