Racial and ethnic facial characteristics including skin type and underlying facial bone structure may be included in discussing alternatives and surgical planning. Crease formation should not be high on the levator (if above tarsal plate at all) to avoid a distorted westernized look, asymmetry, and ptosis. Provided by the Springer Nature SharedIt content-sharing initiative, Eye (Eye) Allergy Asthma Proc 2003; 24:9. Another outcome noted by patients is asymmetry of lateral hooding reduction. I experienced significant swelling in my tear duct area (especially on the right side) My right eye now appears to have webbing on the inner corner. 99, no. 604606, 1989. Lewis CM, Lavell S, Simpson MF. 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. The surgical technique was developed by one of the senior authors (NJ). 1992; 99:222. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. People notice this scar within minutes of meeting me and I am very self-conscious about it. Blindness after blepharoplasty: mechanism and early reversal. D. R. Jordan and R. L. Anderson, The lateral tarsal strip revisited: the enhanced tarsal strip, Archives of Ophthalmology, vol. I had eyelid surgery one year ago and have been left with a very unsightly scar. When skin shortage dictates skin graft placement, the technique is similar to that for other forms of cicatricial ectropion. 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. Any true globe injury must have prompt and appropriate treatment by an ophthalmologist. One approach to assuring that sufficient skin remains for complete closure of the eyelid is the 20mm rule. Z. i Anterior flap is completely excised. Patients may inadvertently rub their eyes in the hours after surgery when their lids are numb or while sleeping. Swelling and bruising you may have will be virtually gone by day 10. 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. Significant lagophthalmos illustrated. 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. Normal postoperative swelling may normally worsen during the initial 24 hours following surgery and can be partly alleviated by applying ice. Pure skin lack can be remedied by a full thickness skin graft. 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. 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. 9, pp. Lagophthalmos can increase reflex tear secretion, leading to relative epiphora. Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in the operating room, required. Patient discomfort from suture removal is minimized by using Jewellers forceps and sharp Vannas scissors. CAS The rounding can have a significant component of scar tissue, creating an aesthetic or functional deficit that can be distressing for patients. Fortunately, diplopia after blepharoplasty is extremely rare but is still a known complication. 8, no. In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. do you think epicanthoplasty would be a good option? Blindness and embolic stroke can occur with accidental intravenous or intra-arterial injection of these materials, particularly near the supraorbital vessels [10, 11]. Patients who experience severe itching, erythema, and progressive conjunctival injection should be advised to discontinue topical ointment due to possible allergy. Usually, it is a mistake to try and change their upper eyelid nature too drastically, unless this desire and postoperative appearance is made abundantly clear. May be due to inadvertent trauma, poor wound healing, excessive tension, early suture removal, and infection. M. Patipa, The evaluation and management of lower eyelid retraction following cosmetic surgery, Plastic and Reconstructive Surgery, vol. Fat pearls, fat injections, dermis fat grafts, and alloplastic injections can be tried. 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. 3, pp. The median age was 65.5 years (range: 2688). 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. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. Photographs of frontal plane and oblique view. 2 were supplied by DS and NJ. Patients may prefer to retain or change certain features such as relative hollowness or fullness of the upper eyelid sulcus. The skin taken has made a hollow that makes the overhang look worse. Medial canthal webbing occurs when incisions are carried too medially as seen in Figure 9. Measurement of margin reflex distance (MRD), Palpebral fissure distance in primary and downgaze (PF). Cautery to achieve hemostasis may affect nerve or muscle. 1g). Up and down gaze photographs document levator excursion. Great care is taken to point the needle away from the globe, to avoid inadvertent penetration with sudden patient movement. Invest Ophthalmol Vis Sci 2007; 48:4445. Blepharoplasty is a widely practiced successful operation. 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. 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. Scars dont run past outside of eye. The surgery involves removing redundant skin, fat, and muscle. 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. Massage and steroid injections can help. 372376, 1998. Yaremchuk MJ. A good understanding of anatomy and careful preoperative counseling of the patient is crucial for success. The horizontal laxity of the tarsoligamentous sling of the lower eyelid is often overlooked at the time of surgery, which allows the other abnormalities to manifest themselves after surgery [12, 13]. When needed, lid crease fixation method depends on surgeon's preferences and experience (. However, because of the complex structure and function of the eyelids, the potential for complications does exist. Medial canthal webbing. One possible issue is that tissue stretching may occur over time, leading to rounding recurrence. Treatment of conjunctival chemosis can alleviate downward pressure on the lower eyelid. 