Visual acuity measurement and slit lamp examination are critical on the first postoperative visit (almost always the day after surgery) to rule out ocular injury and to document its absence. It is virtually unheard of for this to fail to resolve. Avoid placing the crease too high to prevent the appearance of over-westernization. 12511260, 1997. 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! Fronto-ethmoidal external approaches and more rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing. 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. 1h) then split into its anterior and posterior lamellae as described earlier. It aims to improve the appearance of the lower eyelids by addressing skin laxity, fat prominence, and adjusting the lower eyelid position. If the obstruction is more distal than 8mm from the punctum (unlikely in blepharoplasty surgery), a canaliculo-dacryocystorhinostomy may reconstruct the system. Lateral skin often takes longer to soften and smooth because it is thicker compared to eyelid skin. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. Arch Ophthalmol 1999; 117:907. A test spot can be offered the patient although a good result with the test spot is not a guarantee of subsequent good results. Rapid treatment is critical. The lower lateral marking is extended to the orbital rim or end of the eyebrow and may course superiorly or follow existing creases to meet the upper mark. The procedure can be carried out under local anaesthesia only or in combination with sedation. Patients must be taught to check their vision one eye at a time. Nonabsorbable sutures are removed 714 days after surgery. Canthal web revision (Canthoplasty, Revision Canthoplasty) The area where the upper and lower lids meet is called the canthus. The technique of tarsal strip repair has been well described elsewhere. 4, pp. It is often necessary to tighten the lower eyelid at the time of blepharoplasty. Inadvertent injury to the lacrimal system should be avoided in upper blepharoplasty by limiting incision medially. http://tabanmd.com/gallery/revisional-eyelid/. A cold stimulation test may confirm the diagnosis of PACU. One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. Prospective analysis of changes in corneal topography after upper eyelid surgery. Cautery is applied as needed to achieve hemostasis. Medial canthal webbing seen after upper lid blepharoplasy done by a dermatologist. Find a surgeon who can do this for you but you also have to understand that there is always a risk for scarring that may be visible. Patients may fail to recognize substantial change in their appearance until they view pre- and postoperative photographs. 2, pp. He said he would try to fix it with skin grafting if I like but, is this very successful? The erythema lasts an average of 3 months in women but can be covered readily with make up after 8 or 9 days. Early injection takes advantage of the time required to move, position, prep, and drape the patient, during which time the anesthetic will take effect. Dysmorphophobia. Am J Ophthalmol 1996;121:677. 4, pp. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. Tenzel RR: Complications of blepharoplasty. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. Thank you. Fat pearls, fat injections, dermis fat grafts, and alloplastic injections can be tried. In the meantime, to ensure continued support, we are displaying the site without styles Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in the operating room, required. There were no peri- or post-operative complications. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. Patients often complain of headache and brow ache from overworked frontalis muscles, pulling excess skin away from the eyelid margins. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. This area near the nose is called the medial canthus and the same area on the outer eyelids is called the lateral canthus. 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. Lagophthalmos secondary to upper lid overcorrection. Plast Reconstr Surg. Dry eye symptoms may worsen if there is a decreased blink after removal of orbicularis muscle. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. Wound may be repaired electively in 1 to 2 weeks if it does not close on its own. b The canthal rounding is split into its anterior and posterior lamellae. The skin taken has made a hollow that makes the overhang look worse. Canthoplasty repair for canthal rounding. The amount of lagophthalmos must be such that lower lid elevation would eliminate it. Ophthal Plast Reconstr Surg. Visual field loss increases the risk of falls in older adults: the Salisbury Eye Evaluation. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser. The lid should be kept on upward traction 1 to 7 days with a frost suture to the lateral eyebrow [28, 29]. 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. The incision, which is made along the previously marked lines, can be made with a 15Bard Parker blade, an incisional CO2 laser, a diamond blade, or a needle-tipped Bovie or radiofrequency instrument. My eyes were lovely and i fear Ive ruined them.I think Im a difficult as my eyes were good before and I wanted just a tweak. Lid crease in Asians can be absent, may be nasally tapered, or flat but typically lies lower and flatter than Caucasians. A running prolene suture, with several interrupted reinforcements is useful. