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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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Fig. 5.10
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.11
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䊏
With the mosquito hook still left in place, the edges of the incision are
carefully coagulated. This is to prevent the fat pad from whipping back
and possibly causing bleeding of the eyeball.
䊏
The same procedure is followed to remove the intermediate fat body, if
there is one.
While resecting fat in this manner, the eyeball is the limiting factor. It is
very hard to continue removing tissue as one gets closer to the eyeball.
Care should be taken to split the orbital septum only pointwise. In the
lateral part of the lid, in particular, it is important to leave the septum
intact to prevent injury to the lacrimal gland.
(Fig. 5.12)
Removal of a Strip of Connective Tissue and Muscle (Fig. 5.13)
䊏
In the lateral region of the upper eyelid, in particular, it is generally a
goodproceduretoremoveastripofconnectivetissueandmuscleto
achieve the desired tightening effect. The new palpebral fold can later
be reshaped and correctly positioned.
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Fig. 5.12
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.13
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Repeat ed trimming of wound edges and bipolar coagulation. (Fig. 5.14)
Cutaneous Sutures (Fig. 5.15)
䊏
The wound is closed, without tension, with cutaneous sutures. A fine
needle and 6/0 or 7/0 Ethilon suture material are used. Wound closure
starts at the lateral orbital margin with simple interrupted sutures.
These are followed by continuous subcuticular sutures. The wound
edgesshouldbeslightlyeverted;careshouldbetakennottosutureany
subcutaneous tissue.
䊏
The assisting surgeon holds the suture material for the continuous
sutures under mild tension. The medial end of the thread is left relatively long; no knot is made.
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Fig. 5.14
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Fig. 5.15
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䊏
The surgeon now checks whether the eyelid slit is about 2–3 mm open
and the sutures lie exactly in the palpebral fold.
䊏
After the same procedure has been carried out on the contralateral eye,
the symmetry of both eyelids should be rechecked.
(Fig. 5.16)
䊏
At the end of the operation, the wound is fixed with Steri-Strip tape,
which is left in place for 24 h. (Fig. 5.17)
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Fig. 5.16
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.17
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Postoperative Treatment and Precautions
The patient can already leave the hospital 2–4 h after the operation.
Strenuous activities should be avoided postoperatively. The proper
position for sleeping during the postoperative period is on the back,
with the upper body elevated. To protect the surgical wound and the
conjunctivae, the patient should wear sunglasses for the first several
days after the operation.
The antibiotic treatment which was instituted intraoperatively should
be contin ued for 5 days postoperatively. During the first 24 h, the
wound should be intensively and intermittentl y cooled. The sutures can
generally be removed by the patient’s own ophthalmologist 4 days after
the operation.
Patients with a tendency to form scar tissue should massage a scar-preventing ointment into the skin of the upper eyelid, starting on the 14th
day postoperatively.
If a tendency toward swelling or bruising is noted, medication should
be administered to reduce swelling.
Any small scars which remain can be “polished away” with a laser after
½–1 year.
Two weeks after the operation, the patients can resume normal physical
activities, including sports.
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Results
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a1
5 Eyelid Surgery – Blepharoplasty
a2
b1
Fig. 5.18
a1, b1, c1 Before: Eye-
lid ptosis with muscle
weakness
a2, b2,c2 After: The
same patients 12 months
after blepharoplasty
b2
c1
c2
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Lower Eyelid Surgery – Blepharoplasty
Introduction
Lower lid blepharoplasty is one of the most difficult operations in the
facial area.
Topreventeyelideversion,greatcaremustbeexercisedherenottocut
away too much tissue or overly tighten the skin. If the surgeon resects
too little skin, however, the patient will be dissatisfied. The two most
important points to follow during lower eyelid blepharoplasty are the
formation of a strong musculocutaneous flap and carefully dosed resectioningoffattytissue–removingtoolittletissueresultsinanunhappy
patient, while removing too much results in the phenomenon of “holloweyesockets.”Theextentoffattytissueremovedmustbeexplained
in detail to the patient before the operation. We use canthal sutures
only in patients with severely drooping eyelids.
If blepharoplasty is performed without an external incision, an ultrapulsed CO
can be used in patients with only a small amount of excess cutaneous
tissue. During this procedure, excess fat is removed via the conjunctiva
and the lower eyelid is resurfaced. We believe that this is the only indication for using a laser during blepharoplasty; it does not offer any
advantages on the upper eyelid.
laser or an erbium:yttrium–aluminum–garnet (YAG) laser
2
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In the following, we have presented a standardized blepharoplasty procedure step by step. Surgeons who have recently started performing
eyelid surgery will find this approach especially useful.
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