134 |
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M.E. Hartstein |
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|
Cold compresses are placed immediately after surgery. |
5 min 4 times a day. If the overcorrection is more significant, |
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They are continued at frequent intervals for the next 48 h. |
a minor “in-office revision” is necessary. A small amount of |
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The patient is advised to keep his/her head elevated, includ- |
local anesthetic is given (the incision site is typically par- |
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ing sleeping on several pillows, in order to minimize postop- |
tially denervated from the initial surgery), and the wound is |
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erative edema. Antibiotic ointment is applied to the sutures |
partly opened by gently pulling apart the edges without re- |
|
3 times daily for a week with artificial tear supplements used |
incising. Sutures can then be adjusted to modify lid height |
|
as needed. Patients are usually seen in the office at 5–7 days |
and contour. If there is an obvious undercorrection, the same |
|
postoperatively, when nonabsorbable sutures are removed. |
technique is used for revision. Conversely, if there is only |
|
|
|
mild undercorrection, it is best to wait until all the edema has |
|
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subsided before considering revision [17]. |
12.6Complications
Mild lagophthalmos and exposure keratitis (dry eye) are probably the most common complications after surgery, and are typically self-limiting. Treatment for this problem includes the use of artificial tear supplements during the day and ointment before sleep for a short period postoperatively. The placement of punctal plugs can also be of benefit if symptoms persist. In addition, oral doxycycline may be helpful to correct meibomian gland dysfunction which can contribute to dry eye after surgery. In rare cases, corneal abrasion or ulcer may develop requiring the eyelids be closed temporarily with a tarsorrhaphy procedure [15, 16].
An overor undercorrection of lid height can also occur. A small overcorrection may respond to gentle lid massage. Once the incision is sufficiently healed, the patient is instructed to use several fingers to hold the lid downward while simultaneously trying to open (creating countertraction) the lid for
12.7Conclusion
Levator resection/advancement is a powerful technique for ptosis repair. Successful surgery requires a thorough appreciation of eyelid anatomy and experience with detailed dissection of the eyelid. In addition, comfort and familiarity with performing surgery on the awake patient and with intraoperative adjustment of lid height and contour are needed to attain consistent and reproducible surgical outcomes. Preoperative examination and counseling is essential in order to successfully identify and address both the ptosis and eyelid fullness (excess skin, herniated fat) components in cosmetic surgery patients (Figs. 12.18 and 12.19). In the appropriate setting, this surgery is an invaluable tool for the eyelid surgeon.
Fig. 12.18 (a) Preoperative and (b) postoperative photographs of a young patient who underwent upper blepharoplasty combined with minimal levator advancement to correct ptosis, more pronounced in the right eye
Fig. 12.19 (a) Preoperative and (b) postoperative photographs of middle-aged patient with significant dermatochalasis and ptosis. Both components were addressed surgically
12 Levator Ptosis Repair in the Aesthetic Patient With and Without Blepharoplasty |
135 |
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