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Consider patient’s expectations when planning blepharoplasty
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WAILEA, Hawaii – Preoperative evaluation is critical to achieve a balanced blepharoplasty, according to a speaker here.
Surgery has to reflect the patient’s ideals of beauty, Femida Kherani, MD, said in a presentation at the Hawaiian Eye.
Femida Kherani
“In all ethnicities, we think of beauty as high cheekbones, small nose, large smile and big eyes,” she said.
The eyelid skin is the thinnest in the body, and the lid crease has ethnic variations. In Asian eyes, there is a lack of levator interdigitation to the pretarsal orbicularis and more fat in the eyelid than in Caucasian eyes.
“The most important thing in my consultation is the time that we spend with the patient to evaluate what they want and what they expect from their surgery,” she said.
Kherani said that she assesses for brow position, blepharoptosis and symmetry, then asks what the patient expects with regard to creases, fullness, amount of tarsal plate exposed and hollowness.
“Sometimes patients may want you to remove fat, but they may not look better by having fat removed,” she said.
Before surgery, Kherani evaluates for history of corneal surgery, skin cancer, keloids, lagophthalmos and dry eye.
“If they have insufficient tear production, they may be aggravated later,” she said.
Complications include bruising, wound dehiscence, skin abnormality, overcorrection and asymmetry. But the “most feared complication” is orbital hemorrhage, she said, which occurs only in 1 in 2,000 to 1 in 25,000 cases, depending on the risk and premorbid condition of the patient. —
Disclosure: Kherani reports being on the speakers bureau of Allergan and Alcon.