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.     

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.     

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.     

Current concepts in aesthetic upper blepharoplasty

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss nomenclature and anatomy associated with upper blepharoplasty. 2. Perform preoperative assessment, decision-making, and counseling of patients. 3. Describe current surgical planning, eyelid marking, and various techniques used in upper blepharoplasty, including lasers. 4. Recognize and treat postoperative complications from blepharoplasty.Traditional blepharoplasty has often involved the excision of both lax skin and muscle and excessive removal of fat, leaving patients long term with a hollow orbit and a harsh, operated appearance that accelerates the aging process. Current methods of periorbital rejuvenation are more conservative, are based on concise preoperative evaluation, and involve the limited resection of the coveted soft tissue from the eye to restore a youthful appearance. The authors describe anatomy, preoperative assessment, decision-making and counseling of patients, surgical planning, eyelid marking, and various techniques, including lasers, along with postoperative complications associated with current concepts in aesthetic upper blepharoplasty.     

Two helpful technical aids in blepharoplasty

We describe two helpful technical aids in blepharoplasty. The first is a method of securely holding orbital fat without risk of excessive traction if the patient's head moves. The second involves use of a battery-powered cautery as a safe, convenient cutting instrument.     

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.     

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.     

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.     

The oculocardiac reflex in blepharoplasty surgery

The oculocardiac reflex (OCR), a previously undescribed phenomenon in aesthetic blepharoplasty surgery, involves intraoperative bradycardia exceeding 10 percent of the preoperative heart rate or any dysrhythmia during ocular manipulation. It is a trigeminal-vagal-mediated reflex arc. The oculocardiac reflex was noted to occur in 25 of 100 patients (25 percent) undergoing blepharoplasty. A data sheet designed and distributed for use in the operating room identified a reflex-prone patient (RPP) as a young, anxious female, with a cardiac history, operated on under light anesthesia with aggressive fat pad resection. The oculocardiac reflex was more likely to occur in a reflex-prone patient during traction on the medial fat pads and in the left eye. Despite anticipating the fatigue phenomenon in those patients who exhibited a profound bradycardia (35 to 40 beats per minute), it was necessary to release traction in order to permit the heart rate to return to normal. Awareness and treatment of this potentially life-threatening oculocardiac reflex are necessary. Careful patient surveillance and monitoring are mandatory.