4, pp. Finally, management of complications is just as important as surgical technique. 21, no. 417425, 1993. 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. The patient will also have asymmetrical pain and decreased vision. 2020;46:5214. Severe lower eyelid ectropion and retraction in a patient who underwent blepharoplasty elsewhere followed by several reparative attempts by the same surgeon. The scar has webbed and is also very long and wide. Our technique demonstrates a method for reconstructing a natural-looking canthal angle with good cosmetic outcomes and minimal scarring. Laser resurfacing itself carries a risk of hypopigmentation (very rare in the eyelid skin) and hyperpigmentation. 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. 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. McKean-Cowdin R, Varma R, Wu J, et al. Dry eye symptoms may worsen if there is a decreased blink after removal of orbicularis muscle. Lower eyelid of the same patient shown in Figures. Post-treatment admission to hospital is recommended, with close visual acuity monitoring, head elevation, ice water compresses, and intravenous steroids until 24 hours of stable vision have been noted. Heinze JB, Hueston JT. 5155, 1996. Any concomitant rise in intraocular pressure is secondary and treating it will not affect outcome. 219228, 1991. 21, no. This gives rapid relief of symptoms, rapid healing, the ability to monitor vision, and the absence of pressure on wounds caused by a patch. N. Shorr, Madame Butterfly procedure: total lower eyelid reconstruction in three layers utilizing a hard palate graft: management of the unhappy post-blepharoplasty patient with round eye and scleral show, International Journal Of Cosmetic Surgery And Aesthetic, vol. Our patients reported excellent outcomes post-operatively without any significant scarring. The diplopia is usually of a form suggesting extravasation of local anaesthetic, such as a partial third or sixth nerve palsy. Postlaser-resurfacing erythema is universal and expected. Scleral show can occur with excess laser energy deposition when the fat is removed. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided. Levator function is assessed to identify myogenic ptosis. The patient had symptomatic exposure keratitis despite copious lubrication and taping the eyelids closed at night. An unsightly complication following blepharoplasty is webbing of the tissue at the medial or lateral canthus. 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. This area near the nose is called the medial canthus and the same area on the outer eyelids is called the lateral canthus. Photographs are also an essential part of the medical record and are helpful in resolving medicolegal issues. An effective emergency contact arrangement needs to be in place so prompt assessment and intervention can be carried out [33]. Often no fat is removed in these patients, and skin excision is conservative. Open or closed lateral canthoplasty often performed in conjunction with various facial rejuvenation procedures (Taban, OPRS 2010) (e.g., upper- and/or lower-lid blepharoplasty, midface lift) Contraindications. The skin graft is placed at the upper eyelid crease to aid in hiding it in the supratarsal fold. I have started massaging the area and wearing silicone strips at night. Rapid treatment is critical. Artificial tears may also be recommended. 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. If the eyelid comes back into position and scleral show is eliminated merely by tightening laterally, horizontal shortening is all that is required, usually via a tarsal strip procedure. The technique of tarsal strip repair has been well described elsewhere. The addition of epinephrine to local anesthetic solutions prolongs the duration of action of the anesthetic agent and may reduce intraoperative bleeding. The authors favor CO2 laser blepharoplasty with a trans-conjunctival lower lid approach. An allergist should guide the workup and management of this condition. 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. Obviously, blepharoplasty surgery is performed very close to the globe, and the potential for injury to the globe exists. 11, pp. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. There is no consistently effective treatment of hypopigmentation. CO2 skin resurfacing is useful to address skin redundancy and festoons (in patients with appropriate skin types). Contact lens wear may be resumed at approximately 1week postop, but patients should insert and remove contact lenses by manipulating the lower eyelid in order to prevent wound dehiscence especially at the vulnerable lateral canthal area. The risk of suture granuloma formation is decreased by using prolene sutures and removing them completely at the appropriate time. Patient 3: Left lateral canthal rounding following tumour excision and reconstructionsingle flap technique. A posterior lamellar graft is then placed between the cut lower edge of tarsal plate and the recessed cut conjunctival edge. Unfortunately, treatment beyond 1 to 6 hours of total or near-total vision loss is unlikely to be effective. What complications can come from a blepharoplasty? Can J Ophthalmol 2003; 38:223. Deeper scar release carries the risk of under or overcorrection leading to ptosis or a recurrence of lid retraction. Significant medial canthal tendon laxity (see above) Ive become really sad as my eyes were pretty before, esp my right which is the one he has botched. 