Upper blepharoplasty







Table 3.1

Indications for surgery











Functional dermatochalasis affecting vision
Cosmetically displeasing dermatochalasis and/or upper eyelid fullness
To correct associated lash ptosis, entropion, blepharitis or anophthalmic prosthetic instability
Use of upper eyelid dermatochalasis for anterior lamellar skin grafting elsewhere


Table 3.2

Preoperative evaluation

















Prior facial surgery or trauma
Dry eye symptoms
Prior refractive surgery
Degree of dermatochalasis and fat prolapse
Presence of lacrimal gland prolapse
Presence of concurrent eyebrow ptosis and eyelid ptosis
Ethnic differences between Asian and Occidental eyelid crease


Introduction


Several parameters should be evaluated in the preoperative blepharoplasty examination. Documentation of functional symptoms, photographs, and visual-field testing are mandatory for coverage by many third-party carriers. When photographing the patient, images should be captured in the frontal plane, three-quarter profile, and the side plane. Before and after photographs documenting improvement and changes are essential particularly for the discerning cosmetic patient. History of dry eye symptoms, prior facial surgery or trauma and refractive surgery are elicited. Aesthetic considerations should be addressed with the patient holding a mirror during the examination to point out salient features. During the examination, the degree of dermatochalasis present should be noted as well as any co-existent brow and/or eyelid ptosis ( Figure 3.1A ). The eyelid creases are then measured for symmetry. Asymmetric eyelid creases are often associated with eyelid ptosis ( Chapter 11 , Chapter 12 , Chapter 13 ) and this should be identified and addressed at the time of blepharoplasty. Often, the higher eyelid crease is associated with levator dehiscence ptosis ( Figure 3.1B ). Lateral eyelid fullness should be noted and palpation may reveal a prolapsed or pathologically enlarged lacrimal gland ( Figure 3.1C ) and require repositing and possible biopsy ( Chapter 70 ). Examination of the tear film (tear breakup time, tear lake, Schirmer’s testing) should be performed as well as assessment for lagophthalmos with the eyelids gently closed ( Figure 3.1D ).




Preoperative Examination





Figures 3.1A–D


Preoperative examination




Surgical Technique







Figures 3.2A–D


Marking of eyelid crease

The skin marking is one of the most critical parts of upper blepharoplasty. The height of the eyelid crease varies with gender and ethnicity. If a native eyelid crease is present, the central height corresponding to the pupillary light reflex is marked ( Figure 3.2A ). In non-Asians, the central eyelid crease height is typically 6–9 mm in males and 8–11 mm in females ( Figure 3.2B ). For marking of the Asian eyelid, refer to Chapter 4 , Chapter 5 , Chapter 6 . If the upper eyelid crease is unusually high or asymmetric, concurrent ptosis may be present and this should be evaluated. The central height is then symmetrically marked on both eyelids and visually confirmed. The mark is then inferiorly tapered in a gradual fashion towards the medial canthus and then tapered superiorly prior to reaching the punctum ( Figure 3.2C ). Laterally, the marking also tapers inferiorly towards the lateral canthus. Beyond the lateral canthus, the marking is directed superiorly if lateral hooding of the skin is present ( Figure 3.2D ). Failure to address the lateral hooding will result in residual dermatochalasis after upper blepharoplasty. Once both creases are marked, the two sides are compared for symmetry.

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May 16, 2019 | Posted by in Reconstructive surgery | Comments Off on Upper blepharoplasty
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