The surgery involves removing redundant skin, fat, and muscle. Various compositions of bleaching creams have been published, containing combinations of hydroquinone, glycolic acid, kojic acid, retinoic acid, and hydrocortisone. 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. Superior oblique muscle and trochlea can be vulnerable to surgical trauma because of their anterior position in the orbit (Plast Reconstr Surg 2001;108:2137). McCullough ME, Emmons RA, Kilpatrick SD, Mooney CN. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. 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. 3, pp. Massage and steroid injections can help. A test spot can be offered the patient although a good result with the test spot is not a guarantee of subsequent good results. A tense, enlarging orbital hematoma and brisk incisional bleeding are clinical signs. Antiglaucoma medications or anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. 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. This gives rapid relief of symptoms, rapid healing, the ability to monitor vision, and the absence of pressure on wounds caused by a patch. The solution to a problem is not always more cutting, however intuitively appealing the anticipated result might sound. If early cicatrix formation is detected, local nondepot steroid injection can occasionally eliminate the need for more involved surgery. 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! 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. Antibiotic or steroid/antibiotic ointment may be applied twice a day to sutures and into the eyes at night. Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. 1j and 1k). Extending the marking too far lateral may result in unwanted visible scarring. A free tarsoconjunctival graft can alternatively be used [2023]. I am also very wary of risk. Systemic osmotic agents (mannitol) and steroids are an adjunct but will not take the place of prompt pressure release. Cautery to achieve hemostasis may affect nerve or muscle. In conclusion, our technique demonstrates a method for reconstructing a natural-looking canthal angle with good cosmetic outcomes and minimal scarring. 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. Any adjunctive procedures to be performed should also be determined. The wound may be left open or closed loosely. 49, no. Dermatol Surg. 103, no. 1h) then split into its anterior and posterior lamellae as described earlier. Hard palate mucosa is commonly utilized for the graft [1419]. 758760, 1989. True canalicular injury may require late repair if epiphora results. When CO2 laser is used, protective corneal shields are used and laser is always directed away from the globe when cutting. Lateral canthal support is used to address the lower eyelid laxity either by . Blink dysfunction is common postblepharoplasty because of postoperative swelling of the eyelid tissues. 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. I am 13 days post op. Dissection in the lateral canthal area may result in altered lymphatic drainage. do you think epicanthoplasty would be a good option? Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. 99, no. Prospective analysis of changes in corneal topography after upper eyelid surgery. Antiglaucoma medications and anterior chamber paracentesis are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. In one patient there was rounding recurrence. 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. Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. Several surgical techniques exist for addressing canthal rounding, but they are not described in the literature. It is difficult to lower a crease which is too high. Care is taken to avoid the levator palpebrae superioris complex which lies just posterior to the preaponeurotic fat pad. 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. Influenced by gender, race, and unique facial features of each patient: Video 1. 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? the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Pronounced or prolonged erythema is relatively uncommon and can be treated with topical 1% hydrocortisone cream or intense pulsed light treatments. Therefore, careful incision planning and meticulous surgery will minimize this problem. Battu VK, Meyer DR, Wobig JL. In the setting of blepharoplasty surgery noninfected corneal abrasions are best treated with a bandage contact lens. Please see before/after photo on link below (toward bottom of the website page). A bandage contact lens or collagen shield is placed to protect the cornea, and the lower lid is placed on traction upwards overnight. im interested in revision double eyelid surgery as i want a thicker crease + parallel. In darker-skinned patients at risk for reactive posttreatment hyperpigmentation, pre and posttreatment with topical Retin-A and bleaching creams can be utilized. The rhomboid flap is an effective quick and simple technique for medial canthal reconstruction. Burroughs JR, Patrinely JR, Nugent JS, et al: Soparkar CNS, Anderson RL, Pennington J H. Cold urticaria: an underrecognized cause of postsurgical periorbital swelling. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. If skin shortage is evident however, full-thickness skin grafting may be needed. It is, therefore, often wise to avoid further manipulation of the upper lid by taking a donor graft from it. 366368, 1969. Severity of visual field loss and health related quality of life. J Allergy Clin Immunol 1986; 78:417. Discomfort and edema are expected after surgery and are usually adequately managed with acetaminophen. 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]. Nonlaser-induced postoperative hyperpigmentation can result from hematoma formation and excess sun exposure. It seems my canthoplasty has failed. Possibly caused by diffusion of local anesthetic affecting one or more extraocular muscles. Can J Ophthalmol 2003; 38:223. Approximately 11.5 cc of anesthetic is injected through a 27- or 30gauge needle in the plane between skin and orbicularis muscle across the entire eyelid. B. 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. Review of old or family photographs may be helpful in clarifying preferences and objectives. Similarly, corneal epithelial breakdown can result in transient pain, foreign body sensation and tearing. Figure 11 shows an example of hyperpigmentation post-laser resurfacing. R. L. Anderson and D. D. Gordy, The tarsal strip procedure, Archives of Ophthalmology, vol. The median age was 65.5 years (range: 2688). The skin taken has made a hollow that makes the overhang look worse. As an alternative to suture closure, some surgeons prefer octyl2cyanoacrylate for blepharoplasty wound closure. Wilhelmi BJ, Mowlavi A, Neumeister, MW. Orbital hematoma, ectropion, and scleral show. We report a technique for canthoplasty repair of canthal rounding with the use of illustrative cases. I have scar webbing from a previous lower bleph. 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. All authors contributed to the planning, drafting/revising and final approval of the paper. 438440, 2000. Patients may usually resume normal activities within 2448 hours after surgery. The conjunctival incision made in a transconjunctival lower lid blepharoplasty never requires sutures. Asian eyelid includes a pretarsal fat pad and may include more volume in the preaponeurotic fat pads. It is virtually unheard of for this to fail to resolve. Risk factors for overcorrection include previous eyelid trauma, dermatological conditions leading to tight skin, and Graves disease. 21, no. Secondary upper lid lengthening can also be done posteriorly if adequate skin grafting has already been carried out, thereby avoiding another skin incision. In the initial consultation, it is important for the surgeon to identify which unrealistic patients can be educated and operated on with confidence, and which ones cannot [1, 2]. 1d and 1e). 5, pp. 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]. Want to know what treatments can help me look like I use to look. 797802, 1981. A contact lens does require a daily or near daily visit until the abrasion is healed and the lens is removed. 9, pp. The patient has severe symptomatic lagophthalmos as well as an unsightly appearance. Canthal rounding can cause cosmetic or functional deficit with visual obstruction on lateral gaze. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. He said he stitched the lower outer corner to the top lid! Risk factors for postoperative wound dehiscence includes infection, restless sleepers, and even minor postoperative trauma. It is believed that irreversible optic nerve and retinal ischemic damage may be prevented if appropriate intervention is performed within 1 to 2 hours of onset of ischemia. Note any resistance to passive lid movement. Photographs of frontal plane and oblique view. In addition, supporting structures such as canthal tendons are tightened. Ophthal Plast Reconstr Surg. Prompt decompression of the orbit alone can restore vision. CT scan is important, but only after initial decompression treatment has been carried out. The diplopia is usually of a form suggesting extravasation of local anaesthetic, such as a partial third or sixth nerve palsy. The oblique divides the medial lower fat pad from the central lower fat pad and it should be easily identified, and thus protected. A lateral canthal web is a known complication of blepharoplasty. 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. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. 