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BLEPHAROPLASTY

BLEPHAROPLASTY. Anatomy. Periorbital muscles. The orbital bones. Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013. Tarsoligamentous sling and retinacular structure.

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BLEPHAROPLASTY

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  1. BLEPHAROPLASTY

  2. Anatomy Periorbital muscles The orbital bones Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  3. Tarsoligamentous sling and retinacular structure Anatomy of the deepest structures of the posterior lamella and orbital fat pad Codner MA, Ford DT. Blepharoplasty. Grab and Smith Plastic Surgery 6th edition. Philladelpia: Raven, 2007

  4. The anatomic variations in the upper eyelid Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  5. Anatomy • Topography periorbital region (eyelid crease) • Superior tarsus is 10 mm in height at its center • Inferior tarsus 3.8-4.5 mm in vertical height

  6. Orbicularis Oculi Muscle • Divided into three subdivisions • Pretarsal muscle • Preseptal muscle • Orbital muscle • Orbital septum • Fascial membrane that separates eyelid structures to deeper orbital structures • Neither thin nor elastic would make analogous to weakened fascia

  7. Anatomical comparison betweenOriental and Caucasian eyelid Deep set eye Average depth Oriental

  8. Oriental eyelid • Supratarsal fold is absent • Eyelid thick and hangs down like pseudoptosis • Palpebral fissure is narrow • Eyelashes point downward • Plica mongolia is present in 50% of cases Khoo Boo-Chai

  9. In sagittal section

  10. Preoperative Evaluation • General Condition • Clinical history and physical examination • Patient personality, expectations for surgery • Psychological assessment • Eye Function • Visus, Intraocular pressure, Muscle Function • Frame of the eyelid • Forehead (ptosis, wrinkles), shape &position eyebrow • Cheeks and depth of nasolabial folds • Upper orbital rim

  11. Preoperative Evaluation • Tarsal plate • Orbicularisoculi Stasior lid distention test Flower eyelid retraction test • Skin and subcutaneous Pinch test Squinch test

  12. Surgical technique • Anesthesia • Blepharoplasty is most frequently done under local anesthesia • Use lidocain 1% with 1:100 - 200.000 epinephrine with 27 gauge needle

  13. Surgical technique • Basic surgical technique Think in terms of three layer: • Skin (excision of redundancy) • Muscle (excision of an appropiate strip of orbicularis oculi) • Fat (removal of an appropiate amount of orbital fat if indicated)

  14. Blepharoplasty Blepharoplasty superior - simple skin excision - Anchor blepharoplasty - Levatoraponeurosis plication Blepharoplasty inferior - transconjungtival blepharoplasty - transcutaneous blepharoplasty - simple skin excision - lateral canthal anchoring - Kuntz-simanovsky

  15. Surgery marking Upper blepharoplasty Lower blepharoplasty Codner MA, Ford DT. Blepharoplasty. Grab and Smith Plastic Surgery 6th edition. Philladelpia: Raven, 2007

  16. Upper Blepharoplasty • Skin Marking • Supratarsal fold located at different distances from individual, varying 7 – 12 mm. • There is no uniform distance to locate the line • Usually 8-12 mm above centrally, 5-6 mm above medially and laterally canthal crease

  17. Simple skin excision blepharoplasty Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  18. Anchor blepharoplasty technique Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  19. Lower Blepharoplasty • Objectives • Correction of periorbital fat or skin, or both • Correction of 3 components lower lids: • Orbicularis muscle • The tarsus • The orbital septum • Transconjunctival approach • Skin Muscle Flap Technique

  20. Lower Blepharoplasty(transconjungtival approach) Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  21. Lower Blepharoplasty(transconjungtival approach) Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  22. Fat pad removal-repositioning Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  23. Septoorbitoperiostoplasty for the treatment of palpebral bags Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3rd edition. Washington: Elsevier, 2013

  24. Skin Muscle Flap Technique

  25. Correction a ‘muscle roll’

  26. Post-operative care • Bandaging of the eyes following operation is not essential • Ice compresses (first 24 hrs to reduces edema and echymosis) • Topical antibiotic ointment and oral during fifth day • Suture removed on 4-5 post op • Squeezing eye lids after 1 week • Makeup on about 10 post-op

  27. Complications Short Term • Loss of Vision • Retrobulbar Hematoma • Wound Dehicense • Long Term • Dry eye Syndrome • Hypertrophic scar and Keloid • Epiphora • Infection • Asymmetry

  28. Thank You

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