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. 604606, 1989. Some surgeons prefer to place a corneal protector in each eye. Lower eyelid of this patient shows cicatricial ectropion with middle lamellar scarring causing lid retraction as well after blepharoplasty elsewhere. CAS Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. PubMedGoogle Scholar. Prevent and treat with careful preop evaluation and perioperative artificial tears, ointments, punctal plugs, etc. https://doi.org/10.1038/s41433-021-01497-y, DOI: https://doi.org/10.1038/s41433-021-01497-y. All except one patient reported good surgical outcomes after one procedure. Clinics Plast Surg 1981; 8:797. 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. 122, no. 3, pp. 21922196, 1979. In the initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of their eyelids. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. 4350, 1985. Blindness after blepharoplasty: mechanism and early reversal. The surgical technique was developed by one of the senior authors (NJ). Incisions should be at least 4 to 5mm above the punctum to avoid the canaliculus. Institutional Review Board/Ethics Committee approval was obtained. Prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis. It also includes deciding which technique to perform (steel blade versus CO2 laser, transconjunctival versus external approach to lower blepharoplasty). Excessive bruising can lead to a prolonged recovery, infection, cicatrisation, and skin pigmentation. Do I have any good options? Secondary upper lid lengthening can also be done posteriorly if adequate skin grafting has already been carried out, thereby avoiding another skin incision. For more proximal obstructions with tearing a sequence of increasing interventions is possible. 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. Anticoagulants may increase the risk of postoperative bleeding. 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. 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. 10361040, 1999. 103, no. 207212, 2008. Black EH, Gladstone GJ, Nesi FA. Thank you for visiting nature.com. The most common complication when performing the Asian blepharoplasty is asymmetry. CT scanning the orbits is important, but only after treatment has been carried out. Antiglaucoma medications or anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. This interferes with the tear pump mechanism. 767771, 1990. J. H. Oestreicher and K. Tarassoly, The mini tarsal strip lateral canthopexy for lower eyelid laser-assisted blepharoplasty-indications, technique and complications in 614 cases, Orbit, vol. Median follow up was 12 months (range: 1.548). Preoperative and postoperative oral arnica (a herbal healing agent) has been claimed anecdotally to help when given in normal doses. The surgeon should spread bluntly posteriorly into the orbit down the lateral wall and through the wounds to access deep hematomas and release them. Running, interrupted, subcuticular, and other cutaneous skin closures can be with absorbable or nonabsorbable suture, incorporating skin and orbicularis muscle tissue, which aids in the lid crease formation (. 7, pp. Im losing faith in him though and am looking elsewhere for revision. 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. Orbit 2012; 31:162. The perceived gravity of a given complication may differ between the patient and the surgeon [1, 3]. Partial removal of orbicularis muscle over the medial eyelid area with grafting of medial fat into the lateral sub-brow area has been proposed to restore youthful contours (Fezza J, OPRS 2012;28:446). If canthotomies have not restored vision, spreading bluntly posteriorly into the orbit along the lateral wall to access deep hematomas and release them, may be helpful. Is it possible my plastic surgeon injured my tear duct by cutting too far in? 366368, 1969. Before discharge, wounds are checked for bleeding and dehiscence. Relative merits and disadvantages of addressing concurrent blepharoptosis, eyebrow ptosis, eyelid retraction, and other sources of eyelid, eyebrow and orbital asymmetry can be included in the discussion on proposed blepharoplasty. 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). Especially on one side more than the other! Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. 2020;46:5214. What is the standard eyelid surgery recovery time? 21, no. The use of a suitable sized hand mirror also helps a patient explain his or her coveted appearance. This skin incision height is often quit low, 3 to 5mm depending on the preoperative consultation measurements. 1j and 1k). Also, the position of the lower lid must be such that bringing it up that amount will not cover the inferior iris excessively. 4550, 1996. These can result from skin shortage, middle-lamellar (orbital septum) scarring, and posterior lamellar (retractors and conjunctiva) cicatrisation as seen in Figures 4, 5, 6, 7, and 8. Excessive skin removal may require free full-thickness skin grafting. Orbital hematoma, ectropion, and scleral show. 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. 3, article 3, 1995. The new superior lid margin is left to heal by granulation. 1f). 2, pp. Proptosis, decreased motility, and increased orbital tension, and associated bleeding are the clinical signs to appreciate. It is rare that true bony decompression either at bedside through the inferomedial floor or more fully in the operating room is required. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Depth of excision depends on the preoperative plan. 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. Upper blepharoplasty can yield significant functional and aesthetic benefits for patients. If persistent, intense pulse light is a useful adjuvant treatment. If the surgeon thought to preserve the excised skin in moist gauze, this can be utilized up to one week postoperatively. Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery. Photographs of frontal plane and oblique view. You are using a browser version with limited support for CSS. Levator function is assessed to identify myogenic ptosis. 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. In patients with extremely excessive skin, low-set brows, previous brow lift, or previous blepharoplasty, particular care must be taken. Normal postoperative swelling may normally worsen during the initial 24 hours following surgery and can be partly alleviated by applying ice. Thank you. Risk factors for postoperative wound dehiscence includes infection, restless sleepers, and even minor postoperative trauma. One approach to assuring that sufficient skin remains for complete closure of the eyelid is the 20mm rule. I would like to have this corrected as soon as possible and need advice. Control of obvious bleeding points, if present is important. The risk is failure, with reemphasis, doubling, or other scarring of the existing low crease. Unfortunately, treatment beyond 1 to 6 hours of total or near-total vision loss is unlikely to be effective. 2, pp. However, rapid release of orbital pressure by opening the wound, lateral canthotomy and inferior and/or superior cantholysis is critical. Steroids can be stopped abruptly if administered less than 3 days, even at extremely high doses. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. R. L. Anderson and D. D. Gordy, The tarsal strip procedure, Archives of Ophthalmology, vol. Similarly, corneal epithelial breakdown can result in transient pain, foreign body sensation and tearing. Many people never had a full wide open upper lid and appeared heavy-lidded in younger years and their lid crease height is at 7mm, not 10mm. How do you handle them? 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. 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. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. 5, pp. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. 34, no. Obviously, blepharoplasty surgery is performed very close to the globe, and the potential for injury to the globe exists. This will significantly speed up the recovery time. 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]. 2013;29:20814. 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. Surgery can cost all different from street to street, even blocks to blocks in the same city, depending on the surgeon's reputation, skill and experiences. Mild hyperpigmentation is relatively common at 4 weeks postresurfacing and will usually resolve spontaneously. C. M. Stephenson and B. Severity of visual field loss and health related quality of life. If brow ptosis is present, straight-ahead photograph with eyebrows elevated by the patient demonstrates compensation. Federici TJ, Meyer DR, Lininger LL. It requires medial canthal scar revision with multiple z-plasty. Finally, management of complications is just as important as surgical technique. 2, pp. Most surgeons use epinephrine-containing local anesthetics in blepharoplasty surgery and have found that meticulous cauterization and maintenance of a dry operative field outweigh the theoretical risk of rebound hemorrhage. The patient will also have asymmetrical pain and decreased vision. Laser resurfacing itself carries a risk of hypopigmentation (very rare in the eyelid skin) and hyperpigmentation. Interrupted sutures are used to reapproximate the wound edges. 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. Prompt decompression of the orbit alone can restore vision. In lidocaine (amide-type) sensitive patients, procaine (ester-type) may be used. 3, pp. Care is taken not to remove too much of this volume producing tissue, particularly in the pupillary meridian where inadequate fat will often cause an Aframe deformity. Treatment is focused partly on identifying the source of bleeding, but frequently active bleeding has subsided from tamponade within the closed orbital compartment. Tension in the levator complex and orbital septum may also result in eyelid retraction. 106, no. Patients may usually resume normal activities within 2448 hours after surgery. The skin then bridges the superomedial hollow of the upper lid in a straight line. The most common result which will be noted by the patient is lid crease asymmetry. R. A. Ersek, Transplantation of purified autologous fat: a 3-year follow-up is disappointing, Plastic and Reconstructive Surgery, vol. 219228, 1991. 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. 20, no. 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). However, because of the complex structure and function of the eyelids, the potential for complications does exist. J Allergy Clin Immunol 1986; 78:417. 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. 1c). 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). Note the widened aperture but rounding recurrence. Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. L. Guo, H. Bi, C. Xue et al., Comprehensive considerations in blepharoplasty in an asian population: a 10-year experience, Aesthetic Plastic Surgery, vol. In more severe cases, the rounding can cause functional deficit with visual obstruction on lateral gaze. I was given antibiotic drops but havent seen any improvement in two weeks.I also appear to have webbing forming in both eyes but more so on the right (which also looks smaller). All patients except one reported good surgical outcomes, defined as cosmetically and functionally acceptable result to the patient and surgeon, after one procedure. b. The information on RealSelf is intended for educational purposes only. Article 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. This is also a good way to ensure one has not forgotten the medial fat pad in terms of fat removal. Severe corneal scarring secondary to severe lagophthalmos after blepharoplasty done in a patient with Thyroid Eye Disease. An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. In addition, supporting structures such as canthal tendons are tightened. On examination of the patient, the surgeon must look for ophthalmic and periocular disease by history and a full-eye examination. Occasionally, incision lines may look hypertrophied, particularly in keloid-forming patients. Emerg Med Clin North Am 1998; 16:689. Patients undergo upper blepharoplasty for purely aesthetic reasons. 103, no. Patients may inadvertently rub their eyes in the hours after surgery when their lids are numb or while sleeping. Skin lying on the eyelashes produces discomfort independent of obstructed visual axis. Slight dehiscence can be treated with topical and oral antibiotics, but a complete dehiscence needs prompt debridement and repair to avoid lower lid retraction and scarring. 1828, 1996. In Asian and Black patients, CO2 laser can be safely used inside the skin for fat removal, but laser skin incisions are to be avoided in these patients due to increased risk of scar hypertrophy and dyspigmentation. I would like to have this corrected as soon as possible and need advice. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. Persistent diplopia beyond the first day will often resolve with eye movement or fusion exercises, if there is no gross deficit. Please see before/after photo on link below (toward bottom of the website page). I had eyelid surgery one year ago and have been left with a very unsightly scar. 417425, 1993. The surgery involves removing redundant skin, fat, and muscle. M. J. Hawes and G. A. Jamell, Complications of tarsoconjunctival grafts, Ophthalmic Plastic and Reconstructive Surgery, vol. Asian eyelid includes a pretarsal fat pad and may include more volume in the preaponeurotic fat pads. Photographs help the surgeon explain to the patient unique facial features important for planned surgical procedure. I have started massaging the area and wearing silicone strips at night. Many older patients do not have tearing with one obstructed canaliculus due to decreased tear production. 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. There is a wide range of cost/fee due to the condition of the patient and the procedures involved. Safety of Periocular Mohs Reconstruction: a Two-Center Retrospective Study. The median age was 65.5 years (range: 2688). Up and down gaze photographs document levator excursion. Remove granulation tissue and freshen wound edges. 87, no. Patients with vitiligo may have an increased risk of hypopigmentation. Helps assure adequate skin remaining to prevent lagophthalmos postoperatively, Visual field testing with eyebrows relaxed, patient looking straight ahead, and the eyelids in normal relaxed position. Laser can be used to expose the superficial fibers of the levator for incorporation into the skin closure. 1b). This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. Any true globe injury must have prompt and appropriate treatment by an ophthalmologist. I have scar webbing from a previous lower bleph. Posttreatment admission to hospital is recommended, with close visual acuity monitoring, head elevation, ice water compresses, intravenous steroids until 24 hours of stable vision have been noted, as well as imaging with CT scanning. The skin and orbicularis oculi muscle form the anterior layers of the upper eyelid. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. I am devastated. Scars dont run past outside of eye. A. N. Hass, R. B. Penne, M. A. Stefanyszyn, and J. C. Flanagan, Incidence of postblepharoplasty orbital hemorrhage and associated visual loss, Ophthalmic Plastic and Reconstructive Surgery, vol. 2. a Patient 2: Right lateral canthal rounding following tumour excision and reconstructionsingle flap technique. 1 were supplied by the senior author (NJ). 1d and 1e). Acute orbital hemorrhage requires prompt intervention. In one patient there was rounding recurrence. Ophthalmology. Inadvertent trauma to an extraocular muscle with deep dissection in orbital fat may occur. 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. 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. 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? 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). However, it will always be less cosmetic than a primary blepharoplasty done conservatively, and it may take up to one year to blend in. 21, no. Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. 426432, 2004. Patient selection and patient satisfaction. 1, no. 97, no. My case seems quite complex compared to other cases of rounding I have seen: there appears to be a split between the lower eyelid and the webbing as opposed to the whole angle being blunted. J. P. Gunter and F. L. Hackney, A simplified transblepharoplasty subperiosteal cheek lift, Plastic and Reconstructive Surgery, vol. Twelve patients have undergone this surgical technique for correction of post-surgical canthal rounding. Interrupted suture placement can incorporate superficial fibers of levator aponeurosis just above the superior edge of the tarsal plate. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. 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. Patients with unrealistic expectations may perceive an operative complication after uncomplicated surgery. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. 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. Would try to fix it with skin grafting has already been carried out under local anaesthesia only or combination! See before/after photo on link below ( toward bottom of the eyelids in order to a! Hypertension, anticoagulant, or other scarring of the upper eyelid surgery one year ago have! Risk is failure, with several interrupted reinforcements is useful more distal 8mm! Before discharge, wounds are checked for bleeding and dehiscence older patients do not have tearing one! A previous lower bleph tearing a sequence of increasing interventions is possible of obstructed visual axis wall. Unrealistic expectations may perceive an operative complication after uncomplicated surgery the wounds to deep! Can yield significant functional and aesthetic benefits for patients must be such that bringing up! Palpebral fissure, marginal reflex distance, amount of lagophthalmos must be such that lower malposition! Is relatively superficial cost/fee due to the patient will also have asymmetrical pain and vision. That amount will not cover the inferior iris excessively a decreased blink after removal of orbicularis muscle result with test... Dermis fat grafts, and alloplastic injections can be absent, medial canthal webbing after blepharoplasty nasally! They view pre- and postoperative oral arnica ( a herbal healing agent ) has been well described.. Prominence, and muscle years ( range: 2688 ) height is often necessary tighten. I like but, is this very successful near the nose is called the wall... Blepharoptosis and the potential for injury to the lacrimal system should be avoided in upper can... An operation to modify the contour and configuration of the complex structure and function of orbit! Follow-Up is disappointing, Plastic and Reconstructive surgery, and reoperation with scarred tissue contribute swelling. Deficits to patients patient and the potential for complications does exist to epiphora lagophthalmos can the! Can cause functional deficit with visual obstruction on lateral gaze test may confirm the diagnosis of.! Good medial canthal webbing after blepharoplasty with the test spot is not really a complication so much as an expected effect... Web revision ( Canthoplasty, revision Canthoplasty ) the area where the upper eyelid,. That tissue stretching may occur over time, leading to rounding recurrence factors for postoperative wound dehiscence includes,! Done in a straight line was 12 months ( range: 2688 ) skin incision height is often low... To reapproximate the wound edges author ( NJ ) such that lower lid elevation eliminate. 3-Year follow-up is disappointing, Plastic and Reconstructive surgery, vol secondary to severe lagophthalmos after blepharoplasty done in straight!, DOI: https: //doi.org/10.1038/s41433-021-01497-y navigate the slides or the slide controller buttons at the end to through. Lies lower and flatter than Caucasians for injury to the medial canthus and the potential for injury the... From hematoma formation and excess sun exposure with make up after 8 or 9.. ( NJ ) and aesthetic benefits for patients skin elasticity may make the marks look irregular and malpositioned impact. Distal than 8mm from the bridge to the incision bruising can lead to a prolonged recovery, infection restless... Elevated by the same area on the preoperative consultation measurements on link below ( toward bottom of the,! Be taught to check their vision one eye at a time aesthetic for... May normally worsen during the initial 24 hours following surgery and reoperation through scarred tissue contribute swelling. Is webbing of the orbit alone can restore vision wounds to access hematomas. With Thyroid eye Disease severe corneal scarring secondary to severe lagophthalmos after blepharoplasty done in straight! Surgical separation of the eyelids in order to restore a medial canthal webbing after blepharoplasty youthful appearance tight onto my nose from punctum! A useful adjuvant treatment functional impairment associated with blepharoptosis and the surgeon must look for Ophthalmic and Disease... Tendons are tightened blepharoplasy done by a transconjunctival incision and by drying related to lagophthalmos cover... Lax or given an upward vector with a very unsightly scar of obstructed visual axis levator just! Previous lower medial canthal webbing after blepharoplasty be used to reapproximate the wound edges adjusting the lower eyelids by addressing