Learning Objectives: After studying this article, the participant should be able to: 1. Identify pertinent findings in the preoperative evaluation of the blepharoplasty patient that could affect operative management. 2. Describe different techniques of upper and lower lid blepharoplasty. 3. Describe ancillary procedures that could blend the lower eyelid-cheek junction and optimize the aesthetic result of blepharoplasty surgery. 4. Identify common postoperative complications and describe their treatment.
Summary: Blepharoplasty plays a vital role in facial rejuvenation, with direct aesthetic connection to the brow and the cheek. Upper and lower eyelid blepharoplasty may be indicated for the presence of excess skin and/or orbital fat. Preoperative evaluation should include a thorough medical and ophthalmic history, along with a vision examination. Symptoms of preexisting dry eye should be elicited preoperatively, as they directly correlate with postoperative complications. Physical examination should take into account brow position, eyelid ptosis, lower eyelid position, and cheek projection. Blepharoplasty is a broad topic with many operative approaches. Skin-only upper blepharoplasty with medial orbital fat excision is an effective procedure. Lower eyelid blepharoplasty is a more controversial topic. The senior author (R.J.R.) uses a transconjunctival orbital malar retaining ligament disruption along with a lateral retinacular canthopexy, and a lower eyelid skin pinch excision for his lower blepharoplasty. Postoperative care should include aggressive corneal lubrication with eye protection, eye drops, and ointment. Small amounts of lagophthalmos are tolerated postoperatively but usually correct within 7 days. Complications may include retrobulbar hematoma, lower eyelid malposition, dry eye, and need for revision surgery. In summary, blepharoplasty is a common procedure in cosmetic surgery, with important contributions to facial rejuvenation.
The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications with authoritative, information-based references.
This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.
MOCERT AVAILABLE AT http://www1.plasticsurgery.org/ebusiness4/OnlineCourse/CourseInfo.aspx?Id=14014.
From the Department of Plastic Surgery, The University of Texas Southwestern Medical Center.
Received for publication September 30, 2006; accepted January 16, 2007.
Disclosures: Neither of the authors has a financial interest in any of the products, devices, or drugs associated with this article. There are no commercial associations that might pose or create a conflict of interest with information presented in this article such as consultancies, stock ownership, or patent licensing arrangements. All sources of funds supporting the completion of this article are under the auspices of The University of Texas Southwestern.
The test for the MOC-PS–aligned CME article “Blepharoplasty” by Trussler and Rohrich is available at http://www1.plasticsurgery.org/ebusiness4/OnlineCourse/CourseInfo.aspx?Id=14014.
Rod J. Rohrich, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, HD01.544, Dallas, Texas 75390-8820, firstname.lastname@example.org