Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Dermatochalasis Follow-up

  • Author: Grant D Gilliland, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 06, 2015
 

Inpatient & Outpatient Medications

Topical antibiotics and lubrication of the cornea are indicated postoperatively.

Most patients with dermatochalasis have difficulty in closing their eyes fully in the first week after surgery. For this reason, topical erythromycin ointment is used to keep the cornea moist at night.

Next

Deterrence/Prevention

Smoking and eyelid rubbing should be avoided.

Previous
Next

Complications

Lagophthalmos in dermatochalasis

Lagophthalmos can be a potentially serious complication if overjudicious resection of the skin and/or muscle is performed or if the orbital septum is incorporated into the wound closure or undergoes excessive scar contraction.

Some patients may have lagophthalmos prior to surgery. It is unlikely that resection of a small amount of preseptal orbicularis oculi causes lagophthalmos or dry eye.

Keratitis in dermatochalasis

Keratitis can be a potentially serious complication. This is most commonly due to lagophthalmos but can occur in its absence. It is imperative that patients be evaluated preoperatively for dry eye.

Dry eye is treated with topical lubricants, taping the eyelid shut at night, and punctal plugs.

Scarring is rarely a significant problem after blepharoplasty. If hypertrophic scarring develops, it is treated with topical steroid ointment, massage, and silicone gel.

Corneal topography may change after upper eyelid blepharoplasty surgery. With a skin-only excision, minimal astigmatic changes are noted.[14, 15] However, with removal of large fat pads, corneal astigmatism has been shown to change approximately 0.2 diopters.

Diplopia is very rare after blepharoplasty and occurs most commonly after lower eyelid blepharoplasty. In most cases, it is due to injury to the inferior oblique or inferior rectus muscle; rarely, the lateral rectus muscle can be injured.[16]

Ptosis in dermatochalasis

Ptosis is a rare complication of upper eyelid blepharoplasty. It is imperative that ptosis be ruled out prior to surgery.

In most cases, ptosis is due to prolonged eyelid edema with dehiscence of the levator aponeurosis or injury to the levator aponeurosis.

Eyelid retraction in dermatochalasis

Eyelid retraction is the most common complication after lower eyelid blepharoplasty. The incidence of this complication after transconjunctival blepharoplasty is approximately 0.5%, and, after subciliary blepharoplasty, it is 3-5%.

The treatment is directed initially at massaging the lower eyelid. Subcutaneous steroid injection can be considered.

If the retraction persists despite aggressive massage, canthopexy, tissue grafts (eg, skin, hard palate, Alloderm, ear cartilage), and cheek elevation may be indicated.

Conjunctival chemosis in dermatochalasis

This usually resolves spontaneously in a few weeks but may persist for months.[17, 18]

Treatment consists of topical lubrication and topical steroids.

If chemosis persists, conjunctival incision and temporary tarsorrhaphy may be considered.

For chronic chemosis, subconjunctival injection of tetracycline 2% may be useful.[19]

The incidence has been reported as high as 26% and is more common in patients undergoing concurrent upper and lower blepharoplasty.[20]

Blindness in dermatochalasis

Blindness is a rare but devastating complication of blepharoplasty surgery.[21, 22]

In most documented cases, blindness results from retrobulbar hemorrhage with resultant optic nerve and vascular compression.

Central retinal artery occlusion has also been documented as a cause of blindness after blepharoplasty.

If orbital hemorrhage occurs, emergent canthotomy and orbital decompression should be performed.

Previous
Next

Prognosis

The prognosis is excellent with blepharoplasty surgery.

Previous
 
Contributor Information and Disclosures
Author

Grant D Gilliland, MD Private Practice, Texas Ophthalmic Plastic, Reconstructive and Orbital Surgery Associates

Grant D Gilliland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Texas Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.

References
  1. Gonnering RS, Sonneland PR. Ptosis and dermatochalasis as presenting signs in a case of occult primary systemic amyloidosis (AL). Ophthalmic Surg. 1987 Jul. 18(7):495-7. [Medline].

