Complications Of Blepharoplasty Research Articles

Persistent Conjunctival Chemosis after Lower Lid Blepharoplasty: A Comparison of Different Surgical Techniques.

Background: Conjunctival chemosis, a complication of lower blepharoplasty, can cause persistent discomfort and functional disturbances with worsening in the postoperative period following surgery. Methods: A review of the records of the lower blepharoplasty procedures carried out at the Humanitas Research Hospital, Rozzano, Milan, Italy was performed. Patients were categorized into two groups depending on the procedure performed: (1) transconjunctival blepharoplasty with the removal of the fatty lodges with canthopexy and (2) transcutaneous blepharoplasty with the removal of the fatty lodges with lateral canthoplasty. Each group was further divided into two more groups based on the surgical method used, that is either (a) cold blade and disposable cautery or (b) radiofrequency cut and coagulation and colorado tip (respectively 1a, 1b, 2a and 2b). All patients underwent a postoperative follow-up up to 24 months, which included an evaluation of cosmetic appearance, eyelid scarring and the severity of chemosis. The aim of the study was to investigate which of the surgical procedures causes a lower incidence of persistent type 3 conjunctival chemosis. Results: A total of 1047 patients who underwent lower lid blepharoplasty were included in the study. A total of 512 patients underwent transcutaneous blepharoplasty and 535 underwent the transconjunctival procedure. Among the first group of patients, 266 belong to group 1a and 246 to group 1b. In the second group, 264 were categorized as group 2a and 271 as group 2b. The incidence of type 3 chemosis in the transcutaneous blepharoplasty procedure with lateral canthoplasty was statistically significantly higher than in the transconjunctival approach, considering both the cold blade and the radiofrequency (p = 0.012, 0.010, 0.006, 0.004, respectively). Conclusions: A higher incidence of persistent type 3 conjunctival chemosis is associated with lateral canthus surgery and with the use of radiofrequency.

Early laser treatment of local complications after surgical blepharoplasty

Purpose of the study: to evaluate the effectiveness of early laser treatment of various types of local complications after surgical blepharoplasty based on the dynamics of the clinical picture and outcome, as well as patient satisfaction indicators according to FACE-Q.Material and methods. The study involved 24 patients with various types of local postoperative complications: scars with a tendency to hypertrophic growth (5 cases), inversion of the lower eyelid (4), seroma with undetected ligature fragments (2), aseptic inflammation of soft tissues of unknown genesis (2), neoangiogenesis in the eyelid area (3), extensive hemorrhages in the surgical intervention area (8 cases). Treatment was started on the day of the patient's treatment when the fact of the complication was established. The treatment was performed using the MultilineTM laser multiplatform using the Nd:YAP/KTP vascular laser with a combination of two wavelengths of 540 and 1079 nm and/or the Er:YAG, 2940 nm laser with SMA technology. The choice of the type of laser radiation and the interval between sessions were determined by the nature of the complication. Patients' satisfaction with the results of treatment was determined by the FACE-Q questionnaire.Results. The results of treatment by evaluators were determined as excellent in 19 patients (79.2%) and good in 5 patients (20.8%). The outcome of the resolution of complications in all patients was a thin, flat, inconspicuous scar, persistent defects requiring additional correction were not observed. During 6 months of follow-up, the dynamics of FACE-Q indicators after laser treatment of complications showed a statistically significant improvement on all assessed scales: the general appearance of the eye, the outcome of the operation performed, the severity of side effects, psychological stress, social adaptation.Conclusion. Laser treatment of postoperative complications of blepharoplasty allows improving the aesthetic result of the operation and restoring the psychoemotional state of the patient.

Lower Eyelid Blepharoplasty: Minimizing Complications and Correction of Lower Eyelid Malposition.

Lid retraction is a feared complication of lower blepharoplasty. Anatomical variations like negative orbital vector, horizontal lid laxity, and preexisting lid retraction are more prone to lid malpositions. Meticulous and precise execution of a series of surgical steps is key to preventing complications. This includes minimizing surgical trauma, meticulous hemostasis, preserving innervation to the medial lid and pretarsal orbicularis, safe method of fat excision, septal tightening while maintaining lid traction, and conservative and titrated skin excision. Canthal fixation addresses lid laxity and maintains the lid stretched vertically while postoperative healing and fibrosis are taking place. Post-blepharoplasty lid retraction may occur due to failure to address lid laxity and the occurrence of middle lamellar fibrosis. Excessive skin excision may also result in anterior lamellar deficiency. The "sag and drag" concept is useful to evaluate the post-blepharoplasty retracted lid. The treatment of the retracted lid includes lid massage, replacing the anterior lamella, or releasing the middle lamellar fibrosis or a combination of techniques. In conclusion, understanding the mechanisms of lid retraction, careful preoperative assessment, and surgical precision will help surgeons to prevent and manage this complication.

