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Preop steps crucial for successful lower eyelid blepharoplasty
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WAIKOLOA, Hawaii — Ophthalmologists are key in the current aesthetic revolution as blepharoplasty is the most popular aesthetic procedure, as reported by the International Society of Aesthetic Plastic Surgery, according to Femida Kherani, MD, FRCSC, at Hawaiian Eye 2019.
“The most important thing is your preoperative consultation. A thorough preop evaluation is essential to identify what patients want,” Kherani said. “What is their ideal eyelid? Identify their expectations and discuss the limitations of blepharoplasty.”
Prior to the procedure, she suggests reviewing the anatomy with the patient and being realistic about the expectations.
“Festoons are really hard to treat, I think it’s important to tell patients that we can improve them, but not remove them,” Kherani said.
Using lasers, surgeons may improve skin texture and tone of festoons, she added. Additionally, direct surgical incision can help.
“I always do a full eye exam with visual acuity, check motility and do a lid distraction test,” she said.
Lid laxity should also be assessed. “You have to know how much lid laxity there is, so you can re-approximate it intraoperatively,” she said.
Any suspicious lesions like basal cell carcinoma, should be ruled out.
Inquiring about a full patient history is also important.
She waits 6 months after a patient’s corneal surgery before blepharoplasty.
She enquires about history of skin cancer and keloids.
Further, she checks for dry eye with a Schirmer test, a dry eye assessment score and a slit lamp.
The treatment of ocular surface disease should be discussed right away, she added.
“Changing the eye lid position will change the corneal surface,” Kherani said.
“It’s relevant to address the cheek when doing the lower lid,” she added.
She uses filler to optimize the position of the cheek area prior to considering lower eyelid surgery.
Furthermore she suggests ruling out body dysmorphic disorder, which is common.
In a cosmetic practice up to 1 in 5 patients have the disorder.
Some warning signs may be unrealistic surgical expectations, and/or a multitude of previous cosmetic procedures, she said.
“Beware of patients who come in with drawings of how you should repair their lower eyelid,” she said. – by Abigail Sutton
Reference: Kherani F. How to deal with excess baggage: Lower eyelid blepharoplasty. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.
Disclosures: Kherani reports receiving a consulting fee from Malinckrodt and is on the speaker bureau for Allergan and Shire.