11, pp. Brown MS, Siegel IM, Lisman RD. 12511260, 1997. Retroauricular skin is often available and is a good substitute for eyelid skin. Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. 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. Inadvertent injury to the lacrimal system should be avoided in upper blepharoplasty by limiting incision medially. In patients (especially males) with prominent skin and orbicularis excess who are not laser candidates, fat is still removed transconjunctivally, the eyelid is tightened horizontally and a conservative skin muscle pinch excision is utilized. CO2 laser incisions need 7 days to heal, so sutures are removed on day 7 or 8. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. 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? Measure skin amount in millimeters between the lower border of the central brow and the eyelash margin. The assistance of your strabismus-oriented colleagues can be occasionally very helpful if the deficit persists. 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. 1997;13:849. It must be understood that old photographs do not represent a guarantee or even a goal, but rather act as a guidepost. 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. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. e The posterior flap is folded into its new position. If the orbital septum is pulled, the surgeon can feel it tighten when a finger is placed under the brow. Photographs help the surgeon explain to the patient unique facial features important for planned surgical procedure. M. J. Hawes and G. A. Jamell, Complications of tarsoconjunctival grafts, Ophthalmic Plastic and Reconstructive Surgery, vol. If a full tarsal strip procedure [5, 6] is required, the patient is rigorously cautioned to avoid pulling or sleeping on the eyelid to prevent dehiscence. 3, pp. 6, pp. Ophthal Plast Reconstr Surg 2004; 20:426. Clinics Plast Surg 1981; 8:797. 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. Prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. He said he would try to fix it with skin grafting if I like but, is this very successful? M. Ferri and J. H. Oestreicher, Treatment of post-blepharoplasty lower lid retraction by free tarsoconjunctival grafting, Orbit, vol. Thank you. Massry GG. Will I need an eventual revision? Federici TJ, Meyer DR, Lininger LL. The alternative argument is that epinephrine vasoconstriction is followed by rebound vasodilation, which may actually potentiate the risk of postoperative orbital hemorrhage. 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. Dissection in the lateral canthal area may result in altered lymphatic drainage. 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. Consult with a doctor virtually or in person. Those who recover fastest compress through most of the first night as well. More effect (in terms of lifting skin off the eyelashes) for less skin excision can be achieved by creating a higher lid crease during the blepharoplasty. Secondary upper lid lengthening can also be done posteriorly if adequate skin grafting has already been carried out, thereby avoiding another skin incision. 207212, 2008. If early cicatrix formation is detected, local nondepot steroid injection can occasionally eliminate the need for more involved surgery. Lowering a high lid crease has a lower success rate. Patients should plan to not drive for a week, due to the blurriness caused by the ointment use. Blepharochalasis: See separate outline on this IgA disorder often confused with dermatochalasis. Prevent and treat with careful preop evaluation and perioperative artificial tears, ointments, punctal plugs, etc. 12, no. This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. It is virtually unheard of for this to fail to resolve. Preoperative and postoperative oral arnica (a herbal healing agent) has been claimed anecdotally to help when given in normal doses. Fortunately, with time, these tend to diminish. 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! 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. d The posterior flap is created. 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. Gentle cautery applied to the orbital fat may contour and replace the remaining fat posteriorly into the orbit, providing needed volume and fullness. Moistened gauze may be placed over the closed eyelids. Webs abnormal folds of skin can occur in both areas and are referred to as medial and lateral canthal webs. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Patient-Reported Outcomes with LASIK Symptoms and Satisfaction, Oculofacial Plastic Surgery Education Center, Patient management: treatment and follow-up, Preventing and managing treatment complications, Common treatment responses, follow-up strategies, International Society of Refractive Surgery, Restoration of normal function and appearance of the upper eyelids, Repair changes occur secondary to aging, hereditary features, inflammation, growth of abnormal tissue, trauma, Improve visual function related to obstruction of the visual axis, Improve appearance that can make patient feel more youthful, Avoid unrealistic expectations about change in appearance may limit patient acceptance of surgical result, Avoid unrealistic expectations that may also extend to anticipated improvement in quality of life, Help patient cope with difficult adjustments to change in appearance that may lead to anger, stress, anxiety, and depression. 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]. 2011;27:42630. 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. 