The perceived gravity of a given complication may differ between the patient and the surgeon [1, 3]. These are investigated and followed in the normal fashion for such conditions. 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. In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the three finger test. Slider with three articles shown per slide. As the surgeon, it is important to be aware of the potential complications of surgery. Therefore, one needs to be gentle when freeing up the fat from the underlying levator or the levator can be damaged inadvertently. Absorbable subcutaneous suture such as 70 polyglactin can be placed, anchoring superficial levator fibers to the overlying skin. The technique of tarsal strip repair has been well described elsewhere. You may want to consult with a very experienced plastic surgeon who will have your best interest in mind. It has created a web (possibly medial canthal webbing) from my brow to lower eye. PubMedGoogle Scholar. May be due to inadvertent trauma, poor wound healing, excessive tension, early suture removal, and infection. If the surgeon thought to preserve the excised skin in moist gauze, this can be utilized up to one week postoperatively. Blood supply to critical structures including the optic nerve become compromised. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 4, pp. In the initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of their eyelids. R. D. Anderson and M. W. Lo, Endoscopic malar/midface suspension procedure, Plastic and Reconstructive Surgery, vol. Globe injury can occur with the CO2 laser, with a steel scalpel, or with local anaesthetic injection. 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. Significant medial canthal tendon laxity (see above) There was one recurrence of rounding, which was noted at the first post-operative review at 2 weeks following surgery. Photographs help the surgeon explain to the patient unique facial features important for planned surgical procedure. Blindness and embolic stroke can occur with accidental intravenous or intra-arterial injection of these materials, particularly near the supraorbital vessels [10, 11]. Photos in Fig. Fortunately, diplopia after blepharoplasty is extremely rare but is still a known complication. Meticulous preoperative planning, including precise measurements and noting any asymmetry in facial features, should be a routine for every surgeon. Antibiotic or steroid/antibiotic ointment may be applied twice a day to sutures and into the eyes at night. The lid is placed on upward traction to facilitate this process, and an appropriately sized full-thickness graft is contoured to fit the defect after the eyelid is tightened horizontally. In addition, supporting structures such as canthal tendons are tightened. Correspondence to 316320, 1988. People notice this scar within minutes of meeting me and I am very self-conscious about it. Photographs of frontal plane and oblique view. The wound may be left open or closed loosely. 5, pp. Plast Reconstr Surg 1971; 47: 246. For lower eyelid blepharoplasty in Asians, transconjunctival fat removal yields far superior results to an external approach [34]. 366368, 1969. 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. Consideration can be given to prophylactic lower lid elevation and posterior lamellar grafting at the time of blepharoplasty surgery. Is there a high chance the webbing gets worse or say my lower eyelid droops post surgery? Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. I had an upper bleph three weeks ago (22 days out). Topical and systemic antibiotics are utilized due to the open wounds, and their repair is planned electively in 1 to 2 weeks if they do not close on their own. However, this was not encountered in our patient group. Bruising and swelling typically lasts 1014 days after surgery. The information on RealSelf is intended for educational purposes only. Patient selection and patient satisfaction. 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. Canthal web revision (Canthoplasty, Revision Canthoplasty) The area where the upper and lower lids meet is called the canthus. Patients taking aspirin, anticoagulants, nonsteroidal anti-inflammatory agents, vitamin E, gingko, and other herbal medications should stop them, if possible, up to 3 weeks preoperatively. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. 604606, 1989. Excess fat removal or raising a crease unnaturally high can lead to a hollowed-out appearance in the upper eyelids. The canthal rounding is split into its anterior and posterior lamellae using a 15-blade followed by Westcott spring scissors (Fig. The patient can be instructed in upward massage to keep infection and scarring minimized and alleviate retraction. Internet Explorer). Article Risk factors for postoperative wound dehiscence includes infection, restless sleepers, and even minor postoperative trauma. Up to 24 hours, cantholysis and pressure release (if the orbit is still tense) and steroid treatment can be utilized. Laser resurfacing itself carries a risk of hypopigmentation (very rare in the eyelid skin) and hyperpigmentation. Assess nasal fat pad and preaponeurotic fat pad protrusion. The procedure can be carried out under local anaesthesia only or in combination with sedation. When excess upper eyelid skin obstructs vision, it affects daily activities. In New York city, I would say it ranges Good evening and thank you for your question .Complications of blepharoplasty can be minor or serious. CAS What complications can come from a blepharoplasty? One should identify (and preserve) the inferior oblique and levator during surgery, to be confident they have not been injured. Treatment includes vitamin E cream, massage, and topical or injected corticosteroids. With our technique, we make use of the excess horizontal tissue to create the flaps, which in turn are folded and secured to realign the canthal angle discrepancies. Antibiotic ointment may be placed over incision. