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Bill Ramsdell V1

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Transcript of Bill Ramsdell V1

UPPER BLEPHAROPLASTY
PROCEDURE

LOWER BLEPHAROPLASTY
PROCEDURE

BLEPHAROPLASTY
COMPLICATIONS
BLEPHAROPLASTY
REPAIR & REJUVENATION
BLEPHAROPLASTY
REPAIR & REJUVENATION

UPPER BLEPHAROPLASTY
PROCEDURE

LOWER BLEPHAROPLASTY
PROCEDURE

BLEPHAROPLASTY
COMPLICATIONS

History
Medications, Hypertension, Grave’s disease, Dry eyes, Vision, Myasthenia Gravis, Personality Characteristics
WHAT IS
NORMAL?
Brows

superior to orbital rim, arched with highest point above lateral limbus
just below orbital rim, straighter
Lateral canthi
4 mm superior
to medial canthus
2 mm superior
to medial canthus
Upper Eyelids
Upper Eyelid Crease
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.
1. Monitor blood pressure
2.Consider clonidine 0.1 mg PO – can repeat q 30 minutes prn
3. Consider ondansetron 4mg or 8 mg for nausea
4. Establish upper eyelid crease = inferior incision
5. Establish upper incision line – minimum 1 cm between brow and incision line (never excise > 1/3 of upper eyelid skin)
6. Skin only vs skin and muscle flap excision –scalpel, CO2 laser, electrosurgical, Ellman unit
7. +/- supratarsal fixation
8. Fat pad sculpting – Not in men! Incise septum medially and superiorly
9. Skin to skin (only) closure.
vs
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Infraciliary
Approach

Develop skin muscle flap through skin and orbicularis muscle, 1-2 mm inferior to lashes
Incise orbital septum to expose fat, excise conservatively
Trim excess skin, then close Advantage – excellent exposure to mobilize orbicularis muscle =/- SOOF
for canthoplasty or midface lift Disadvantage – scar, rounding of canthal angle

Transconjunctival Approach
Expose palpebral conjunctivae
“Open Sky”
excision through conjunctivae and capsulopalpebral fascia – place incision midway between lid margin and inferior fornix = 3-5 mm inferior to tarsal plate
Identify 3
(usually) fat pads
Avoid
the inferior
oblique muscle

Fat Resec vs Fat Repositioning
Based upon Maxillary Anatomy
Negative Vector
Fat Pad Resection
Fat Repositioning
Neutral Vector- globe and orbital rim coincide. Either resection or repositioning.
Positive Vector- inferior orbital rim projects beyond the globe . Fat pad excision, not repositioning.

Central pad
– easiest to locate, excise first

Medial pad –
gentle traction, meticulous hemostasis

Lateral pa
d- can be difficult to locate
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.

Reposition fat pedicles over tear trough.

Percutaneous suture to hold fat in place.
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AFTER
BEFORE
Adjunctive Procedures
for Scleral Show or Ectropion.
Cantho
pexy
– Suture fixation of lateral canthus to orbital periosteum.

Cantho
plasty
– Excision of excess (horizontal) eyelid followed by suture fixation to orbital periosteum.
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