Prevention of Lower Eyelid Malposition After Blepharoplasty (original) (raw)
Related papers
Lateral Canthal Support in Prevention of Lower Eyelid Malpositioning in Blepharoplasty
Journal of Craniofacial Surgery, 2015
Lower blepharoplasty is a cornerstone in facial rejuvenation and improvement. Despite its popularity, several adverse effects have been described; of these, postsurgical eyelid displacement, with its aesthetic and functional consequences, is one of the more frequent complications. The tarsal sling procedure is a simplified canthopexy
Plastic and Reconstructive Surgery, 2015
he lower eyelids undergo characteristic malposition changes with aging. These include inferior migration of the lower eyelid associated with lid margin eversion, scleral show, and horizontal lid laxity. 1-6 Lower eyelid malposition may also develop following lower eyelid surgery that did not address specific preoperative anatomical findings. Lateral canthal procedures have been described to avoid lower eyelid malposition in the blepharoplasty patient and to address an existing lower eyelid deformity. 4,7-16 There remains uncertainty in choosing the most appropriate lateral canthal procedure. 17-19 Contributing factors to this uncertainty are a lack of understanding of the complex functional anatomy of the lower eyelid and an inadequate documentation of patient specific morphologic and anatomical physical
Lower Eyelid Retraction following Blepharoplasty
The American Journal of Cosmetic Surgery, 1989
T he most common complication of the lower eyelid blepharoplasty is eyelid retraction ("scleral show") of the lateral one-third of the lower eyelid with associated rounding and inferior displacement of the lateral canthus. We present a system of evaluation and management of these patients, with procedures ranging from lateral canthal resuspension to skin grafting, depending on the degree of vertical shorteningof the eyelid lamellae. A procedure is presented in which the middle lamellar cicatrix is lysed, the lateral canthus reconstructed, and the cheek elevated to provide additional vertical anterior lamellar skin. This procedure may be used to elevate the lower eyelid rather than lower the upper eyelid in cases of postblepharoplasty lagophthalmos with exposure keratopathy, and will often avert the need for skin grafts in patients with lower eyelid retraction following blepharoplasty.
Vertical Midface Lifting with Periorbital Anchoring in the Management of Lower Eyelid Retraction
Plastic and Reconstructive Surgery, 2017
Background: Lower eyelid retraction can be the unfortunate result of aesthetic surgery, trauma, disease, or the aging processes. The purpose of this article is to assess whether midface lifting based on purely vertical repositioning constitutes an effective procedure for its correction. Methods: A retrospective study was carried out on 199 patients (311 eyelids) operated on between January of 2004 and January of 2014. The various causes of eyelid retraction in this population included cosmetic blepharoplasty (56.8 percent), involutional ectropion (23.1 percent), tumor resection (9.5 percent), facial nerve paralysis (8.5 percent), and trauma and related surgery (2 percent). The study was restricted exclusively to cases of moderate and severe lower eyelid retraction addressed by means of midface lifting. The mean follow-up time was 16.8 months. All of the patients were subjected to midface lifting with strengthening of the lateral canthus. A spacer graft was also used in 37.7 percent of the cases. Results: One hundred ninety-five patients (97.9 percent) displayed objective improvement of the eyelid retraction and a marked degree of improvement both in aesthetic terms and as regards the functional disorders reported. Only four patients (2 percent) presented complications such as needing another operation. Conclusion: Midface lifting based on purely vertical repositioning makes it possible to recruit a considerable amount of "new" skin at the lower eyelid, thus ensuring a decrease in vertical distraction and correct recovery of the height of the external lamellar plane.