Analysis of risk factors for quality management to blepharoplasty based on DEMATEL-ISM.

Blepharoplasty is a typical complex structural system, which involves many factors and the interaction among them. Therefore, it is the basis of controlling the occurrence of medical complications in blepharoplasty to clarify the hierarchical relationship of various risk factors and find out the key risk factors. On the basis of identifying the risk factors for quality management of blepharoplasty by means of literature research, questionnaire survey and expert interview, the risk factor model of blepharoplasty quality management were analyzed and constructed. The relationship between the risk factors and the degree of influence on the risk factors was studied using Decision-Making Trialand Evaluation Laboratory and Interpretative Structural Modeling Method, and the hierarchical structure model of the risk factors for blepharoplasty quality management was obtained. Six levels of risk factors in quality management of blepharoplasty were identified and classified, and the causal attributes among risk factors were determined. Six key risk factors in quality management of double eyelid surgery were determined according to centrality, and finally the above risk factors were divided into three categories: direct cause, excessive cause, and essential cause. This study realizes the comprehensive risk factor analysis of the complex system of quality management of blepharoplasty, which can provide reference for plastic surgeons to make safety decisions of blepharoplasty.

How I do it: lateral canthal web revision—single Z-plasty technique

BackgroundLateral canthal webbing is a known complication of blepharoplasty, which occurs when the lateral aspect of the upper blepharoplasty incision is taken below the equator of the lateral canthus. Removing excessive eyelid skin laterally can also result in a lateral canthal web. Currently, there is no standard approach for addressing this complication.MethodsRetrospective review of single surgeon practice between 2011 and 2019. All patients underwent revision surgery using the proposed single Z-plasty technique.ResultsTwenty-three patients referred for lateral canthal web were included in the study. All patients had previous upper lid blepharoplasty, with the initial procedure occurring 8–63 months prior to the referral for revision. The majority of the blepharoplasties occurred in Ontario (n = 19), but some patients also underwent surgery in Alberta (n = 1), British Columbia (n = 1), and United States (n = 1). The initial surgeries were performed by a variety of specialities including plastic surgery (n = 16), otolaryngology (n = 4), ophthalmology (n = 2), and family medicine (n = 1). Following revision surgery using the single Z-plasty technique, all patients reported a subjective increase in functional and aesthetic satisfaction. No further revision surgery was required for any of these patients.ConclusionThe single Z-plasty technique is simple, robust, and could be easily incorporated into any cosmetic practice to address this complication of blepharoplasty.Graphical

"Complications in Blepharoplasty and How to Resolve Them"

Any type of eyelid correction or postoperative blepharoplasty complication should be well managed and studied before attempting its correction, as it could lead to a worsening of the original alteration. Although postoperative scars in a blepharoplasty are relatively rare, they can generally be improved by massage and late with the application of topical corticosteroids, with the understanding that their best use is during the first twelve months. An early intervention should be avoided as this can worsen the result and rarely improve the final result, when there is a healing problem, remembering that stress is a determining factor in the final result. The laxity of the canthus tendons should always be evaluated either by directly pulling the eyelid down, with an eyelid glide test, the impingement test, and a poor eyelid position prior to surgery should always be documented. In these cases, the surgeon who operates blepharoplasty must have a perfect knowledge of the management of the canthal tendons and have within his surgical resources the realization of the canthal application or the repositioning of the palpebral canthal tendon.

Impact of Full-Incision Double-Eyelid Blepharoplasty on Tear Film Dynamics and Dry Eye Symptoms in Young Asian Females.