  2. Lee H, Park M, Lee J, Lee ES, Baek S. Histopathologic findings of the orbicularis oculi in upper eyelid aging: total or minimal excision of orbicularis oculi in upper blepharoplasty. Arch Facial Plast Surg. 2012 Jul-Aug. 14(4):253-7. [Medline].

  3. Cahill KV, Bradley EA, Meyer DR, Custer PL, Holck DE, Marcet MM, et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2011 Dec. 118(12):2510-7. [Medline].

  4. McKinney P, Zukowski ML. The value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation. Plast Reconstr Surg. 1989 Oct. 84(4):572-6; discussion 577. [Medline].

  5. Espinoza GM, Israel H, Holds JB. Survey of oculoplastic surgeons regarding clinical use of tear production tests. Ophthal Plast Reconstr Surg. 2009 May-Jun. 25(3):197-200. [Medline].

  6. Finn JC, Cox S. Fillers in the periorbital complex. Facial Plast Surg Clin North Am. 2007 Feb. 15(1):123-32, viii. [Medline].

  7. Montes JR. Volumetric considerations for lower eyelid and midface rejuvenation. Curr Opin Ophthalmol. 2012 Sep. 23(5):443-9. [Medline].

  8. Hoorntje LE, Lei BV, Stollenwerck GA, Kon M. Resecting orbicularis oculi muscle in upper eyelid blepharoplasty - A review of the literature. J Plast Reconstr Aesthet Surg. 2009 Apr 10. [Medline].

  9. Nassif PS. Lower blepharoplasty: transconjunctival fat repositioning. Otolaryngol Clin North Am. 2007 Apr. 40(2):381-90. [Medline].

  10. Prado A, Andrades P, Danilla S, Castillo P, Benitez S. Nonresective shrinkage of the septum and fat compartments of the upper and lower eyelids: a comparative study with carbon dioxide laser and Colorado needle. Plast Reconstr Surg. 2006 May. 117(6):1725-35; discussion 1736-7. [Medline].

  11. Korn BS, Kikkawa DO, Cohen SR. Transcutaneous lower eyelid blepharoplasty with orbitomalar suspension: retrospective review of 212 consecutive cases. Plast Reconstr Surg. 2010 Jan. 125(1):315-23. [Medline].

  12. Tonnard PL, Verpaele AM, Zeltzer AA. Augmentation blepharoplasty: a review of 500 consecutive patients. Aesthet Surg J. 2013 Mar. 33(3):341-52. [Medline].

  13. Meier JD, Glasgold RA, Glasgold MJ. Autologous fat grafting: long-term evidence of its efficacy in midfacial rejuvenation. Arch Facial Plast Surg. 2009 Jan-Feb. 11(1):24-8. [Medline].

  14. Brown MS, Siegel IM, Lisman RD. Prospective analysis of changes in corneal topography after upper eyelid surgery. Ophthal Plast Reconstr Surg. 1999 Nov. 15(6):378-83. [Medline].

  15. Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol. 2007 Dec. 125(12):1610-2. [Medline].

  16. Ghabrial R, Lisman RD, Kane MA, Milite J, Richards R. Diplopia following transconjunctival blepharoplasty. Plast Reconstr Surg. 1998 Sep. 102(4):1219-25. [Medline].

  17. Cheng JH, Lu DW. Perilimbal needle manipulation of conjunctival chemosis after cosmetic lower eyelid blepharoplasty. Ophthal Plast Reconstr Surg. 2007 Mar-Apr. 23(2):167-9. [Medline].

  18. Weinfeld AB, Burke R, Codner MA. The Comprehensive Management of Chemosis following Cosmetic Lower Blepharoplasty. Plast Reconstr Surg. 2008 Aug. 122(2):579-86. [Medline].

  19. Moesen I, Mombaerts I. Subconjunctival injection of tetracycline 2% for chronic bulbar chemosis after transcutaneous four-eyelid blepharoplasty. Ophthal Plast Reconstr Surg. 2008 May-Jun. 24(3):219-20. [Medline].