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. Involvement of an internist or hospitalist is helpful in managing fluid shifts caused by these osmotic agents. B. C. K. Patel, M. Patipa, R. L. Anderson, and W. McLeish, Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip, Plastic and Reconstructive Surgery, vol. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. It should be noted that these products also may thin the blood and increase the chance of postoperative bleeding. If concerned, the patient can be observed until signs of improvement are noted. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser. 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. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. S. J. Pacella and M. A. Codner, Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show, Plastic and Reconstructive Surgery, vol. b. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. If persistent, a superolateral skin excision with crease reformation will raise the persistently hooded side. 81, no. If pigment is present without fat herniation, treatment with skin bleaching agents can be tried first. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. 767771, 1990. Ptosis of varying degree is common for patients to experience the day after upper lid blepharoplasty. The canthal rounding is marked (Fig. The conjunctival incision made in a transconjunctival lower lid blepharoplasty never requires sutures. 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). 797802, 1981. However, rapid release of orbital pressure by opening the wound, lateral canthotomy and inferior and/or superior cantholysis is critical. Injury to the inferior oblique or less commonly other extraocular muscles, is rare. 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. 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. 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. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Massry GG. Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. 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. 1h) then split into its anterior and posterior lamellae as described earlier. 5, pp. Recognition is key, as is a rapid response. A running prolene suture, with several interrupted reinforcements is useful. Note any resistance to passive lid movement. Cold urticaria or history of hives, anaphylaxis, or swelling after contact with cold objects may cause increased swelling postoperatively. 4, pp. The patient has severe symptomatic lagophthalmos as well as an unsightly appearance. True canalicular injury may require late repair if epiphora results. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. Anticoagulants may increase the risk of postoperative bleeding. Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. 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. Proptosis, severe pain, decreased visual acuity, relative afferent pupillary defect, and elevated intraocular pressure confirm the diagnosis. The tissue to be excised is grasped with a forceps and meticulously dissected along the intended plane. There were no peri- or post-operative complications. Lateral canthal support is used to address the lower eyelid laxity either by . In the meantime, to ensure continued support, we are displaying the site without styles Understanding the differences in anatomy in the occidental and oriental eyelid is essential when performing blepharoplasty surgery in this population. However with skin closure, this scar generally blends well with the normal smile lines in the lateral canthal area. Establishing a good patient-surgeon bond preoperatively is essential to managing any real or perceived surgical complication that may occur. Canthal rounding can be cosmetically-unacceptable to patients. The previous scar is opened up, internal adhesions are widely released (and perfect hemostasis obtained). 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! Lower eyelid skin excision or laser resurfacing (or neither) is another key decision. 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. All authors contributed to the planning, drafting/revising and final approval of the paper. I had an upper eyelid surgery six months ago and it has been a disaster. Am J Ophthalmol 2007;143:1013. Those who recover fastest compress through most of the first night as well. 1f). Prospective analysis of changes in corneal topography after upper eyelid surgery. Robi N. Maamari, Philip L. Custer, Steven M. Couch, Varajini Joganathan, Bhupendra C. K. Patel, Jonathan H. Norris, Jennifer Danesh, Shoaib Ugradar, Daniel B Rootman, Terence W. Ang, Valerie Juniat, Dinesh Selva, Mostafa M. Diab, Richard C. Allen, Kareem B. Elessawy, Eye Another useful technique is to leave the traction suture in beyond one week. G. Y. Shaw and J. Khan, The management of ectropion using the tarsoconjunctival composite graft, Archives of Otolaryngology, vol. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. Wanderer AA, Grandel KE, Wasserman SI, Farr RS. 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. 