Dry eye symptoms as a complication of double-eyelid blepharoplasty are controversial. This article evaluates tear film dynamics and changes in dry eye symptoms after cosmetic double-eyelid blepharoplasty in young Asian female. One hundred and twenty patients underwent full-incisional double-eyelid blepharoplasty. Subjective and objective parameters were documented before surgery, at 1week, 1month and 3months post-surgery, which included Ocular Surface Disease Index questionnaire (OSDI), tear meniscus height (TMH), noninvasive breakup time (NIBUT), Schirmer I test, corneal and conjunctival fluorescein staining scores, and palpebral fissure height. Dry eyes were defined based on the DEWS II criteria: OSDI ≥ 13 points and NIBUT < 10s. Patients were divided into two groups, group A included patients with redundant skin, while group B included patients with absence of redundant skin. The incident rate of dry eyes preoperatively, and at 1week, 1month and 3months were 12.5%, 12.5%, 32.5%, and 16.67%. OSDI scores were significantly increased at 1 week (9.71 ± 10.07, P < 0.001) and 1 month (11.35 ± 12.28, P < 0.001) postoperatively. A significant increase in TMH, NIBUT and Schirmer's test I values were observed at 1 week post-surgery (P < 0.001). Patients in group A showed higher OSDI scores compared to group B at 1 week and 1 month (P = 0.051) post-surgery, and the other variables showed no difference between the groups. Cosmetic double-eyelid blepharoplasty may temporarily affect tear film dynamics and aggravate dry eye symptoms in young females. However, these changes generally recover 3 months postoperatively. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Devastating sight- and life-threatening laser blepharoplasty complications

A 53-year-old woman was referred to our centre by a private aesthetic clinic. She presented with bilateral severe periorbital swelling and reduced visual acuity in her left eye for three days prior to presentation. She had undergone CO2 laser blepharoplasty one week prior to assessment. Ophthalmic examination revealed periorbital swelling in both eyes with pouring pus discharge from the lower lid as well as underlying erythematous and ulcerative skin. There was limitation of extraocular muscle movement and conjunctival chemosis. Right-eye vision was 6/9, left-eye vision was counting fingers secondary to anterior segment inflammation. No sign of optic nerve involvement was noted. Computed tomography findings showed rim-enhancing preseptal collections with air pockets bilaterally involving the lower eyelids and measuring 2.6 x 4.3 x 2.7 cm on the left and 2.3 x 4.2 x 2.8 cm on the right with an extension of the collection into the lateral extra-conal region. She was treated as bilateral orbital cellulitis secondary to postsurgical infection. The patient underwent incision and drainage and started with systemic antibiotics promptly. She showed significant improvement after treatment. This is an unusual complication from cosmetic surgery in which delayed treatment can lead to sight- and life-threatening complications.

Percutaneous Lower Blepharoplasty: A Novel Technique in Lower Eyelid Aesthetics.

More preservative approaches are being adopted in periorbital surgery each day. To avoid the possible complications of transcutaneous and transconjunctival blepharoplasty, the author has developed the safe and simple "Percutaneous Lower Blepharoplasty" technique, which he has been performing since 2008. The technique consists of the removal and transfer of lower orbital fat pads through 4-mm skin incisions with minimal dissection. The study is designed as a retrospective analysis of the operations done by the author from 2008 to 2018. The author performed 297 percutaneous lower blepharoplasty operations alone or in combination with tear-trough deformity correction, pinch skin excision, and/or carbon dioxide laser application. The video of the technique is demonstrated in the supplemental digital content. The patients were followed for an average of 58.8 months. All the patients were satisfied with the result. There were no retractions or scleral show seen. The only complication was chemosis in 1 patient that subsided with steroid ointment. Percutaneous lower blepharoplasty is a novel technique that has the following advantages: Simple and fast, low complication rates, good cosmetic outcomes, tear trough deformity correction, better estimation of fat amount to be removed, and minimal dissection and avoidance of violation of lamellar structures. It can be performed safely alone or in combination with pinch excision and/or fractional laser resurfacing.

Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury.

Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery. Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery.

Clinical efficacy and strategy of complications of blepharoplasty for double eyelids

Objective To investigate the causes, the prevention and the treatment of the complications of blepharoplasty for double eyelids. Methods The clinical data, the surgery methods and the causes were analyzed in 100 cases of blepharoplasty from July 2011 to December 2017. Results All of these patients underwent these perfect procedures with satisfied anesthesia. Incisions were all healed in one stage with no infection. Double eyelid width was (7.0±1.2) mm with natural and smooth lines after 3 months operation, 86 patients (86%) had double eyelid with natural and smooth lines, slight scars and good bilateral symmetry. 14 patients (14%) required surgical revision for complications, as asymmetry of supratarsal folds (7%), over narrow of supratarsal folds (4%), over width of supratarsal folds (2%), disappearance of supratarsal folds (2%), multiple eyelid (3%) and ptosis (1%), and the effects were satisfactory. Conclusions In order to achieve the natural and smooth double eyelids, it is important for plastic surgeons to have the comprehensive grasp of overall outline and operational details in blepharoplasty for double eyelids. Preoperative design should be accurate, intraoperative procedures should be careful, and postoperative care should be standardized. Key words: Blepharoplasty; Postoperative complications; Treatment outcome; Retrospective studies; Double eyelids

Unusual Laser Blepharoplasty Complications: Sight and Life-Threatening!

