PR48 UPPER BLEPHAROPLASTY

Abstract

Introduction Upper blepharoplasty is performed in order to correct age‐related upper lid changes including dermatochalasis and irregular contours due to bulging post‐septal fat pads. Additionally, upper lid ptosis can be repaired in an anterior approach through the blepharoplasty incisions when indicated. These procedures are gratifying and have relatively low associated morbidity.Methods/Techniques Pre‐operative assessment includes observation of excess upper eyelid skin, bulging fat pads, lid position, and location of the suprataral crease. Most excess skin is located centrally and laterally. The most common bulging fat pad is the nasal fat pad, however the central fat pad also frequently requires excision. If a combination of procedures is being preformed, upper blepharoplsty follows browlifts and facelifts but precedes lower lid blepharoplasty. Surgical markings are made with the patient prone, under general anesthesia. Local anesthesia is also administered for hemostasis. The lower location of the incision is marked 8–10 mm above the lid margin centrally and 6 mm above the lateral canthus. The upper incision is identified by assessing the amount of excess skin by pinch testing. The upper incision is marked and calipers are used to confirm at least 10 mm of skin will still be present between the upper incision and the lower border of the eyebrow at the mid pupil location. A scalpel is used to make the incisions. A Bovie is used to cut through the orbicularis oculi muscle on cutting current. Westcott scissors are used to excise the skin and muscle. Hemostasis is acheived Gentle pressure is applied to the globe to reveal the excess nasal fat pad. The septum is opened focally and the excess portion of the fat pad is excised using coagulation current with the bovie. The central fat pad is reduced if needed. If ptosis exists, it is repaired using a tarso‐levator advancement technique. Often in cases of senile acquired ptosis, a high supratarsal fold exists. While the ptosis repair will partially resolve this cosmetic deformity, the septum is opened and the central fat pad is freed and advanced to further fill the sulcus. A supratarsal fixation stitch using 6‐O vicryl is placed in a mid pupil location to prevent postoperative ptosis. The wound is then closed with 6‐O nylon using interrupted sutures lateral to the lateral canthus and running sutures medial to the canthus.Results 527 patients underwent upper blepharoplasty with the technique described over a 12 year period. 10% underwent ptosis repair at the same time and all other patients underwent supratarsal fixation. 90% were satisfied satisfied with there procedure. Acute re‐operation for bleeding occurred in less than 1% of patients. The most common acute complication was chemosis occurring in 12% of patients which was far more likely to occur if a upper blepharoplasty was performed in conjunction with lower lid blepharoplasty. All cases of chemosis resolved with non‐surgical management including liberal use of ointment and taping the lid shut, and occasionally incision and drainage of the chemosis. The most common indication for re‐operation was residual excess skin.Conclusion Upper lid blepharoplasty is a very gratifying procedure whether preformed alone or in conjunction other procedures for facial rejuvenation. Complications are infrequent and generally minor. Satisfaction is generally very high. The open sky technique was used which includes removal of the skin, muscle, and septal flap with conservative fat removal.