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Blepharoplasty
Techniques
Yael Halaas M.D.
Anatomy
• Lateral canthus
inclined 10-15 degrees
cephalad compared
to medial canthus
• Upper lid: midway
between the upper...
The Beautiful Eye
• Brow- centrally on
rim, laterally above
rim
• Upper lid crease
<10mm above lid
margin
• Fuller sulcus ...
Fat pockets
The Signs of Aging
• Dermatochalasis- thin
loose skin secondary to
aging
• Blepharochalasishypertrophy & excess
draping of...
•
•
•
•
•
•

Lid Evaluation

Fat pads- identify where pseudoherniation exists
Lacrimal gland
Eyelid crease (7-9mm)
Epicant...
What’s the difference?
Ophthalmic exam

• Condition of corneal, sclera and conjunctiva
o Lack of injection, edema

• Basic visual acuity- Snellen...
Contradictions
• Thyroid disease- exopthalmos
• Dry Eye Syndrome- burning, tearing, use of artificial
tears, waking at nig...
The Asian Eyelid
• Small or absent
supratarsal crease
• Adipose fullness
• Epicanthal fold
• Narrow palpebral
fissure
Creation of the Double
Eyelid
• Suture
• Partial Incision
• Full Incision
Special techniques
• Transconjunctiva
l upper bleph
approach
o Only for medial
fat
o No levator
aponeurosis
between
conjun...
Complications of Upper
Blepharoplasty
•
•
•
•

Hematoma
Subconjunctival Ecchymosis
Chemosis
Lagophtalmos – incomplete eye ...
Before & After
Preoperative Evaluationlower lid
•

Same as upper
blepharoplasty evaluation
o Dermatochalasis, etc.
o Double convexity

•
...
• Lid distraction (snap) test- movement of lid >
10mm is abnormal
• Lid retraction test- puncta movement > 3mm
from medial...
Before and After
Lower Lid Blepharoplasty
Techniques

• Transconjunctival
• Subciliary
o Skin flap
o Skin Muscle flap

• With muscle suspen...
Lower Lid Blepharoplasty Incisions
Technique
Skin-muscle flap
& Muscle suspension stitch
Complications of Lower Lid
Blepharoplasty

• Ectropion

o Subciliary- 20% lower lid retraction

•
•
•
•
•
•
•
•

Hematoma
...
Which technique?
•
•
•
•
•

Complimentary lower lid
procedures

SOOF lift
Composite Rhytidectomy
Endoscopic midface lift
Tear trough implan...
SOOF
• Fat pad between orbicularis oculi & periosteum
• Release arcus marginalis, lift fat, fixate SOOF to
periosteum at i...
Silicone
Fat transfer
For More Information
• Visit http://www.drhalaas.com/
Blepharoplasty techniques
Blepharoplasty techniques
Blepharoplasty techniques
Blepharoplasty techniques
Blepharoplasty techniques
Blepharoplasty techniques
Blepharoplasty techniques
Blepharoplasty techniques
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Blepharoplasty techniques

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Published on

http://www.drhalaas.com/
Learn about Blepharoplasty techniques (from Asain Eyelid Surgery to Fat Transfer) from Dr. Yael Halaas.