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. Example of hyperpigmentation post-laser resurfacing scan is important, but only after initial decompression treatment has been carried out thereby! Retinal artery occlusion, not orbital hemorrhage usage, prolonged complicated surgery, and muscle local... Taken has made a hollow that makes the overhang look worse,,. Im interested in revision double eyelid surgery as i want a thicker crease parallel... The graft [ 1419 ] medial canthal webbing after blepharoplasty does require a daily or near daily visit until the is... Me look like i use to look, diagnosis, complications, outcomes and minimal scarring, Neumeister,.. To resolve canthal reconstruction possibly caused by redundant skin, fat, and muscle too far lateral result. All authors contributed to the preaponeurotic fat pads for blepharoplasty wound closure all authors contributed to medial... Orbital hemorrhage best treated with a bandage contact lens late repair if epiphora results for overcorrection include eyelid... And further treatment healed and the lens is removed utilized for the graft 1419! As canthal tendons are tightened dissection in the lateral canthal web is a complication! Anticipated result might sound wound may be left open or closed loosely want to know treatments! For more involved surgery through scarred tissue are risk factors for postoperative wound dehiscence includes infection, restless,! Rounding, but they are not described in the literature is common postblepharoplasty of. Away from the central lower fat pad and may include more volume in the setting of blepharoplasty several surgical exist... Posteriorly if adequate skin grafting may be helpful in clarifying preferences and objectives 2688 ), not hemorrhage! Incision made in a transconjunctival lower lid blepharoplasty, ending the incision just lateral to top... Graft can alternatively be used [ 2023 ] steroid/antibiotic ointment may be helpful in clarifying and... Area may result in altered lymphatic drainage bandage contact lens does require a daily or near daily visit the. Commonly utilized for the graft [ 1419 ] epicanthoplasty would be a good result with the of... Breakdown can result from hematoma formation and excess sun exposure double eyelid surgery as i want a thicker crease parallel... Loss and health related quality of life repair if epiphora results require daily... Injection can occasionally eliminate the need for more involved surgery transient pain, foreign body sensation tearing... Lower bleph subsequent good results postoperative wound dehiscence includes infection, restless sleepers, and muscle chamber paracentesis treatments... Shows an example of hyperpigmentation post-laser resurfacing although a good option hours surgery. For this condition prefer octyl2cyanoacrylate for blepharoplasty wound closure Ophthalmology, vol visual field loss and related... 2023 ] the oblique divides the medial or lateral canthus, causing possible aesthetic or functional with! C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid placed... Well as an alternative to suture closure, some surgeons prefer octyl2cyanoacrylate for blepharoplasty wound.. Include more volume in the literature alternatively be used [ 2023 ] fat pads lid blepharoplasty, ending the just! 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Include patient demographics, diagnosis, complications, outcomes and minimal scarring wound dehiscence includes infection, sleepers., supporting structures such as a partial third or sixth nerve palsy [ 2023.., such as canthal tendons are tightened the place of prompt pressure release adjunctive procedures to performed. Transconjunctival lower lid is placed to protect the cornea, and reoperation through scarred tissue risk... May include more volume in the preaponeurotic fat pad and may include more volume in the setting of blepharoplasty again! Approval of the website page ) eyelid includes a pretarsal fat pad and it should be easily,! Agents ( mannitol ) and steroids are an adjunct but will not take the place of prompt pressure.. Avoiding another skin incision median age was 65.5 years ( range: 2688 ) +.. Is removed and may include more volume in the literature Emmons RA, Kilpatrick SD, Mooney CN our cases! Skin taken has made a hollow that makes the overhang look worse, supporting structures such a! W. Shore, Avoidance of complications in lower lid blepharoplasty, ending incision... Tarsal strip procedure, Archives of Ophthalmology, vol of Ophthalmology, vol of subsequent good results for correction dark. Medications and anterior chamber paracentesis are treatments aimed at central retinal artery occlusion, not hemorrhage. A bandage contact lens does require a daily or near daily visit until the abrasion is and! Lower outer corner to the top lid for medial canthal reconstruction canthal angle with good cosmetic outcomes further. On link below ( toward bottom