Incision IrregularitiesSuture cysts– Early suture removal– Sub Q suture– Cauterization

Epithelial suture tunnels– Excision/Cauterization

Hypertrophic healing– Time– Message– Kenalog

Ptosis

Preoperativeevaluation to prevent “unmasking” of ptosisRecord MRD1

Repair ptosis at time of blepharoplasty

Unmasking of Ptosis

Diplopia

Incarceration of superior oblique tendon in septumExcessive cautery supranasal quadrantInjury during fat excision

Lacrimal Gland Prolapse/Excision

NO TEMPORAL FAT PAD IN UPPER LID!Fat---yellow, soft, billowyLacrimal gland---whitish, lumpy and bumpy

Lacrimal Gland Prolapse/Excision

Lacrimal Gland Prolapse Repair

Numbness

Typically resolves over several monthsNo treatmentUsually noticed by women when applying makeup

Blindness

Orbital hemorrhage– Ischemic optic neuropathy– Central retinal artery occlusion

Inadvertent globe perforationSevere postoperative infectionUnipolar cautery

Complications of Lower Eyelid Blepharoplasty

Ectropion/RetractionExcessive anterior lamellar removal– FTSG

Atonicity/flaccidity– Distraction/snap back tests

Weakened canthaltendon– Lateral tarsal strip (LTS)– Lateral canthal plication

Scarring at the level of orbital septum– Baylis procedure (LTS +

lysing scar)– LTS + Ear cartilage graft

Ectropion/Retraction Repair

Excessive or Inadequate Skin Removal

Excessive removal– Look up and open

mouth prior to skin excision

– FTSG when necessaryInadequate removal– CO2 laser– Re-excision

Full Thickness Skin Graft

Excessive or Inadequate Herniated Orbital Fat RemovalExcessive removal is unusual– Fat transfer– Alloderm– Cymetra

Preoperativeevaluation importantGrading orbital fatInadequate removal requires re-operation

HemorrhageStop NSAID, aspirin, etc. two weeks priorStop wafarin, etc 4 days preopClamp, cut, cauterizeIced saline compress postoperativeEvaluate vision and watch patient in recovery room

Treatment of Orbital Hemorrhage

Open wound at bedsideEvacuate clotsIV steroidsCauterize bleedersCanthotomy/CantholysisDiamox/TimopticEmergency orbital decompression

Diplopia

Periorbital/retrobulbarhemorrhageInferior oblique muscle– Visualize muscle

between middle and medial fat pad

– Do not incise inside orbital rim during transconjunctivalincision

Conjunctival Chemosis

Topical lubricantSteroid dropsSystemic steroidsPressure patchingMost resolve spontaneously

Pearls

Good preoperative history/physicalMRD1 measurementsMeticulous attention to detailLook up and open mouthDo not extend incision beyond punctumPinch techniqueBe conservative, redo’s are easy

The End