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Blepharoplasty

Thomas Procedures in Facial Plastic Surgery

Ira D. Papel, MD, FACS

Facial Plastic Surgicenter

Associate Professor

The Johns Hopkins University

Baltimore, Maryland, USA

2012

PEOPLE’S MEDICAL PUBLISHING HOUSE—USA

SHELTON, CONNECTICUT

People’s Medical Publishing House-USA

2 Enterprise Drive, Suite 509 Shelton, CT 06484 Tel: 203-402-0646 Fax: 203-402-0854 E-mail: info@pmph-usa.com

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the publisher.

11 12 13 14/PMPH/9 8 7 6 5 4 3 2 1

ISBN-13: 978-1-60795-151-3 ISBN-10: 1-60795-151-7

Printed in China by People’s Medical Publishing House Copyeditor/Typesetter: Spearhead Global, Inc. Cover designer: Mary McKeon

Library of Congress Cataloging in Publication Data

Blepharoplasty : Thomas procedures in facial plastic surgery / [edited by] Ira D. Papel. p. ; cm. Thomas procedures in facial plastic surgery Includes bibliographical references. ISBN-13: 978-1-60795-151-3 ISBN-10: 1-60795-151-7 I. Papel, Ira D. II. Title: Thomas procedures in facial plastic surgery. [DNLM: 1. Eyelids––surgery. 2. Blepharoplasty––methods. 3. Cosmetic Techniques. 4. Esthetics. WW 205] LC classiﬁ cation not assigned

617.7'710592––dc23 2011033015

Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the beneﬁ ts anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information contained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment.

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https://t.me/medicina_free

Contributors

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Sumit Bapna, MD

Chief Resident Department of Otolaryngology - Head and Neck Surgery The Ohio State University Columbus, OH

Koﬁ Boahene, MD

Assistant Professor Facial Plastic and Reconstructive Surgery Otolaryngology Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore, MD

Eugene A. Chu, MD

Otolaryngology Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore, MD

Christopher R Cote, MD

Board Certiﬁ ed and Fellowship Trained Facial Plastic and Reconstructive Surgery Board Certiﬁ ed Otolaryngology/Head & Neck Surgery Faces First Cosmetic Surgery Denver, CO

Lisa A. Earnest, MD

Assistant Professor Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology-Head and Neck Surgery The Johns Hopkins University Baltimore, MD

Marc J. Hirschbein, MD, FACS

Associate Chairman The Krieger Eye Institute Sinai Hospital of Baltimore Director, The Center for Advanced Aesthetic Eyelid and Facial Surgery Division of Oculoplastic Surgery Baltimore, MD

James Karesh, MD

Director of Oculoplastic Surgery The Krieger Eye Institute Sinai Hospital of Baltimore Baltimore, MD

Theda C. Kontis, MD, FACS

Facial Plastic Surgeon Facial Plastic Surgicenter Assistant Professor Johns Hopkins Medical Institutions Baltimore, MD

Samuel M. Lam, MD

Director Willow Bend Wellness Center Lam Facial Plastic Surgery Center & Hair Restoration Institute Plano, TX

Guy G. Massry, MD

Director Ophthalmic Plastic and Reconstructive Surgery Spalding Drive Cosmetic Surgery and Dermatology Beverly Hills, CA

vi / Contributors

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Paul S. Nassif, MD, FACS

Clinical Assistant Professor Department of Otolaryngology – Head & Neck Surgery Division of Facial Plastic & Reconstructive Surgery University of California – Los Angeles School of Medicine Los Angles and University of Southern California, CA

Ira D. Papel, MD, FACS

Facial Plastic Surgicenter Associate Professor The Johns Hopkins University Baltimore, MD

Stephen P. Smith, Jr., MD

Medical Director Smith Facial Plastics Dublin, OH Director Division of Facial Plastic and Reconstructive Surgery Assistant Professor Department of Otolaryngology-Head and Neck Surgery The Ohio State University Columbus, OH

Ifepo O. Sofola, MD, FACS

CEO Inkerra Facial Plastics and Rhinology Houston, TX

Edwin F. Williams, III, MD

Facial Plastic and Reconstructive Surgery Williams Center for Excellence Latham, NY Facial Plastic and Reconstructive Surgery Department of Surgery Division of Otolaryngology-Head and Neck Surgery Albany Medical Center Albany, NY

Table of Contents

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Chapter 1 Surgical Anatomy of the Eyelid ......................................................1

Eugene A. Chu, MD, Theda C. Kontis, MD and Ira D. Papel, MD

Introduction ..................................................................................................................................................1

Surface Anatomy ............................................................................................................................................1

Eyelid Skin and Subcutaneous Tissue ...........................................................................................................1

Orbicularis Oculi Muscle ..............................................................................................................................3

Submuscular Areolar Tissue ..........................................................................................................................3

Tarsal Plates ....................................................................................................................................................3

Lid Margins ....................................................................................................................................................4