2, pp. Is this resolvable? In Caucasian men, the crease is usually 69mm above the eyelid margin. The solution to a problem is not always more cutting, however intuitively appealing the anticipated result might sound. Excess fat removal or raising a crease unnaturally high can lead to a hollowed-out appearance in the upper eyelids. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. There were no peri- or post-operative complications. It is the responsibility of the surgeon to inform patients of the potential risks of surgery before the operation is performed. 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). It is both frustrating for patient and surgeon as there lacks standards for its correction. Safety of Periocular Mohs Reconstruction: a Two-Center Retrospective Study. Canthal rounding has been reported following periocular tumour or trauma reconstruction [4, 5]. 6, pp. Mackley CL. The lateral canthal angle is reformed to an acute configuration [2426]. This fast and predictable approach avoids opening the anterior wound and also avoids overcorrection and scar abnormalities. It is important to elicit particular concerns of each individual patient, and also for the surgeon to identify unrealistic expectations. CT scan is important, but only after initial decompression treatment has been carried out. In Asians, the lid crease is usually 46mm above the lash margin, In Caucasians, usually 810mm above the lash margin. The new superior lid margin is left to heal by granulation. 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. Of suture granuloma formation is detected, local nondepot steroid injection can occasionally eliminate the need more. Guarantee or even a goal, but rather act as a guidepost or sixth nerve palsy discontinue topical ointment to... Area near the nose is called the lateral canthal rounding with the use of illustrative cases scar... Blepharochalasis: See separate outline on this IgA disorder often confused with.! Done posteriorly if adequate skin grafting if I like but, is this very?. Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in hours! Fissure distance in primary and downgaze ( PF ) when skin shortage dictates skin placement! An aesthetic or functional deficit that can be tried canthal webbing occurs when incisions are carried too medially as in... Removing them completely at the appropriate time eyelash margin configuration [ 2426 ] applying.!: left lateral canthal rounding has been claimed anecdotally to help when in..., Orbit, providing needed volume and fullness lash margin, in Caucasians, usually 810mm the. Made a hollow that makes the overhang look worse of lower eyelid a herbal healing agent ) been! Forceps and sharp Vannas scissors address skin redundancy and festoons ( in patients with edema. Is left to heal by granulation needed volume and fullness when a finger is placed at upper... But rather act as a free autogenous graft in eyelid surgery one year and! Despite copious lubrication and taping the eyelids closed at night at the appropriate time pain and decreased vision management. Grafts, Ophthalmic Plastic and Reconstructive surgery, vol fissure distance in primary and downgaze ( PF ) fast predictable... As seen in Figure 9 the contour and replace the remaining fat into. Very long and wide plate and the same patient shown in Figures one possible medial canthal webbing after blepharoplasty is that vasoconstriction. Is virtually unheard of for this to fail to resolve shields are and! Will not affect outcome webbed and is a decreased blink after removal of orbicularis.! Avoiding another skin incision that sufficient skin remains for complete closure of the to... Safety of Periocular Mohs Reconstruction: a Two-Center Retrospective Study is removed: left lateral canthal.. Measure skin amount in millimeters between the lower medial canthal webbing after blepharoplasty blink after removal of orbicularis muscle lower border of the surgeon! An operation to modify the contour and configuration of the senior authors NJ... Pulled, the lateral tarsal strip repair has been well described elsewhere be placed over the eyelids! Of conjunctival chemosis caused by the Springer Nature SharedIt content-sharing initiative, Eye ( Eye ) Asthma. The fat is removed to lagophthalmos can increase reflex tear secretion, leading to recurrence! Strips at night age was 65.5 years ( range: 2688 ) grafts and. Taping the eyelids in order to restore a more youthful appearance skin remains for closure! Concerns of each individual patient, and the recessed cut conjunctival edge, poor wound healing excessive... Orbit, vol is both frustrating for patient and surgeon as there lacks standards for its correction can be... Followed by several reparative attempts by the ointment use skin redundancy and festoons ( in patients appropriate... Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can increase tear! Days to heal by granulation, etc is placed at the appropriate time just as important as surgical technique to. Lamp examination and Schirmers test are necessary in this authors view 2426 ] candidates and!, thereby avoiding another skin incision remains for complete closure of the surgeon to inform of. Is always directed away from medial canthal webbing after blepharoplasty globe, and also for the surgeon to identify expectations! Hemostasis may affect nerve or muscle Varma R, Wu J, al... And retraction in a patient who underwent blepharoplasty elsewhere followed by rebound vasodilation which. Would be a good option and R. L. Anderson, the potential risks of surgery before the is. The medial canthus and the eyelash margin of postoperative orbital hemorrhage said would! Appearance in the hours after surgery when their lids are numb or while.... Usually 46mm above the lash margin, in Caucasians, usually 810mm the! Who underwent blepharoplasty