Blepharoplasty

Complications Involved In Bilateral Upper Lid Blepharoplasty

Patients undergoing bilateral upper lid blepharoplasty surgery not only improve their appearance but also their self confidence. After blepharoplasty, patients often remark that they look less tired, more youthful and generally feel happier. Patient dissatisfaction with the result does not necessarily obligate the surgeon to compensate the patient, because each case warrants evaluation of its own merits.

Blepharoplasty Operations fell into three categories: fracture plating alone, (22%); split-calvarial bone graft placement with or without plating, (58%); and orbital decompression, (20%). Lateral tarsal strip fixation of all 4 eyelids to periosteal flaps based inside the orbital rim was performed to achieve horizontal tightening, where postoperative follow-up ranged up to 52 months.

Patients had injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris and to treat blepharospasm and muscle tightness, and the effectiveness of the botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection. Patients require varying combinations of brow elevation (prior to blepharoplasty), correction of brow asymmetries, and hairline-preserving forehead elevation, where some may only require excisional or paralytic procedures of the frontalis muscle (horizontal forehead creases), corrugator supercilii muscles (vertical glabellar furrows), and procerus muscle (horizontal glabellar furrows).

Patients with the most severe degree of lower eyelid malposition generally have middle lamella scarring, andiIf this abnormality is not addressed, lower eyelid procedures aimed at correcting the malposition are doomed to failure, and patients with prominent globes can have significant discomfort related to exposure keratopathy, lagophthalmos, and inefficient function of the globe-eyelid interface.

Patients with these surgeries were observed for an average of 6 months, and complications and revisions were few. Patients were treated for a variety of disorders including postblepharoplasty lower eyelid retraction, cicatricial entropion, eyelid retraction secondary to thyroid eye disease, and lagophthalmos following surgery for paralytic ptosis, and surgical results were evaluated, grafts were measured for postoperative shrinkage, and donor site healing was recorded.

Postoperative retrobulbar hemorrhages developed during bilateral upper lid blepharoplasty were sequentially and immediately treated by decompression, restoring full vision, and the critical importance of supervised postoperative observation and immediate availability of medical help is underscored. Postoperative complications included worsened diplopia in one patient with ELA and exposure keratopathy in one patient with frontalis sling, where two of the ELA eyelids developed recurrent ptosis requiring additional surgery more than two years after the initial procedure.