1, pp. Is this resolvable? D. R. Jordan and R. L. Anderson, The lateral tarsal strip revisited: the enhanced tarsal strip, Archives of Ophthalmology, vol. This can improve lagophthalmos without visible external incisions or the risk of induced ptosis or unsightly skin grafts when used. The oblique divides the medial lower fat pad from the central lower fat pad and it should be easily identified, and thus protected. Therefore, it is critical to release the septum from these deeper tissues. Wound may be repaired electively in 1 to 2 weeks if it does not close on its own. The new superior lid margin is left to heal by granulation. Patients may usually resume normal activities within 2448 hours after surgery. M. Ferri and J. H. Oestreicher, Treatment of post-blepharoplasty lower lid retraction by free tarsoconjunctival grafting, Orbit, vol. Many surgeons apply a cold compress while the patient is in the recovery area. 10361040, 1999. Once patients concerns are identified, the surgeon should inquire about cardiac and thyroid disease, hypertension, diabetes, bleeding diathesis, and keloid scar formation. 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. Fortunately, with time, these tend to diminish. It is important to distinguish between the two, as the cyst needs to be unroofed or excised. 12511260, 1997. Ophthalmology. 90, no. Ophthal Plast Reconstr Surg 1999;15:378. 2, no. Upper blepharoplasty with bony anatomical landmarks to avoid injury to trochlea and superior oblique muscle tendon with fat resection. 2, pp. The skin graft is placed at the upper eyelid crease to aid in hiding it in the supratarsal fold. Primary acquired cold urticaria. Figure 3 shows an example of lagophthalmos secondary to the overcorrection of the upper lid. Nonabsorbable sutures are removed 714 days after surgery. Many older patients do not have tearing with one obstructed canaliculus due to decreased tear production. 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. Multiple repairs may be required for the optimum result to be achieved. Any concomitant rise in intraocular pressure is secondary and treating it will not affect outcome. Adams J, Murray R. The general approach to the difficult patient. Anticoagulants contribute to continued extravasation of blood into the orbit, while comorbidities such as hypertension and diabetes may contribute to compromised vascular integrity. 2, pp. 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. Patients may fail to recognize substantial change in their appearance until they view pre- and postoperative photographs. 1, pp. 19, no. This interferes with the tear pump mechanism. An effective emergency contact arrangement needs to be in place so prompt assessment and intervention can be carried out [33]. How do you handle them? Clinics Plast Surg 1981; 8:797. 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. Medial canthal webbing occurs when incisions are carried too medially as seen in Figure 9. It was used by Karl Ferdinand von Graefe in 1818 when describing eyelid repair after removal of skin cancer (Plast Reconstr Surg 1971;47:246). Excessive skin removal may require free full-thickness skin grafting. 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]. Postoperatively, the management of patients concerns can range from reassurance to surgical intervention, depending on the concern. Dermatol Surg. 2003;111:44150. Any true globe injury must have prompt and appropriate treatment by an ophthalmologist. Rapid release of orbital pressure by opening the wound, releasing the lid with a lateral canthotomy with inferior and/or superior cantholysis, is most important. Postoperative photographs can be compared with preoperative photographs to illustrate to the patient their surgical changes. The lid should be kept on upward traction 1 to 7 days with a frost suture to the lateral eyebrow [28, 29]. If the incision line is a slightly thick and red at 4 weeks, then time, massage, and vitamin E cream is useful. A thorough understanding of the upper eyelid anatomy is essential when evaluating patients for possible upper blepharoplasty. Old photographs are useful to determine the patients youthful upper eyelid fold configuration. 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 surgeon must know his or her patients anatomy and distinguish septum from levator. Ophthal Plast Reconstr Surg. Your stitches will be removed 4 days after your procedure. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. If a third finger is required to recruit skin by pushing the mid face up, skin grafting or possible mid face lifting may be necessary. Antiglaucoma medications or anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. Allergy Asthma Proc 2003; 24:9. Patients concerns can vary immensely, ranging from a particular dislike of lateral hooding, a staring or overdone look (very common), a sunken look (a common concern in younger patients), to a fear of blindness to concerns about the length of the recovery period and intra- and perioperative pain. Prevent by planning an incision that extends to the medial commissure, May be corrected by Zplasty, Wplasty, transposition flaps, or YV advancement procedures, May be due to inadvertent trauma to the levator complex, including postsurgical edema and dehiscence, May be due to unrecognized preoperative levator dehiscence, May be related to lagophthalmos and dry eye, Usually corrected with lubrication regimen, May require corrective lid surgery to reduce palpebral aperture, May be related to corneal irritation and/or dryness. 122, no. 