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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. 5.33
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.34
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Skin Resection
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䊏
The holding suture is now removed and the excess skin in the lower
eyelid is pressed out cranially and smoothed with a small moist compress.
䊏
If local anesthesia has been used, the patient should be asked to open
and close his or her mouth several times. This is to ensure that only
skin which can be smoothed over the eyeball without any tension is in
fact resected. Tension of any kind is to be avoided.
5 Eyelid Surgery – Blepharoplasty
䊏
The surgeon grasps the skin on the lateral corner of the eyelid with the
small surgical tweezers. Exerting mild tension, he or she then resects
theexcessskinparalleltothelowereyelid.
(Fig. 5.35)
䊏
Only after this procedure has been performed is skin resection carried
out in the lateral ocular angle in a crow‘s foot pattern. (Fig. 5.36)
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Fig. 5.35
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.36
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5 Eyelid Surgery – Blepharoplasty
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In general, canthal sutures are not necessary. These are made only in
caseswiththickskinandpronouncedeyeliddrooping.Forthiskindof
suture, a small part of the muscle is attached to the periosteum of the
lateral bony orbital margin with a 5/0 PDS suture to relieve the tension
on the overlying skin. (Fig. 5.37)
Sutures and Dressing
䊏
Before cutaneous sutures are made, a small amount of fibrin adhesive is
distributed in the wound to prevent swelling and bruising.
䊏
The skin flap is then modeled over the edges of the incision without
any tension.
(Fig. 5.38)
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Fig. 5.37
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.38
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5 Eyelid Surgery – Blepharoplasty
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Suturing of the skin commences on the lateral edge. Two or three simple interrupted sutures are made between here and the lateral ocular
angle. A small needle and 6/0 Ethilon suture material are used to
prevent any bleeding caused by the stab incisions. (Fig. 5.39)
䊏
Subsequently, the wound is closed by continuo us 7/0 subcuticular
sutures. The assisting surgeon holds the suture material for the continuous sutures under constant mild tension.
䊏
The last suture in the medial ocular angle should be placed in a cranial
to a caudal manner to prevent irritation of the conjunctivae during the
recovery phase. The end of the thread is left relatively long; it is not
knotted.
Intracutaneous sutures are a possible alternative here. However, they do
not offer any aesthetic advantages, and we prefer the illustrated
method.
(Fig. 5.40)
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Fig. 5.39
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.40
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5 Eyelid Surgery – Blepharoplasty
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The wound is subsequently bandaged with two pieces of Steri-Strip
tape. These are left in place for 24 h. The wound is cooled intermittently
for 1 day . (Fig. 5.41)
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Fig. 5.41
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5 Eyelid Surgery – Blepharoplasty
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5 Eyelid Surgery – Blepharoplasty
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Postoperative Treatment and Precautions
As a rule, the patient remains in the hospital overnight following the
operation.
The lower eyelid region is cooled intensively. If the operation was
performed under local anesthesia, however, the patient can leave the
hospital 4 h after the procedure.
The antibiotic treatment instituted intraoperatively should be con tinued for 5 days postoperatively. The Steri-Strip tape and the sutures are
removedonday1andday4postoperatively,respectively.
The patient should wear sunglasses for at least 8 days after the operation to prevent irritation of the wound or conjunctivae by sunlight.
Lower eyelid surgery is followed by a longer recovery period than
upper eyelid surgery . Mild swelling and bruising can persist for up to
2 weeks. Lymph drainage can cause the swelling to subside more
quickly. After the sutures have been removed, bruises can be covered
with camouflage makeup.
Any small scars which remain can be “polished away” with a laser after
½–1year.Thisisnecessaryonlyinextremelyrarecases,however.
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