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BLEPHAROPLASTY

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SUMMARY

  • Blepharoplasty is the most frequently performed facial aesthetic surgical procedure in the United States.

  • Blepharoplasty is primarily used to treat dermatochalasis, and both upper and lower blepharoplasty result in a more alert and youthful appearance.

  • Anesthesia options include local anesthesia, local anesthesia with IV sedation, and general anesthesia.

image Beginner Tips

  • Be sure to distinguish between eyelid ptosis, brow ptosis, and dermatochalasis.

  • Upper lid blepharoplasty with en bloc excision of upper lid skin, orbicularis oculi muscle, and/or orbital fat is the gold standard for the correction of dermatochalasis.

  • The consequences of aggressive skin removal are more difficult to correct than the consequences of managing residual skin excess.

image Expert Tips

  • Superior sulcus hollowing is a common postoperative complication, prompting a recent shift toward volume preservation in upper lid blepharoplasty.

  • Lid malposition seems to occur less frequently with concomitant canthal suspension.

  • Instead of fat excision, many now advocate for fat preservation and repositioning as a more effective means of lower lid and mid-face rejuvenation.

image Don’t Forget!

  • Negative-vector patients (those with prominent eyes without bony support) are at increased risk of ectropion and dry eye postoperatively.

  • There is significant variation in technique options, though what the surgeon knows and is most comfortable with might be more important that the actual choice of technique and surgical approach.

image Pitfalls and Cautions

  • Brow ptosis should be distinguished from dermatochalasis. If both problems are present and blepharoplasty alone is performed, the degree of brow ptosis may be worsened.

  • With transcutaneous lower eyelid blepharoplasty, lower eyelid ectropion and retraction can occur in up to 30% of cases.

  • For lower eyelid blepharoplasty, avoid excessive skin removal; usually only 2 mm of skin excision is required at the most.

image Patient Education Points

  • Controlling patient expectations is critical.

  • If the patient does not want brow surgery, they should be made aware that the degree of brow ptosis could worsen after isolated blepharoplasty, creating the appearance of excess upper lid skin from the descended brow.

  • Counsel patients that the need for additional skin removal should not adversely influence an overall successful cosmetic outcome.

image Billing Pearls

  • Most insurance companies require clinical photographs and visual field images for preapproval purposes.

  • Aesthetic blepharoplasty patients may benefit from combining blepharoplasty with other procedures, and sometimes they can see cost savings by doing this.

INTRODUCTION

Blepharoplasty is the most common aesthetic surgical procedure performed on the face in the United States,1 and its goal is to restore a youthful contour to the eyelids and midface. Upper and lower eyelid blepharoplasty are two distinct procedures with distinct aesthetic aims. Upper blepharoplasty is performed to address excess skin, asymmetric eyelid creases, fat or lacrimal gland prolapse, and/or sulcus hollowing. Lower blepharoplasty is performed to address the orbitomalar region, including tear-trough deformity and/or prominence of the lid–cheek junction. While an excellent ...

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