Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Bill Ramsdell - V5 10.26.16

No description

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Bill Ramsdell - V5 10.26.16

History
Medications, Hypertension, Grave’s disease, Dry eyes, Vision, Myasthenia Gravis, Personality Characteristics
Lateral canthi
Upper Eyelid Margin
Lower Eyelid Margin
8-10 mm superior
to eyelid margin

6-8 mm superior
to eyelid margin
Asian
– highly variable, may be absent
1.5 – 2 mm
below the superior margin of the limbus
Lid should just touch or
closely approximate the
inferior aspect of the limbus.
BLEPHAROPLASTY
COMPLICATIONS

LOWER BLEPHAROPLASTY
PROCEDURE

Monitor blood pressure
UPPER BLEPHAROPLASTY
PROCEDURE

BLEPHAROPLASTY
AND BROWLIFTS

William M. Ramsdell, MD
Austin, Texas

Consider ondansetron 4mg or 8 mg for nausea
Consider clonidine 0.1 mg PO – can repeat q 30 minutes prn
for Scleral Show or Ectropion
Trim excess skin, then close Advantage
Incise orbital septum to expose fat
Develop skin muscle flap through skin and orbicularis muscle
Fat Resection vs Fat Repositioning
Infraciliary
Approach
just below orbital rim, straighter
superior to orbital rim, arched with highest point above lateral limbus
Brows

WHAT IS
NORMAL?
2 mm superior
to medial canthus
4 mm superior
to medial canthus
Upper Eyelids
Upper Eyelid Crease
Based upon Maxillary Anatomy
1
2
3
1-2 mm inferior to lashes
excise conservatively
excellent exposure to mobilize orbicularis muscle =/- SOOF
for canthoplasty or midface lift Disadvantage – scar, rounding of canthal angle
Adjunctive Procedures
3
BLEPHAROPLASTY
REPAIR & REJUVENATION

-------------------------------------
---------------------------------------
----------------------------------------
Establish upper eyelid crease = inferior incision
Establish upper
incision line
minimum 1 cm between brow and incision line
(never excise > 1/3 of upper eyelid skin)
Skin only vs skin and muscle flap excision
scalpel, CO2 laser, electrosurgical, Ellman unit
+/- supratarsal fixation
Fat pad sculpting
Incise septum medially and superiorly
Not in men!
Skin to skin (only) closure
video placeholder
Avoid the inferior oblique muscle
Identify 3 (usually) fat pads
place incision midway between lid margin and inferior fornix = 3-5 mm inferior to tarsal plate
“Open Sky” excision through conjunctivae and capsulopalpebral fascia
2
Expose palpebral conjunctivae
1
Transconjunctival Approach
Corneal Abrasion
treat with lubrication, patching, proparacaine, contact Ienses
Eyelid crease malposition
Lagophthalmos
secondary to over-resection of skin or vertically shortened orbital septum due to inadvertent inclusion of the septum into the skin closure
Strabismus/Diplopia
DRY EYES
Chemosis
Ptosis
secondary to edema, damage to levator aponeurosis or supratarsal fixation placed too high (limits excursion of levator muscle)
Scleral show/
Ectropion
Retrobulbar hematoma
Bleeding usually from orbicularis muscle or vessels within fat pads. Causes optic nerve compression , 90 minutes until irreparable damage occurs.
B. Lyse lateral canthal tendon
C. Stop bleeding
D. Control blood pressure - clonidine
A. Remove all sutures
Negative Vector
hypoplastic maxilla, globe projects beyond inferior orbital rim. Consider fat repositioning or fillers.
Fat Pad Resection
Central pad
– easiest to locate, excise first
Medial pad
– gentle traction, meticulous hemostasis
Lateral pad
- can be difficult to locate

Fat Repositioning
Dissect central and medial fat pads from “pseudocapsules”, fibrous septae and inferior oblique muscle
Develop fat pedicles.
Lyse arcus marginalis with cutting current.
Develop subperiosteal vs supraperiosteal pocket.
Percutaneous suture to hold fat in place.
Reposition fat pedicles over tear trough.
Canthopexy
– Suture fixation of lateral canthus to orbital periosteum
Canthoplasty
– Excision of excess (horizontal) eyelid followed by suture fixation to orbital periosteum.

video placeholder
Orbital Fat
Preseptal Fat
Orbital Fat
Malar Fat Pad
Suborbicularis Oculi Fat
Orbital Septum
Levator
Aponeurosis
Capsulopalpebral Fasica
Orbital Septum
Orbicularis Oculi Muscle
AGE-RELATED
ANATOMICAL CHANGES
Boney Changes
Lower orbital rim
and maxilla recede
Consequences
scleral show
ectropion
Soft Tissue Changes
Brow
Upper Eyelid
Lower Eyelid
retaining ligaments lengthen

Consequences
- inferior descent of the retroorbicularis oculi fact (ROOF) with brow ptosis

levator muscle attenuation with levator aponeurosis dehiscence

Consequences
- upper eyelid ptosis
high eyelid crease


tarsal plates and canthal tendons become lax
Consequences
- scleral show
ectropion
orbital septum attenuation
Consequences
- fat pads prolapse
orbicularis retaining ligaments lengthen
Consequences
- fat pads prolapse
determines shape and extent of fat pad
contributes to tear trough formation
vertically lengthened lower eyelid
prolapse(steatoblepharon)
Mullers Muscle
Superior Tarsus
Inferior Tarsus
Conjunctiva
Thanks for your attention!
Full transcript