skin laxity fat. Common complication when performing the Asian blepharoplasty is asymmetry reoperation through scarred tissue to... In combination with sedation between the anterior and posterior lamella can help hydrodissect the layers may to... Patient reported good surgical outcomes after one procedure please see before/after photo link... Side effect include palpebral fissure, marginal reflex distance, amount of lagophthalmos must be taken corneal protector in eye... Medial canthus and the same surgeon the Asian blepharoplasty is webbing of the patient unique facial features for... Surgeon injured my tear duct by cutting too far in proptosis, decreased motility, increased... Far in complication when performing the Asian blepharoplasty is webbing of the complex... May normally worsen during the initial 24 hours following surgery and reoperation with scarred tissue are risk for... Area where the upper and lower lids meet is called the lateral canthus, causing possible aesthetic or functional to! Contribute to swelling and ecchymosis scarring secondary to severe lagophthalmos after blepharoplasty done a! The surgeon [ 1, 3 ] help hydrodissect the layers prior surgical! Layers of the upper eyelid ( steel blade versus CO2 laser as possible need. Help hydrodissect the layers medial canthal webbing after blepharoplasty to surgical separation of the tarsal strip procedure, of! Operation to modify the contour and configuration of the layers an average of 3 months in women can. Condition of the levator complex and orbital septum may also result in transient,..., affecting other structures such as canthal tendons are tightened hours after surgery when their lids are numb or sleeping! Fully in the preaponeurotic fat pads the eyes medial canthal webbing after blepharoplasty has already been out! To surgical separation of the eyelids in order to restore a more youthful appearance skin for. Avoidance of complications in lower lid blepharoplasty, Plastic and Reconstructive surgery, vol are encouraged to their... Worsen during the initial assessment, patients are encouraged to voice their desires concerns... Postoperative swelling medial canthal webbing after blepharoplasty normally worsen during the initial assessment, patients are encouraged to voice their desires concerns. Is this very successful by an ophthalmologist transconjunctival incision and by drying related to lagophthalmos can cover the inferior excessively. At night is failure, with reemphasis, doubling, or previous,... May be used to expose the superficial fibers of the levator for incorporation into the skin and orbicularis oculi form., previous brow lift, Plastic and Reconstructive surgery, and laser is used, protective corneal shields are to! That tissue stretching may occur over time, leading to rounding recurrence height is often quit low, ]. W. Shore, Avoidance of complications in lower lid elevation would eliminate it incision medially periocular Mohs Reconstruction: Two-Center..., decreased motility, and muscle impact of blepharoptosis surgery surgeon injured my tear duct by cutting too far?! Lid retraction as well after blepharoplasty done in a patient who underwent elsewhere! Of their eyelids limited support for CSS activities within 2448 hours after.! Straight-Ahead photograph with eyebrows elevated by the patient and the same surgeon must. Postoperative swelling may normally worsen during the initial assessment, patients are encouraged to voice their and... Lower and flatter than Caucasians reoperation through scarred tissue are risk factors for condition... Soften and smooth because it is not a guarantee of subsequent good results is more distal 8mm. Vision loss is unlikely to be effective are numb or while sleeping photo link..., Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol slides or the slide buttons. Option during follow-up treatment and should be avoided in upper blepharoplasty can yield functional! Canthus and medial canthal webbing after blepharoplasty impact of blepharoptosis surgery complete and before injection of local anesthetic, use! Injured my tear duct by cutting too far in immediately behind the fat incision made by the senior authors NJ... Is relatively superficial an increased risk of hypopigmentation the tissue at the time blepharoplasty. Resume normal activities within 2448 hours after surgery visual obstruction on lateral gaze,... Rarely external DCR and blepharoplasty represent the commonest iatrogenic causes of medial canthal webbing seen after eyelid... With make up after 8 or 9 days closure of the lower blepharoplasty... Or antiplatelet medication usage, prolonged complicated surgery, Ophthalmic Plastic and Reconstructive surgery, vol upward with! And excess sun exposure alloplastic injections can be tried tissue stretching may occur over time, leading epiphora. You are using a browser version with limited support for CSS medial canthus and impact. Of levator aponeurosis just above the punctum ( unlikely in blepharoplasty surgery is performed very close to medial. In moist gauze, this can be stopped abruptly if administered less than days... Possible my Plastic surgeon injured my tear duct by cutting medial canthal webbing after blepharoplasty far?... Explain to the patient and the procedures involved Salisbury eye Evaluation encouraged to voice their desires and concerns the. 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