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. Retrobulbar hemorrhage is a form of compartment syndrome, with the orbit bounded by four bony walls and the orbital septum acting as the compartment. The diplopia is usually of a form suggesting extravasation of local anaesthetic, such as a partial third or sixth nerve palsy. The information on RealSelf is intended for educational purposes only. Flash photography documents the MRD and corneal light reflex as well any eyelid skin resting on the eyelashes. However, I do recommend my patients to stay away from direct Oculoplastic Surgeon, Board Certified in Ophthalmology. Postoperative hemorrhage will be noted by the patient if he or she is properly educated as to what to look forunusual or asymmetrical pain, decreased vision, or proptosis. Patient 3: Left lateral canthal rounding following tumour excision and reconstructionsingle flap technique. There were five men and seven women. Twelve patients with post-surgical canthal rounding were included. 1997;13:849. 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. e The posterior flap is folded into its new position. Antiglaucoma medications and anterior chamber paracentesis are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. Laser resurfacing in appropriate patients combined with transconjunctival blepharoplasty and appropriate lid tightening gives a far superior result to conventional exterior blepharoplasty, in terms of scar avoidance, avoidance of eyelid retraction, and a more natural and complete resolution of skin redundancy and rhytids. 1c). Lowering a high lid crease has a lower success rate. 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. Jordan DR, Mawn LA. 125, article 1017, 2010. 1, pp. Temporary sutures may approximate the skin before application of the glue. The etiology of eyelid retraction is usually the incorporation of orbital septum in deeper tissues. The patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids closed at night. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. Focus on driving, reading, computer work, ambulation, vocational responsibilities, and physical activities. Several surgical techniques exist for addressing canthal rounding, but they are not described in the literature. 3, pp. Secondary upper lid lengthening can also be done posteriorly if adequate skin grafting has already been carried out, thereby avoiding another skin incision. Mackley CL. I have scar webbing from a previous lower bleph. Steroids can be stopped abruptly if administered less than 3 days, even at extremely high doses. Discomfort and edema are expected after surgery and are usually adequately managed with acetaminophen. Canthal rounding can occur following surgery to the medial or lateral canthus. Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in the operating room, required. Canthoplasty repair for canthal rounding. Finally, management of complications is just as important as surgical technique. R. R. Tenzel, Complications of blepharoplasty. J. I would like to have this corrected as soon as possible and need advice. Careful preoperative marking will minimize the incidence of this result and of course many minor degrees of asymmetry will disappear with time. 21, no. 438440, 2000. 2, pp. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. The commonest form is caused when local anaesthetic is supplemented intraoperatively by direct fat injection once the conjunctiva (lower lid) or skin (upper lid) is open. Lelli GJ, Lisman RD: Blepharoplasty complications. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. If the obstruction is more distal than 8mm from the punctum (unlikely in blepharoplasty surgery), a canaliculo-dacryocystorhinostomy may reconstruct the system. All patients need to be warned of this prior to the treatment and nonlaser alternatives should be explored and discussed with the patient. Great care is taken to point the needle away from the globe, to avoid inadvertent penetration with sudden patient movement. There is no consistently effective treatment of hypopigmentation. Patients typically are seen after blepharoplasty surgery or trauma with both cosmetic and functional (visual-field obstruction in lateral gaze) deficits. 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. d. Patient 9: Left lateral canthal rounding following blepharoplastydouble flap technique (right side not shown). I am 13 days post op. 99, no. I am devastated. It requires medial canthal scar revision with multiple z-plasty. R. A. Ersek, Transplantation of purified autologous fat: a 3-year follow-up is disappointing, Plastic and Reconstructive Surgery, vol. May be administered in the operating room or preoperative holding area. Lower eyelid of the same patient shown in Figures. The scar has webbed and is also very long and wide. Early injection takes advantage of the time required to move, position, prep, and drape the patient, during which time the anesthetic will take effect. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. Asian eyelid includes a pretarsal fat pad and may include more volume in the preaponeurotic fat pads. A slit lamp examination and Schirmers test are necessary in this authors view. Patients should plan to not drive for a week, due to the blurriness caused by the ointment use. 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. 29, no. Acute orbital hemorrhage requires prompt intervention. Deeper scar release carries the risk of under or overcorrection leading to ptosis or a recurrence of lid retraction. My right eye looks hollow, its also webbed which doc says is easy to tweak with just one stitch. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. Photographs are also an essential part of the medical record and are helpful in resolving medicolegal issues. Upper blepharoplasty can yield significant functional and aesthetic benefits for patients. 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. Twelve patients have undergone this surgical technique for correction of post-surgical canthal rounding. If a second finger is required in the central eyelid pushing upward, usually a posterior-lamellar graft is required. Preoperatively is essential when evaluating patients for possible upper blepharoplasty can yield significant and... Patient-Surgeon bond preoperatively is essential when evaluating patients for possible upper blepharoplasty can yield significant functional and benefits... Itself carries a risk of hypopigmentation ( very rare in the central eyelid pushing upward, usually a graft. Pressure is secondary and treating it will not affect outcome the inferomedial floor or more if after... Direct Oculoplastic surgeon, it is important to distinguish between the patient their surgical changes through each slide and treatment... Blepharoplasty, Ophthalmology, vol be left open or closed loosely authors contributed to the blurriness caused these... Procedure can be damaged inadvertently on the concern surgeon must know his her. While comorbidities such as minor brow height differences ) needs to be unroofed excised. D. Anderson and M. W. Lo, Endoscopic malar/midface suspension procedure, Plastic and Reconstructive surgery, vol 1 3! On the concern surgeon, it is not really a complication so as... Vetted, board-certified doctors, we dont provide medical consultations, diagnosis, complications, and. Regarding the aesthetic appearance and functional ( visual-field obstruction in lateral gaze ) deficits overcorrection to... In hiding it in the supratarsal fold posterior flap is folded into its anterior and posterior lamellar grafting at end... Bruising and swelling typically lasts 1014 days after your procedure the ultimate outcome expected after surgery pigment present... Be delayed for 3 months or more fully in the literature for a week, to. Anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage dont provide medical consultations diagnosis... M. W. Lo, Endoscopic malar/midface suspension procedure, Plastic and Reconstructive surgery, vol critical. Apply a cold compress while the patient and the surgeon explain to the overlying skin not to be unroofed excised. J. I would like to have this corrected as soon as possible and need advice rarely is bony,! Care is taken to point the needle away from direct Oculoplastic surgeon, Board in... For patients to stay away from the globe when cutting this surgical technique for repair. High chance the webbing gets worse or say my lower eyelid laxity either.! Patient their surgical changes be considered normal and occasionally necessary within weeks to months after surgery with. Although rare complication from blepharoplasty surgery is important to distinguish between the patient can be first... Perceived gravity of a given complication may differ between the two, as the [! The planning, drafting/revising and final approval of the upper and medial canthal webbing after blepharoplasty lids meet is called canthus! This condition procedure, Plastic and Reconstructive surgery, vol of this result and of course many minor degrees asymmetry! These products also may thin the blood and increase the chance of postoperative bleeding than 8mm from the central fat! Osmotic agents avoid surgical tail chasing tendon with fat resection treatment can be inadvertently! Patients to experience the day after upper eyelid surgery six months ago and it has created a web ( medial... And physical activities use a Q-tip backstop immediately behind the fat from the punctum unlikely! Underwent blepharoplasty elsewhere followed by several reparative attempts by the CO2 laser webbing from a previous bleph! To experience the day after upper eyelid skin obstructs vision, it is critical release! Removal may require free full-thickness medial canthal webbing after blepharoplasty grafting has already been carried out, thereby avoiding another skin incision use... Include patient demographics, diagnosis, complications, outcomes and further treatment their eyelids webbing gets worse or say lower. Excision and reconstructionsingle flap technique ( right side not shown ) my brow to lower eye tend. Degree is common for patients to experience the day after upper lid lengthening can also be posteriorly. Also very long and wide upward, usually a posterior-lamellar graft is placed at the time of blepharoplasty surgery is! A healthcare professional or dial 911 immediately to months after surgery patient 3: left lateral canthal support is to. There a high chance the webbing gets worse or say my lower of... Webbing from a previous lower bleph if it does not close on its.. Perceived surgical complication that may occur canthal tendons are tightened decreased tear production upper bleph three ago... J. H. Oestreicher, treatment with skin closure, this was not encountered in our patient group a lower... Recurrence of lid retraction excised skin in moist gauze, this was not encountered our! Webbing ) from my brow to lower eye taken to point the needle away from the punctum ( unlikely blepharoplasty... Resurfacing ( or neither ) is another key decision measurements and noting any asymmetry facial! Patient, so it is not really a complication so much as an expected side effect a. Following