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Blepharoplasty

Blepharoplasty. Grand Rounds Presentation by Gregory Young, M.D. Karen Calhoun, M.D. Anatomy. Skin Orbicularis Oculi Septum Levator and Lower Lid Aponeurosis Muller’s/Horner’s Muscle Tarsal Plate Orbital Fat. Indications. Functional Impaired vision Asthenopia Cosmetic

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Blepharoplasty

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  1. Blepharoplasty Grand Rounds Presentation by Gregory Young, M.D. Karen Calhoun, M.D.

  2. Anatomy • Skin • Orbicularis Oculi • Septum • Levator and Lower Lid Aponeurosis • Muller’s/Horner’s Muscle • Tarsal Plate • Orbital Fat

  3. Indications • Functional • Impaired vision • Asthenopia • Cosmetic • Blepharochalasis • Dermachalasis • Excess fat or orbicularis muscle

  4. Precautions • Ocular anatomy- Proptosis, Dry eyes • Systemic- Coagulopathy, Shingles, MI • Meds- NSAIDS, Anticoagulants • Social- Tobacco

  5. Preoperative Evaluation • Complete H & P • Systematic Evaluation of fat, skin, muscle, eyelid position, puncta • Ophthalmologic Exam- visual acuity, visual field, shirmer test, EOM’s, ocular pressures, scleral show

  6. Preoperative Evaluation • Concomitant Cosmetic Deformities • Eyelid or Brow Ptosis • Generalized Skin Conditions • Acne or Keloids • Photographs • Realistic Expectations

  7. Operative Techniques • Upper Lid Blepharoplasty

  8. Operative Techniques • Lower Lid Blepharoplasty • Transconjunctival Approach

  9. Operative Techniques • Lower Lid Blepharoplasty • Transcutaneous Approach

  10. Postoperative Considerations • Ice, elevate HOB, ointment • Watch for hematoma • Postoperative diplopia, lower lid dysfunction • Remove sutures in 3-4 days

  11. Complications • Dissatisfied Patient • Corneal Injury • Subcutaneous/Submuscular Hematoma • Retrobulbar Hematoma • Blindness • Lagophthalmos

  12. Complications • Ptosis • Epiphora • Entropion • Ectropion • Dry eye syndrome • Enophthalmos

  13. Complications • EOM Muscle Imbalance • Conjunctival Granuloma • Prolonged Chemosis • Conjunctival Inclusion Cysts • Lower Lid Retraction

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