A 53-years-old woman presented with bilateral severe periorbital swelling and reduce left eye visual acuity. She had undergone laser blepharoplasty 1 week prior to presentation. Ophthalmic examination revealed both eye periorbital swelling with pouring pus discharge from lower lid with underlying erythematous and ulcerative skin, limitation of extraocular muscles and chemosis. Left eye vision was counting finger (CF) secondary to anterior segment inflammation but no sign of optic nerve involvement noted.

Upper Blepharoplasty: Management of the Upper Eyelid and Brow Complex via Transblepharoplasty Approach.

Upper blepharoplasty is one of the more common facial plastic procedures. The upper lid and brow complex are managed together. Whether upper blepharoplasty is performed for medical or cosmetic reasons, the aim is to improve appearance while retaining natural shape and maintaining (or improving) function. For optimal results, it is important to understand relevant eyelid anatomy and the concept of maintaining youthful volume and position of the eyelid brow orbit complex. Management of patient expectations, meticulous planning, and a degree of surgical finesse all contribute to the desired outcome. The article will focus on the assessment, techniques, and complications of upper blepharoplasty, which involve management of the skin, orbicularis oculi, preaponeurotic fat, levator aponeurosis and muscle as related to concomitant ptosis, and lateral brow complex via transblepharoplasty (internal) brow lift and fixation.

Blepharoplasty: One Touch - Serious Complication

1.1.Purpose:To describe and analyze a serious corneal complication following bilateral (4 lid) blepharoplasty by a plastic surgeon on patient with ultimate eye. 1.2.Case:A 59-year-old male with complicated eye history of pathological myopia, bilateral cataract surgery (June and September 2011) on both eyes and right eye vitrectomy (December 2012) following retinal detachment, decided to improve his esthetic appearance. After the plastic surgery procedure he had significantly decreased vision in his good eye. He was examined by an ophthalmologist 6 days after the plastic surgery and was diagnosed with severe bacterial conjunctivitis and a corneal foreign body. After adequate treatment it took 48 hours for the infection to be controlled but on biomicroscopy, although the cornea was absolutely clear, a strange linear lesion was identified. This lesion was apparently a result of electro-knife touch and was a reason for very poor vision of 0.1, which would not improve even with a pinhole. Corneal topography revealed 8 diopters irregular astigmatism. Anterior OCT demonstrated structural damage resulting in the reduction of corneal thickness to one half of its original size. In vivo confocal microscopy demonstrated a local area of keratocyte loss, with activation of the surrounding keratocytes. RGP lens improved the vision to useful 0.9, as the fellow eye had vision of 0.4 with notable metamorphopsia. 1.3.Conclusion:Although the complications of lower lid noninvasive blepharoplasty appear to be minimal, in the reported case corneal damage had a significant negative quality of vision and life impact. Protection of the eye surface and extreme care for the delicate anterior eye structures should be taken during surgery.

Complications in blepharoplasty: how to avoid and manage them

Complications in blepharoplasty are uncommon and, when they occur, they are usually mild and transient, such as hematomas and chemosis. However, sometimes they can be severe, such as blindness, or they might require surgical correction, such as ectropion. ObjectiveTo evaluate the results and complications of transcutaneous blepharoplasty performed in the same procedure, discussing how to treat and how to avoid them. MethodsA retrospective study of 200 medical records of consecutive patients that underwent transcutaneous blepharoplasty from January 2007 to January 2009. The variables analyzed were age, gender, complications, clinical outcome, patient satisfaction, and photographic documentation. ResultsThe incidence of complications was 9.5% (19 patients). The complications were 1 hematoma, 12 cases of chemosis and 13 patients who underwent canthoplasty, 6 patients with malposition of the lower eyelid (5 retractions and 1 ectropion). Medical treatment was performed in 12 patients and revision surgery in 7 cases of all the patients who had complications. ConclusionsWe demonstrated that blepharoplasty is a procedure with a high satisfaction and a low complication rate, and it is an excellent surgical procedure, when properly indicated.