The American Journal of Cosmetic Surgery, 2008
Purpose: To define a subgroup of postblepharoplasty patients with persistent lower eyelid retraction despite attempted lower eyelid reconstruction and midface-lifting, and to propose a revisional midface-lifting procedure to address complex cicatricial patterns in these patients. Methods: This is a retrospective observational case series of consecutive patients with bilateral persistent cicatricial lagophthalmos from lower blepharoplasty despite prior lower eyelid reconstruction and midface-lifting. An approach for midface-lifting and lower eyelid reconstruction was designed that consisted of transconjunctival, sublabial, and temporal approaches to the subperiosteal space with manual distraction cicatricial scar matrix lysis. Routine postoperative evaluation of clinical outcome, safety, patient satisfaction, and photographic analysis was performed. Results: A total of 8 patients who underwent revisional midface-lift surgery (15 ipsilateral surgeries) were identified. In all 15 cases, a 3-dimensional cicatricial matrix was identified that involved the lower eyelid and midface and limited visual exposure of the subperiosteal space and mobility of the midface despite complete subperiosteal release to the sublabial incision. Manual anterior distraction of the midface via the sublabial incision provided a mechanism for lysis of the cicatricial matrix. Improved midface mobility allowed successful vertical fixation with maximal anterior lamellar recruitment and lower eyelid support. No complications were encountered. All patients reported improvement in cosmesis and ocular comfort. Average improvements in lower margin to reflex distance (MRD2) was 0.9 mm, scleral show was 0.8 mm, palpebral fissure
Subtle Eyelid Retraction after Lower Blepharoplasty
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2019
Background: Lower blepharoplasty is one of the commonest cosmetic surgeries performed in the United States. The delicate balance of the lower eyelid may be detrimentally altered in lower blepharoplasty, leading to lower eyelid retraction with the attendant functional and cosmetic consequences. Marginal reflex distance-2 (MRD2) is an insensitive measure for subtle lower eyelid retraction, and the MRD2 at the lateral limbus (MRD2 limbus) and tarsal marginal show (TMS) may be more sensitive in identifying eyelid retraction and eversion. Methods: A cohort study of consecutive patients undergoing lower blepharoplasty with skin pinch removal, laser resurfacing, or skin pinch removal with prophylactic lateral canthal resuspension. Mean follow-up was 22.1 weeks. Results: There was no significant difference in MRD2 after surgery after either laser resurfacing, skin pinch, or skin pinch with canthoplasty, either after surgery or between groups. MRD2 limbus was significantly increased after surgery in the skin pinch only group (p<0.05). There was a significant difference in postoperative MRD2 limbus in the skin pinch with canthoplasty group compared to the skin pinch only group (p<0.05). Tarsal marginal show was significantly increased after both laser resurfacing (p<0.001) and skin pinch only (p<0.05), and both postoperative groups demonstrated significantly increased tarsal marginal show compared to skin pinch with canthoplasty (p<0.05). Conclusions: MRD2 limbus and TMS more sensitive markers for lower eyelid retraction than MRD2. Subtle eyelid retraction and eversion occurs after anterior lamellar work, and can be prevented with prophylactic lateral canthal resuspension.
Annals of Plastic Surgery, 2001
Ectropion or scleral show resulting from weakness of the lower eyelids is not uncommon after lower blepharoplasty or midface lift via blepharoplasty incision. Denervation of the pretarsal orbicularis oculi muscle (OOM) attributes to such complications. The authors analyzed 102 patients who underwent midface lift via lower blepharoplasty incision for the past 3 years and investigated the motor nerve innervation of the lower OOM in 20 cadavers. They encountered two cases of ectropion attributed to the denervation of the pretarsal OOM: one with dry-eye syndrome and scleral show, and the other with a "polar bear-like appearance" (i.e., outer eversion of the lower eyelid). All pretarsal and preseptal OOMs were innervated by five to seven terminal twigs of the zygomatic branches of the facial nerve that approached the muscle at a right angle. The medial portion of the lower OOM was innervated by one to two terminal twigs of the buccal branch, and the middle portion was innervated with two to three twigs of the zygomatic branch. The lateral portion was supplied by the uppermost zygomatic branch, which split into two to four twigs. The mean horizontal distance between the lateral canthus and the zygomatic branch was 2.31 ؎ 0.29 cm (range, 1.7-2.7 cm) and the vertical distance was 1.20 ؎ 0.20 cm (range, 0.8-1.5 cm). The critical zone was a circle with 0.5-cm radius, and its center was located 2.5 cm inferolaterally (30 deg) from the lateral canthus. It is very important to understand the motor nerve innervation of the lower eyelid and the "critical zone" to avoid postoperative ectropion or weakness of the lower eyelid resulting from paralysis of the pretarsal or preseptal OOM.
Plastic & Reconstructive Surgery, 2017
Background: Lower eyelid retraction can be the unfortunate result of aesthetic surgery, trauma, disease, or the aging processes. The purpose of this article is to assess whether midface lifting based on purely vertical repositioning constitutes an effective procedure for its correction. Methods: A retrospective study was carried out on 199 patients (311 eyelids) operated on between January of 2004 and January of 2014. The various causes of eyelid retraction in this population included cosmetic blepharoplasty (56.8 percent), involutional ectropion (23.1 percent), tumor resection (9.5 percent), facial nerve paralysis (8.5 percent), and trauma and related surgery (2 percent). The study was restricted exclusively to cases of moderate and severe lower eyelid retraction addressed by means of midface lifting. The mean follow-up time was 16.8 months. All of the patients were subjected to midface lifting with strengthening of the lateral canthus. A spacer graft was also used in 37.7 percent ...