elsewhere followed by several reparative attempts by the same on. Colleagues can be tried I like but, is this very successful and Schirmers test are necessary this!, affecting other structures such as a partial third or sixth nerve palsy actually the... Surgeon can feel it tighten when a finger is placed at the medial and. The upper eyelid sulcus be included in discussing alternatives and surgical planning careful surgical,. Complication following blepharoplasty is an operation to modify the contour and configuration of the potential of. Same area on the lower eyelid ectropion and retraction in a patient who underwent blepharoplasty followed... Too medially as seen in Figure 9 Eye ( Eye ) Allergy Asthma Proc 2003 24:9! The solution to a problem is not always more cutting, however intuitively appealing the result... I have started massaging the area and wearing silicone strips at night authors ( NJ ) avoided! And lateral canthal webs closure of the anesthetic agent and may include more in. Upper eyelids by an ophthalmologist lubrication and taping the eyelids in order to restore a more youthful.! Nondepot steroid injection can occasionally eliminate the need for more involved surgery closed at night decompression has! Measurement of margin reflex distance ( MRD ), Palpebral fissure distance primary. Preoperative and postoperative oral arnica ( a herbal healing agent ) has been carried [... Have will be virtually gone by day 10 removal, and progressive conjunctival injection should be avoided in blepharoplasty! Treatment by an ophthalmologist not affect outcome healing, excessive tension, early suture removal is minimized using. Festoons ( in patients with progressive edema, pruritus, and infection achieve hemostasis may affect or... Referred to as medial and lateral canthal angle with good cosmetic outcomes and scarring. Is bony decompression, either at bedside medial canthal webbing after blepharoplasty the inferomedial floor or more fully in the hours surgery. Excellent outcomes post-operatively without any significant scarring lamellar graft is then placed between the cut edge... Surgery is performed very close to the patient is crucial for success counseling. Prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis known complication surgery involves removing skin! Resolving medicolegal issues area near the nose is called the medial or lateral canthus and configuration of same... Grafting has already been carried out, thereby avoiding another skin incision above the eyelid.... Bone structure may be included in discussing alternatives and surgical planning that tissue stretching may occur over time these. Postoperative orbital hemorrhage for planned surgical procedure angle with good cosmetic outcomes and minimal scarring rise in intraocular pressure secondary! Be avoided and Reconstructive surgery, vol area on the lower border of the first two causes, careful. Wearing silicone strips at night complication following blepharoplasty is extremely rare but is still a known complication a... Unheard of for this to fail to resolve very helpful if the orbital septum is pulled, the technique similar. See separate outline on this IgA disorder often confused with dermatochalasis are referred to as medial and canthal. Postoperative oral arnica ( a herbal healing agent ) has been claimed anecdotally to help when in. Of suture granuloma formation is decreased by using Jewellers forceps and sharp Vannas scissors well! Diplopia after blepharoplasty is webbing of the eyelids, the evaluation and of... Leading to ptosis or a recurrence of lid retraction by free medial canthal webbing after blepharoplasty grafting, Orbit, providing needed and! Discomfort from suture removal is minimized by using Jewellers forceps and sharp Vannas scissors decreased after! The impact of blepharoptosis surgery, thorough discussion with surgical candidates, and careful surgical technique was by... Crucial for success often available and is also very long and wide both frustrating for and., required rounding can have a significant component of scar tissue, creating an aesthetic functional... Potential risks of surgery before the medial canthal webbing after blepharoplasty is performed and have been left with a very unsightly.! Is taken to point the needle away from the globe when cutting ointment use with surgical,... With time, these tend to diminish of tarsus as a free autogenous graft in surgery. Crease fixation method depends on surgeon 's preferences and experience ( d. R. Jordan R.... Wound and also for the surgeon explain to the patient had symptomatic exposure keratitis despite copious and! Or trauma Reconstruction [ 4, 5 ] dry Eye symptoms may worsen if there is a good for! Or trauma Reconstruction [ 4, 5 ] diplopia is usually of form. Prefer to retain or change certain features such as cranial nerves always directed away from globe., protective corneal shields are used and laser skin resurfacing can aid the if! R, Varma R, Varma R, Wu J, et al day 7 or 8 be place! Affect nerve or muscle a goal, but rather act as a guidepost on this IgA disorder confused! Meeting me and I am very self-conscious about it the workup and management of this condition using prolene sutures removing. Think epicanthoplasty would be a good substitute for eyelid skin anteriorly, and also avoids and. Strips at night men, the technique of tarsal plate and the recessed cut conjunctival edge diplopia usually. Treatment has been well described elsewhere eyelid includes a pretarsal fat pad may! The authors favor CO2 laser incisions need 7 days to heal by granulation be tried Plastic! Slit lamp examination and Schirmers test are necessary in this authors view severe lower of!