Evidence-based medicine: Blepharoplasty.

After studying this article, the participant should be able to: (1) Identify the essential preoperative considerations for patients undergoing blepharoplasty. (2) Describe upper and lower eyelid anatomy and the relevance to blepharoplasty techniques. (3) Discuss a standard approach to upper and lower lid blepharoplasty, beginning with preoperative assessment, planning, and marking. 4. Describe the major considerations in periorbital rejuvenation and the critical steps taken during blepharoplasty to create aesthetic improvements. Blepharoplasty is one of the most common aesthetic procedures performed in the United States. Significant improvements in facial aesthetics can be made with a relatively short operation that can be performed under intravenous sedation or entirely with local anesthesia. Upper blepharoplasty focuses primarily on removal of excess skin and aesthetic placement of the supratarsal crease, along with filling and contouring of a deep upper orbital sulcus with injections when necessary. Lower blepharoplasty addresses the orbitomalar sulcus (lid-cheek junction and tear-trough abnormalities) and pseudoherniation of periorbital fat, and is based on selective removal and repositioning of fat. Upper blepharoplasty generally does not require fat removal. In addition, lower blepharoplasty involves releasing deep structures, whereas upper blepharoplasty is generally more superficial. In general, the upper lid should be approached transcutaneously, whereas lower blepharoplasty can be safely performed through a transconjunctival or a transcutaneous incision. Complications of upper blepharoplasty are uncommon with more current techniques, but lower lid blepharoplasty has potentially disastrous complications. Blepharoplasty can significantly enhance periorbital and midface aesthetics by improving the tired appearance of even young patients, and is an important tool for facial rejuvenation.

Complications of Blepharoplasty

This article provides a comprehensive discussion on the complications of blepharoplasty. We discuss the importance of preoperative counselling and surgical planning to provide the patient with a satisfactory outcome. Strategies are presented to manage common complications.

Dynamic Diagnosis of "Fishmouthing" Syndrome, an Overlooked Complication of Blepharoplasty

Dysfunction and/or dehiscence of the lateral canthus is 1 source of symptomatic eyelid closure disorder after blepharoplasty. Because the resulting concentric blinking movement resembles mouth closure in a fish, the name "fishmouthing" syndrome (FS) was given to this condition. Fishmouthing syndrome appears to be an overlooked complication of blepharoplasty. The authors performed dynamic assessments of patients who had eyelid discomfort after blepharoplasty to establish the clinical signs of FS. Preoperative and postoperative videos of 36 patients who presented for secondary blepharoplasty were analyzed retrospectively. All 36 patients experienced symptoms of dry eyes and eye discomfort after their initial blepharoplasty and desired symptomatic and cosmetic improvement. The dynamic signs and diagnostic criteria for FS were established clinically and through video analysis of patients' blinking movements. The most common clinical characteristics of FS included lash deformity ("cow lash" sign), abnormal medial displacement of the lateral canthus during blinking, deformity (rounding/narrowing) of the lateral scleral triangle, and visible eyelid closure deficiency or gapping. Other characteristics were lower-lid retraction and compensatory hypercontraction of the orbicularis oculi adjacent to the inner canthus. Patients with FS present with a combination of clinical symptoms and signs and are best diagnosed through dynamic visualization of the animated tissue during blinking. Evaluation of preoperative videos is an essential tool for surgical planning and for analyzing the results, both before and after corrective surgery, in patients with potential FS. 4.

Algorithmic Approach to Lower Lid Blepharoplasty

The debate continues around transconjunctival versus transcutaneous approaches. Despite the perceived safety of the former, many experienced surgeons continue to advocate the latter. This review aims to present a balanced view of each approach. It will first address the anatomic basis of lower lid aging and then organize recent literature and associated discussion into the transconjunctival and transcutaneous approaches. The integrated algorithm employed by the senior author will be presented. Finally this review will describe less mainstream suture techniques for lower lid rejuvenation and lower lid blepharoplasty complications with a focus upon lower lid malposition.

Blepharoplasty Complications

There are three major areas of concern for a patient who has complications following a cosmetic blepharoplasty: cosmetic issues, functional issues, and uncomfortable/symptomatic issues or a combination of the above. An emphasis will be placed on avoiding cosmetic eyelid complications as well as the medical and surgical management of complications.