Septum ...........................................................................................................................................................4

Preaponeurotic Fat Pads ................................................................................................................................5

Lid Retractors ................................................................................................................................................6

Conjuctiva ......................................................................................................................................................7

Neurovascular Anatomy ................................................................................................................................7

Related Anatomy ...........................................................................................................................................8

Asian Eyelid..................................................................................................................................................11

Suggested Readings ......................................................................................................................................12

Chapter 2 Aesthetic Evaluation of the Periorbital Region ...................... 13

Koﬁ Boahene, MD

The Periorbital Region in Youth ..................................................................................................................13

General Evaluation of Patients Seeking Aesthetic Periorbital Rejuvenation ..............................................14

Assessing for Dynamic Changes around the Eye ........................................................................................14

Analysis of the Upper Eyelid........................................................................................................................15

Analysis of the Eyebrow ...............................................................................................................................16

Analysis of the Lower Eyelid ........................................................................................................................17

The Positive and Negative Vector Globe–Orbital Relationship ..................................................................18

Photo Documentation .................................................................................................................................18

Summary .....................................................................................................................................................18

Suggested Readings ......................................................................................................................................18

viii / Table of Contents

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Chapter 3 Upper Eyelid Blepharoplasty ......................................................... 19

Lisa A. Earnest, MD and Ira D. Papel, MD

Introduction ................................................................................................................................................19

Facial Analysis ..............................................................................................................................................19

Preoperative Considerations .......................................................................................................................20

Technique .....................................................................................................................................................20

Postoperative Care .......................................................................................................................................21

Complications .............................................................................................................................................21

Suggested Readings ......................................................................................................................................22

Chapter 4 Lower Eyelid Blepharoplasty ........................................................23

Theda C. Kontis, MD

Introduction ................................................................................................................................................23

Facial Analysis ..............................................................................................................................................23

Preoperative Considerations .......................................................................................................................24

Technique .....................................................................................................................................................26

Complications .............................................................................................................................................31

Suggested Readings ......................................................................................................................................34

Chapter 5 Management of Ectropion, Laxaity,

and Retraction in the Blepharoplasty Patient .............................................35

Marc J. Hirschbein, MD, FACS and James Karesh, MD

Anatomy ......................................................................................................................................................35

Classiﬁ cation ................................................................................................................................................36

Evaluation ....................................................................................................................................................38

Surgical Management ..................................................................................................................................38

Suggested Readings ......................................................................................................................................47

Chapter 6 Asian Blepharoplasty ..................................................................... 49

Samuel M. Lam, MD

Introduction ................................................................................................................................................49

Facial Analysis ..............................................................................................................................................50

Preoperative Considerations .......................................................................................................................51

Technique .....................................................................................................................................................55

Postoperative Care .......................................................................................................................................60

Complications .............................................................................................................................................62

Suggested Readings ......................................................................................................................................63

Chapter 7 Periorbital Aesthetic Procedures ................................................65

Paul S. Nassif, MD, FACS and Guy G. Massry, MD

Introduction ................................................................................................................................................65

Periorbital Fat Grafting ................................................................................................................................65

Facial Analysis & Preoperative Considerations ...........................................................................................66

Surgical Technique .......................................................................................................................................66

Postoperative Care .......................................................................................................................................68

Complications .............................................................................................................................................69

Table of Contents / ix

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Periorbital Volume Augmentation By Fillers ..............................................................................................70

Periorbital Skin Rejuvenation ......................................................................................................................70

Botulinum Toxin Type A .............................................................................................................................72

Conclusion ...................................................................................................................................................73

Suggested Readings ......................................................................................................................................74

Chapter 8 Diagnosis and Management of Ptosis

in the Blepharoplasty Patient ...........................................................................75

Marc J. Hirschbein, MD, FACS

Anatomy ......................................................................................................................................................75

Conclusion ...................................................................................................................................................87

Suggested Readings ......................................................................................................................................87

Chapter 9 Complications of Blepharoplaty ................................................. 89

Ifeolumipo O. Sofola, Christopher Cote, and Ira D. Papel

Anatomy of the Eyelids ................................................................................................................................89

History and Physical Examination ..............................................................................................................90

General Complications ................................................................................................................................92

Suture Line and Wound Healing Complications ........................................................................................97

Upper Eyelid Complications .......................................................................................................................98

Complications of the Lower Lid ................................................................................................................102

Suggested Readings ....................................................................................................................................109

Chapter 10 Aesthetics of the Brow ................................................................ 111

Stephen Smith, Jr., MD, Sumit Bapna, MD, and Edwin F. Williams, III, MD

Anatomy ....................................................................................................................................................111

Aesthetics of the Orbital Complex ............................................................................................................112

Mechanisms for Aging of the Brow ...........................................................................................................113

Patient Evaluation ......................................................................................................................................114

Conclusion .................................................................................................................................................114

Suggested Readings ....................................................................................................................................115

Index .......................................................................................................................117

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