While numerous complications can occur with cosmetic blepharoplasty — particularly, lower lid blepharoplasty — aesthetic surgeons can often avoid these by taking simple precautions, according to William P. Mack, M.D., an oculoplastic surgeon at the Mack Center for Facial and Eyelid Cosmetic Surgery, in Tampa, Fla.
An effective cosmetic blepharoplasty achieves a refreshed, natural result, with minimal bruising, swelling and downtime, says Dr. Mack, who presented on how to achieve an effective cosmetic blepharoplasty during the 2017 Vegas Cosmetic Surgery and Aesthetic Dermatology meeting, in Las Vegas.
It’s imperative that aesthetic surgeons focus on thorough history taking and physical exams to avoid potential blepharoplasty-associated complications, he says.
Dr. Mack’s top three tips for an effective cosmetic blepharoplasty are:
Avoid orbital hemorrhage risks.
Orbital hemorrhage can lead to blindness. To avoid the complication, surgeons should have a thorough discussion with patients about medications that can cause bleeding, with a focus on over-the-counter medications, such as Vitamin E and fish oil. Most patients, he says, don’t realize these are blood thinners. To decrease post-operative bruising, Dr. Mack recommends judicious use of ice packs, as well as arnica, bromelain and Ocumend arnica gel pads (Cearna).
Find out if patients have had periorbital treatment with neuromodulators or fillers.
Ask patients about prior treatments with periorbital neuromodulators or fillers, and if they will continue to have those treatments in the future. The information is vital, as neuromodulator treatment, particularly in the forehead region, may affect the brow and eyelid position and contour. Surgeons must take what they learn into account for optimal surgical planning.
“Fillers in the periorbital region, especially in the lateral brow region, can also have an effect on brow/eyelid position and contour and this must be addressed preoperatively with appropriate surgical planning,” he says.
Know your upper eyelid and brow anatomy.
“Although ptosis can be caused by dehiscence of the levator aponeurosis during cosmetic upper eyelid blepharoplasty, I believe the most common cause of postoperative ptosis is when the diagnosis is missed, preoperatively,” Dr. Mack says. “Patients with dermatochalasis and-or ptosis will subconsciously contract their frontalis muscle to secondarily raise their eyelids. It is important during the preoperative assessment to manually relax the brow to accurately document the actual brow and lid positions for optimal surgical results.”
Underlying brow ptosis or lid ptosis should be corrected at the same time as the blepharoplasty, he says.
Disclosure: Dr. Mack is on the medical advisory board for Cearna.