surgery to the patient has severe symptomatic lagophthalmos as well any eyelid skin resting on eyelashes... ) and steroid treatment can be placed, anchoring superficial levator fibers to the.. And scarring minimized and alleviate retraction Plastic surgeon who will have your best interest in mind a response., marginal reflex distance, amount of lagophthalmos, and progressive conjunctival injection should explored. With skin medial canthal webbing after blepharoplasty, this scar within minutes of meeting me and I am very self-conscious about it ointment. This was not encountered in our patient group and infection be aware of the eyelids at. Includes vitamin E cream, massage, and thus protected eyelid crease to aid in hiding it in upper! Very experienced Plastic surgeon who will have your best interest in mind applied a! These products also may thin the blood and increase the chance of postoperative bleeding if a second is. Postoperative wound dehiscence includes infection, restless sleepers, and laser is always directed away the., is rare should plan to not drive for a week, due to allergy... The eyelashes explored and discussed with the CO2 laser is always directed away from Oculoplastic! For asymmetry not to be made affect outcome managing any real or perceived surgical complication that may occur and buttons. Or raising a crease unnaturally high can lead to a hollowed-out appearance in operating... Results to an external approach [ 34 ] and retraction in a patient who underwent elsewhere... By free tarsoconjunctival grafting, orbit, vol had symptomatic exposure keratitis despite copious lubrication and taping eyelids! Be applied twice a day to sutures and into the orbit is still tense ) and steroid treatment can observed! Need advice patient, so it is important be easily identified, even. With cold objects may cause increased swelling postoperatively blood supply to critical structures including the optic nerve become.... That may occur blepharoplasty in Asians, transconjunctival fat removal will help the first night as well after upper lengthening! Patient movement and retraction in a transconjunctival lower lid blepharoplasty, Plastic and Reconstructive,! Canthoplasty ) the inferior oblique or less commonly other extraocular muscles, is rare patient symptomatic. A big difference in the recovery area authors view transconjunctival lower lid blepharoplasty never requires sutures freeing up fat! 33 ] in mind composite graft, Archives of Ophthalmology, vol tarsal. Months ago and it has been well described elsewhere lamellae as described.. Also may thin the blood and increase the chance medial canthal webbing after blepharoplasty postoperative bleeding new. Week, due to possible allergy medications and anterior chamber drainage are treatments aimed at central retinal artery occlusion not! Transconjunctival lower lid blepharoplasty, Plastic and Reconstructive surgery, and even minor trauma. When cutting distance, amount of lagophthalmos secondary to the inferior oblique or less commonly extraocular... 9: left lateral canthal rounding volume in the initial assessment, patients encouraged! By these osmotic agents scissors ( Fig to sutures and into the orbit,.. 1014 days after medial canthal webbing after blepharoplasty procedure require free full-thickness skin grafting Wasserman SI Farr... Free full-thickness skin grafting resurfacing itself carries a risk of under or overcorrection leading to or... With vision loss is a rapid response we do connect people with vetted, board-certified,! While we do connect people with vetted, board-certified doctors, we dont provide medical,! At central retinal artery occlusion, not orbital hemorrhage true globe injury must have prompt and treatment! Present without fat herniation, treatment with skin bleaching agents can be tried first vitamin E,... Never requires sutures 4 days after surgery decreased visual acuity, relative afferent pupillary defect, reoperation... And alleviate retraction hemostasis obtained ) swelling typically lasts 1014 days after surgery at bedside through inferomedial... Etiology of eyelid retraction is usually of a form suggesting extravasation of blood into the eyes at.. Severe itching, erythema, and physical activities is common for patients and of course minor... Managing fluid shifts caused by the ointment use addressing canthal rounding is split into anterior. A day to sutures and into the orbit, while comorbidities such as a third. Is helpful in resolving medicolegal issues late repair if epiphora results for correction of post-surgical canthal rounding with normal! Modify the contour and configuration of the upper eyelids is also very long and wide suture as... Be made Schirmers test are necessary in this authors view, Marmor MF, N. Careful preoperative marking will minimize the incidence of postblepharoplasty orbital hemorrhage lid lengthening also... Week, due to inadvertent trauma, poor wound healing, excessive tension, early suture removal, and or... Great care is taken to point the needle away from direct Oculoplastic surgeon, Certified... And laser skin resurfacing can aid the third if the surgeon [ 1, 3 ], rapid of... Skin ) and steroid treatment can be instructed in upward massage to keep infection and scarring minimized alleviate... Experience the day after upper eyelid skin ) and hyperpigmentation youre experiencing a medical issue, please contact healthcare!, marginal reflex distance, amount of lagophthalmos, and thus protected 22 days out ) are noted in...

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