  20. Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg. 2013 Jan. 15(1):39-46. [Medline].

  21. Callahan MA. Prevention of blindness after blepharoplasty. Ophthalmology. 1983 Sep. 90(9):1047-51. [Medline].

  22. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. Blindness following blepharoplasty: two case reports, and a discussion of management. Ophthalmic Surg. 1990 Feb. 21(2):85-9. [Medline].

  23. Korn BS, Kikkawa DO, Schanzlin DJ. Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome. Plast Reconstr Surg. 2007 Jun. 119(7):2232-9. [Medline].

  24. Griffin RY, Sarici A, Ayyildizbayraktar A, Ozkan S. Upper lid blepharoplasty in patients with LASIK. Orbit. 2006 Jun. 25(2):103-6. [Medline].

  25. Abell KM, Cowen DE, Baker RS, Porter JD. Eyelid kinematics following blepharoplasty. Ophthal Plast Reconstr Surg. 1999 Jul. 15(4):236-42. [Medline].

  26. Alfonso E, Levada AJ, Flynn JT. Inferior rectus paresis after secondary blepharoplasty. Br J Ophthalmol. 1984 Aug. 68(8):535-7. [Medline].

  27. American Academy of Ophthalmology. Functional indications for upper and lower eyelid blepharoplasty. American Academy of Ophthalmology. Ophthalmology. 1995 Apr. 102(4):693-5. [Medline].

  28. Bernardino CR. Re: improvement of dermatochalasis and periorbital rhytids with a high-energy pulsed CO laser: a retrospective study. Dermatol Surg. 2004 Dec. 30(12 Pt 1):1500; author reply 1500. [Medline].

  29. Collin JR. Blepharochalasis. A review of 30 cases. Ophthal Plast Reconstr Surg. 1991. 7(3):153-7. [Medline].

  30. Custer PL, Tenzel RR, Kowalczyk AP. Blepharochalasis syndrome. Am J Ophthalmol. 1985 Apr 15. 99(4):424-8. [Medline].

  31. Frankel AS, Kamer FM. The effect of blepharoplasty on eyebrow position. Arch Otolaryngol Head Neck Surg. 1997 Apr. 123(4):393-6. [Medline].

  32. Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg. 2004 Jun. 113(7):2124-41; discussion 2142-4. [Medline].

  33. Kamer FM, Mikaelian AJ. Preexcision blepharoplasty. Arch Otolaryngol Head Neck Surg. 1991 Sep. 117(9):995-9; discussion 1000. [Medline].

  34. Kosmin AS, Wishart PK, Birch MK. Apparent glaucomatous visual field defects caused by dermatochalasis. Eye (Lond). 1997. 11 (Pt 5):682-6. [Medline].

  35. Morax S, Touitou V. Complications of blepharoplasty. Orbit. 2006 Dec. 25(4):303-18. [Medline].

  36. Putterman AM, Urist MJ. Reconstruction of the upper eyelid crease and fold. Arch Ophthalmol. 1976 Nov. 94(11):1941-54. [Medline].

  37. Rees TD, LaTrenta GS. The role of the Schirmer's test and orbital morphology in predicting dry-eye syndrome after blepharoplasty. Plast Reconstr Surg. 1988 Oct. 82(4):619-25. [Medline].

  38. Vold SD, Carroll RP, Nelson JD. Dermatochalasis and dry eye. Am J Ophthalmol. 1993 Feb 15. 115(2):216-20. [Medline].

  39. Zimbler MS, Prendiville S, Thomas JR. The "pinch and slide" blepharoplasty: safe and predictable aesthetic results. Arch Facial Plast Surg. 2004 Sep-Oct. 6(5):348-50. [Medline].

 
Previous
Next
 
Preoperative image prior to upper blepharoplasty.
Postoperative image after upper blepharoplasty.
Preoperative image of a patient with thyroid eye disease, dermatochalasis, eyelid retraction, and steatoblepharon.
Postoperative image after 4-lid blepharoplasty and canthopexy.
Pinch technique for measuring redundant skin in upper eyelid blepharoplasty.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.