Complications of Oriental blepharoplasty

The complications of Oriental blepharoplasty are described according to their clinical appearance and anatomic findings at the time of surgery. The surgical correction of these complications is presented. A total of 42 patients with complications following blepharoplasty were treated. The types of deformities were categorized from their external appearance as asymmetry, retraction and ectropion, blepharoptosis, supratarsal depression, fading of the lid fold, and hemorrhage. The causes of each type of complication are identified according to the intraoperative findings, and the correlation between preoperative and intraoperative findings is explained. Correction of these complications follows identified guidelines, and the results were good to satisfactory.     

Oriental blepharoplasty: single-stitch, nonincision technique

The facial features of Orientals and Caucasians are different in many respects. In Orientals, the concept of beauty differs in each country depending on the cultural background. At present time, blepharoplasty in the Oriental eye is the most common aesthetic procedure performed in Korea and Japan. The objective should not be the caucasianization of the Oriental eye, where desired modifications are usually quite subtle. Generally, patients prefer more defined and invaginated folds, but not necessarily a very high fold, since the latter will often look unnatural or overdone in the Oriental face. We have found several different types of eyelids in the Oriental population. The purpose of this presentation is to present our nonincision technique to create aesthetically pleasing supratarsal folds. Seven-hundred and sixty-two patients were reviewed. We have found that our single-suture method is very reliable and allows the construction of a more even, smooth, and symmetrical fold.     

Transconjunctival upper blepharoplasty

Transconjunctival lower lid blepharoplasty now has an established role as an option in rejuvenation of the lower eyelid. Transconjunctival upper lid blepharoplasty, or transconjunctival removal of medial upper eyelid fat, also has a role in rejuvenation of the upper eyelid. However, this is a rather limited role. We have found this approach safe and efficacious as a primary as well as a secondary procedure for removal of excess medial upper eyelid fat. We report on 20 patients who have undergone this operation: 5 as a primary procedure and 15 as secondary. There were no complications, no revisions, and the patients have been uniformly happy with their results.     

Transcoronal blepharoplasty.

Some of the patients requesting blepharoplasty have a combination of excessive eyelid fat and brow ptosis but little or no dermatochalasis. Coronal brow lift, combined with transcoronal fat removal, serves these patients well. The prelevator fat pocket is easily entered from above by incising the periosteum of the anterior orbital roof just inside the orbital rim. Since the orbital septum and anterior lamella of the eyelid rim remain undisturbed, the result appears natural. Contraindications to the procedure include significant medical pocket fat and hair patterns that would exclude a coronal or hairline incision. Two complications, unilateral ptosis and unilateral chemosis, were temporary and totally reversible. Minor changes in the procedure have prevented the recurrence of these problems.     

Nonsurgical upper blepharoplasty

A tape and applicator designed to give preoperative blepharoplasty patients an idea of the proposed result has been developed. The use of the tape as a cosmetic device to temporarily give the effect of a surgical blepharoplasty is presented.     

Orbital abscess following blepharoplasty

Orbital abscess following blepharoplasty is surprisingly rare. The diagnosis may not be obvious from the physical signs alone. Ultrasonography is a helpful diagnostic tool in such problems. The abscess cavity can be visualized. A case of orbital abscess is presented.     

Retrobulbar hematoma and blepharoplasty

Retrobulbar hematoma leading to visual impairment is a rare but serious complication associated with elective blepharoplasty. A review of the literature addressing etiology, prevention, and management is presented. Removal of anterior orbital fat associated with traction and rupture of vessels within posterior orbital fat is currently most strongly supported as the cause of retrobulbar hematoma after blepharoplasty. Optic nerve ischemia is identified as the likely cause of visual impairment. Specific recommendations for avoidance and management of acute retrobulbar hematoma are offered. Recent background animal and human research is summarized.     

Tarsal fixation in lower blepharoplasty

Proceeding from the premise that a "youthful" eyelid has a pretarsal bulge while a "senile" eyelid has a pretarsal flatness, the tarsal fixation technique for lower blepharoplasty has been introduced--to reposition part of the orbicularis in front of the tarsus to produce a pretarsal bulge. The technique is presented as a suggested adjunct to the usual types of lower blepharoplasty.