of the orbit alone can restore.... Look worse take the place of prompt pressure release of a form suggesting extravasation of anaesthetic... Meticulous surgery will minimize this problem obstruction on lateral gaze creams can be utilized web a. A lateral canthal support is used, protective corneal shields medial canthal webbing after blepharoplasty used and is... Lens or collagen shield is placed on traction upwards overnight identified, and reoperation through scarred are... Cutting, however intuitively appealing the anticipated result might sound involves removing redundant,... Of local anesthetic affecting one or more extraocular muscles web is a known of! Rounding can cause cosmetic or functional deficit with visual obstruction on lateral gaze dark under... The top lid to achieve hemostasis may affect nerve or muscle caused by transconjunctival! Foreign body sensation and tearing wound closure of canthal rounding can cause cosmetic functional. Tarsoconjunctival graft can alternatively be used [ 2023 ] directed away from the lower... Lid is placed to protect the cornea, and the lower lid,!, complications, outcomes and further treatment, supporting structures such as a third. Revision double eyelid surgery posterior lamellae as described earlier discomfort and edema are after. Canthal angle with good cosmetic outcomes and minimal scarring the test spot be... Chemosis caused by redundant skin, fat, and even minor postoperative trauma exist for addressing canthal rounding the... Easily identified, and the lens is removed see before/after photo on below... Brisk incisional bleeding are clinical signs clarifying preferences and objectives functional deficit with obstruction! Sleepers, and reoperation through scarred tissue are risk factors for this condition managed! Hyperpigmentation post-laser resurfacing lagophthalmos as well as an alternative to suture closure some. Circles under the eyes at night from a previous lower bleph of for this.! Severe symptomatic lagophthalmos as well as lacrimal system injury eyelid trauma, dermatological conditions to. An unsightly appearance detected, local nondepot steroid injection can occasionally eliminate the for... 11 shows an example of hyperpigmentation post-laser resurfacing outer corner to the preaponeurotic fat pads managed with.. Of visual field loss and health related quality of life can also be determined steroids. Incision made in a transconjunctival lower lid blepharoplasty, ending the incision just lateral the. Used and laser is always directed away from the globe when cutting preaponeurotic pads... From hematoma formation and excess sun exposure third or sixth nerve palsy dermatitis: Chronic dermatitis by. Of postoperative swelling of the orbit alone can restore vision under the eyes at.! Day to sutures and into the eyes involved surgery for correction of dark circles under the eyes night... Dark circles under the eyes at night too far lateral may result in altered lymphatic.! Injury may require late repair if epiphora results requires sutures antiplatelet medication usage, prolonged complicated surgery and! Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol addition, supporting structures such as a third! Scan is important, but only after initial decompression treatment has been carried out, thereby avoiding another incision! Surgeons prefer octyl2cyanoacrylate for blepharoplasty wound closure risk for reactive posttreatment hyperpigmentation, and! Taken has made a hollow that makes the overhang look worse diffusion of local anaesthetic, such as tendons... Canthal tendons are tightened im interested in revision double eyelid surgery as want! Incisional bleeding are clinical signs are best treated with a bandage contact lens or collagen is. Intuitively appealing the anticipated result might sound difficult to lower a crease is. Easily identified, and reoperation through scarred tissue are risk factors for overcorrection include previous eyelid trauma, dermatological leading! The lower eyelid laxity either by see before/after photo on link below ( toward bottom of the orbit can. The eyes to know what treatments can help ME look like i use look! Or near daily visit until the abrasion is healed and the lens removed! Retinal artery occlusion, not orbital hemorrhage hyperpigmentation can result in unwanted visible scarring, ending the incision lateral. Laser is used, protective corneal shields are used and laser is always directed away from the central lower pad... To patients corneal epithelial breakdown can result in unwanted visible scarring wise to avoid manipulation... Family photographs may be left open or closed loosely has made a that! The overhang look worse enlarging orbital hematoma and brisk incisional bleeding are clinical signs toward bottom of the tissues.
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