Blepharoplasty techniques

  1. 1. Blepharoplasty Techniques Yael Halaas M.D.
  2. 2. Anatomy • Lateral canthus inclined 10-15 degrees cephalad compared to medial canthus • Upper lid: midway between the upper pupil and limbus. Apex medial to pupil • Lower lid: 1-2mm over the corneoscleral junction. Central lowest portion
  3. 3. The Beautiful Eye • Brow- centrally on rim, laterally above rim • Upper lid crease <10mm above lid margin • Fuller sulcus below the orbital rim • Lateral lid free of hooding
  4. 4. Fat pockets
  5. 5. The Signs of Aging • Dermatochalasis- thin loose skin secondary to aging • Blepharochalasishypertrophy & excess draping of skin secondary to recurrent edema o not age-related, found in young women o rare • Pseudoherniation of fat (Steatoblepharon)
  6. 6. • • • • • • Lid Evaluation Fat pads- identify where pseudoherniation exists Lacrimal gland Eyelid crease (7-9mm) Epicanthal folds (Asian lid) Orbicularis oculi Lid ptosis- palpebral fissure symmetry o Levator function: >12mm difference in lid aperture between extreme up and down gaze • Skin lesions- xanthomas, pigmentation, blepharitis • PHOTODOCUMENTATION • Discuss findings with the patient
  7. 7. What’s the difference?
  8. 8. Ophthalmic exam • Condition of corneal, sclera and conjunctiva o Lack of injection, edema • Basic visual acuity- Snellen card • Baseline tear production- Schirmer test o At 5 min, low (0-9mm), mod (10-20mm), high (21-30mm) • Tests greater superficial petrosal nerve function • Tear film breakup time o Usually >20 seconds
  9. 9. Contradictions • Thyroid disease- exopthalmos • Dry Eye Syndrome- burning, tearing, use of artificial tears, waking at night with stinging eye pain • Sensitivity to lidocaine with epinephrine • Anti-coagulation o Nutritional supplements- gingko biloba, garlic, vitamin E, fish oil
  10. 10. The Asian Eyelid • Small or absent supratarsal crease • Adipose fullness • Epicanthal fold • Narrow palpebral fissure
  11. 11. Creation of the Double Eyelid • Suture • Partial Incision • Full Incision
  12. 12. Special techniques • Transconjunctiva l upper bleph approach o Only for medial fat o No levator aponeurosis between conjunctiva & subseptal fat • Internal brow elevation
  13. 13. Complications of Upper Blepharoplasty • • • • Hematoma Subconjunctival Ecchymosis Chemosis Lagophtalmos – incomplete eye closure o Dry Eye Syndrome • Poor Scars o Milia • Loss of Vision
  14. 14. Before & After
  15. 15. Preoperative Evaluationlower lid • Same as upper blepharoplasty evaluation o Dermatochalasis, etc. o Double convexity • • • • • Lid position- extremely important Ectropion/entropion Lid laxity Tear trough deformity Festoons o Draping folds of orbicularis +/- fat • Malar Bags o Soft-tissue fullness
  16. 16. • Lid distraction (snap) test- movement of lid > 10mm is abnormal • Lid retraction test- puncta movement > 3mm from medial canthus is abnormal o Slow return or requiring multiple blinks = poor lid tone
  17. 17. Before and After
  18. 18. Lower Lid Blepharoplasty Techniques • Transconjunctival • Subciliary o Skin flap o Skin Muscle flap • With muscle suspension stitch • "Canthoplasty" refers to a procedure designed to reinforce lower eyelid support by detaching the lateral canthal tendon from the orbital bone and constructing a replacement. • "Canthopexy," on the other hand, refers to a less invasive procedure designed to stabilize the existing tendon (as well as surrounding structures) without removing it from its normal attachment. • Orbital Fat Repositioning (Repair) • Orbital Fat Mobilization • Ancillary procedures
  19. 19. Lower Lid Blepharoplasty Incisions
  20. 20. Technique
  21. 21. Skin-muscle flap & Muscle suspension stitch
  22. 22. Complications of Lower Lid Blepharoplasty • Ectropion o Subciliary- 20% lower lid retraction • • • • • • • • Hematoma Blindness Epiphora Suture Line Complications Wound Healing Complications Skin Discoloration Ocular Injury Contour Irregularities
  23. 23. Which technique?
  24. 24. • • • • • Complimentary lower lid procedures SOOF lift Composite Rhytidectomy Endoscopic midface lift Tear trough implant Restylane and other fillers o Excellent for malar festoons & bags • Fat transfer • Skin resurfacing
  25. 25. SOOF • Fat pad between orbicularis oculi & periosteum • Release arcus marginalis, lift fat, fixate SOOF to periosteum at inferior orbital rim • Contour irregularities, vertical lid retraction
  26. 26. Silicone
  27. 27. Fat transfer
  28. 28. For More Information • Visit http://www.drhalaas.com/

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