Complications of blepharoplasty and their management.

BACKGROUND. Blepharoplasty is the most frequently performed cosmetic procedure on the face. Although complications are rare, their consequences can be devastating both the for patient and the surgeon. OBJECTIVE. The complications of blepharoplasty and their management are reviewed.

Monopolar cautery for graft cartilage sculpting in reconstructive eyelid surgery.

We describe a technique for using the monopolar cautery to sculpt ear cartilage to prepare it for use as a graft to reconstruct or support the posterior lamella of the eyelid in oculoplastic procedures. We have used this simple, rapid, and predictable technique in 16 patients with excellent results.

Simultaneous lateral, anterior, and posterior (SLAP) lower-lid blepharoplasty.

We report a hybrid of procedures for correcting the aging lower eyelid--transconjunctival blepharoplasty, skin blepharoplasty, and skin-muscle blepharoplasty--that maximizes the strengths of these procedures while minimizing their shortcomings. Our procedure, a simultaneous lateral, anterior, and posterior blepharoplasty, simultaneously attacks the lateral canthal angle, the anterior lamella, and the posterior lamella of the eyelid.

Refinements of the tarsal strip procedure.

We present several refinements in technique that simplify the tarsal strip procedure and enhance its results. Among these refinements are: electrosurgical deepithelialization of conjunctiva and lid margin, use of a V-shaped needle, direct needle passage about the lateral orbital tubercle, and the parallel placement of a buried absorbable suture to unite the upper and lower lid margins and to maintain a long-lasting sharp canthal angle. We have used these maneuvers in 45 patients with few complications; patient acceptance has been high. Also, we have found that using these maneuvers is helpful in teaching the procedure to residents.

Lateral wall advancement in orbital decompression.

Treatment of dysthyroid orbitopathy can be enhanced with a modified craniofacial approach using a lateral wall osteotomy, and anterolateral advancement and osteosynthesis in conjunction with medial and inferior wall orbital decompression. The technique of lateral wall advancement is described, and the results are discussed. While the authors advocate orbital decompression for dysthyroid optic neuropathy, advancement of the lateral orbital wall can easily be performed as an adjunct to the two- or three-wall decompression procedure. Advancement appears to increase the overall decompressive effect by providing a potential space where lateral expansion can occur and by enlarging the bony orbital volume. It also appears to lessen lid retraction and facilitates (and in some cases, obviates) the need for further lid retraction surgery.

Visualization of the probe tip during lacrimal outflow system probing and intubation.

Probing of the lacrimal outflow system is commonly performed by ophthalmologists for treating nasolacrimal duct obstruction in infants or for intubating the lacrimal system. Visualization of the probe tip in the inferior meatus during probing insures the surgeon of reaching the nose with the probe. Similarly, visualization of the probe is the key to success in intubation irrespective of the retrieval system used. Rotation of a curved metal probe plus infracturing of the inferior turbinate after shrinking the nasal mucosa with cocaine allows such visualization in most instances.

Functional anatomical reconstruction in an oculofacial prosthesis.

The exenterated, maxillectomy, and/or palatectomy patient is ideally referred prior to surgery for two primary reasons: (1) to reassure the patient of an attempt to restore appearance and function to nearly the same as before ablative surgery, and (2) to make an entire face alginate impression for post surgical replication. The sixth week postoperatively, a second full-face alginate impression is made of existing wound and remaining anatomy. Photographs are taken for comparative sculpting. The prosthesis is designed to redirect airflow to a normal pattern in order to avoid "blow out" of the prosthesis from a sneeze or cough. Bone-like acrylic sinus replication provides normal speech resonance, a bonding surface for Silastic "skin" and a hollow socket for an impression-fitted prosthetic eye. The prosthetic eye, intrinsic pigmentation and extrinsic pigmentation, eye lashes and brows are incorporated into completed prosthesis. A combination of aesthetic and functional elements into a single three- or four-piece prosthesis provides restoration of natural appearance, improved functions of facial anatomy, and improved breathing, sinus drainage, speech articulation and resonance.