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Subciliary Approach Blepharoplasty Workup

  • Author: Antonio Riera March, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Mar 31, 2014
 

Laboratory Studies

See the list below:

  • Laboratory testing required to perform a blepharoplasty under local anesthesia varies slightly according to the patient's age and past and present medical history.
  • The usual requested laboratory studies for a healthy person may include the following:
    • CBC count with differential
    • Prothrombin time, activated partial thromboplastin time, if suggested by past medical history
    • Platelet count
    • Serum electrolyte evaluation
    • Glucose level (optional as directed by history)
    • BUN and creatinine level (optional as directed by history)
    • Urinalysis (optional as directed by history)
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Imaging Studies

See the list below:

  • Obtain a chest radiograph if the history so indicates.
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Other Tests

See the list below:

  • Perform an ECG if the patient is older than 40 years or the history so indicates.
  • If the patient has a personal physician, advise the physician about the plan for a blepharoplasty so he or she can have input in the preparation and recommendations prior to the surgical procedure. Request further laboratory studies and/or consultations with medical specialists as needed.
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Contributor Information and Disclosures
Author

Antonio Riera March, MD, FACS Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine

Antonio Riera March, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, Society for Ear, Nose and Throat Advances in Children, American Cleft Palate-Craniofacial Association, American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Keith A LaFerriere, MD Clinical Professor, Fellowship Director, Department Otolaryngology-Head and Neck Surgery, University of Missouri-Columbia School of Medicine

Keith A LaFerriere, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Missouri State Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Jaime R Garza, MD, DDS, FACS Consulting Staff, Private Practice

Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, Texas Society of Plastic Surgeons

Disclosure: Received none from Allergan for speaking and teaching; Received none from LifeCell for consulting; Received grant/research funds from GID, Inc. for other.

Acknowledgements

Juan Trinidad Pinedo, MD, FACS Ad-Honorem Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico Medical School

Juan Trinidad Pinedo, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Puerto Rico Medical Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors wish to acknowledge Joan Flaherty, RN, for her editorial assistance and Gustavo Díaz, MD, for taking the digital surgical pictures.

References
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A: The lower eyelid has been cross-sectioned in order to appreciate the anatomy at this level. B: A magnified view of the cross-section is shown. Note the anatomic details at the level mentioned. From lateral to medial, the eyelid skin, the ciliary line, the orbicularis muscle, the gray line, the tarsal plate, the meibomian gland orifices, and the conjunctiva are visualized. C: Note the 2 fat compartments of the upper eyelid, the middle and the nasal. Note also the position of the lacrimal gland in the lateral aspect of the orbital area. Note the 3 fat compartments of the lower eyelid, the temporal, the middle, and the nasal. The largest compartment is the middle. D: Note the sphincteric structure of the orbicularis muscle and its portions, the orbital, preseptal, and pretarsal portions.
The dissection plane (red arrow) used in the subciliary approach. Access to the lower eyelid fat pads is gained through a surgically created plane just below the orbicularis muscle and above the orbital septum.
A: The lower eyelid is evaluated for the presence or absence of adequate tone. The snap test is shown. This involves pulling the lower eyelid skin away from the globe with the thumb and index fingers. B: This photograph demonstrates the lid retraction test, which involves displacing the lower eyelid inferiorly in order to evaluate lower eyelid tone. C: This is a preoperative oblique view. Note the brow position in relation to the orbital rim. Note also the excessive eyelid skin and crow's feet in this particular patient. D: Preoperative frontal view of the same patient. Note the lower position of the left brow, the redundancy and asymmetry of the upper eyelid skin, and the crow's feet in the lateral orbital areas.
A: This is the incision line of a subciliary lower eyelid blepharoplasty. B: A stab incision is made into the bony orbital rim with a No. 15 Bard-Parker blade. C: Small iris scissors are used to create a skin-muscle flap just below the orbicularis muscle. D: One blade of the scissors is passed above the eyelid and the other remains in the previously created plane. Then, the cutting follows the incision line described above.
A: A small double skin hook is used for gentle retraction of the open inferior edge of the lower eyelid. A 4-0 silk traction suture is used in the superior edge of the lower eyelid. The orbital septum is seen through the open wound. The 3 fat compartments are visualized through the intact orbital septum. B: The lateral fat pad is grasped, dissected, and clamped with a curved hemostat. Using a scalpel, the fat pad is cut just above the hemostat. C: This is the line of excision of the redundant skin-muscle flap. D: Lower eyelid closure with interrupted 6-0 nonabsorbable suture.
A: Upper eyelid blepharoplasty has been completed; the wound is still open. Injection of 1% lidocaine with 1:100,000 epinephrine is performed with a 27-gauge needle, starting at the lateral aspect of the lower eyelid. B: The needle is moved from lateral to medial, proceeding parallel to the edge of the lower eyelid. C: The upper eyelid incision has been closed while waiting for the local anesthesia in the lower eyelid to take effect. Then, a stab incision into the bony orbital rim is made with a No. 15 Bard-Parker blade. D: The planned incision has been marked and initiated with the scalpel.
A: A small double skin hook is used to elevate the tissue while small curved scissors create the skin-muscle flap just below the orbicularis muscle. B: The blades of the scissors are passed, and spreading is accomplished using blunt movements, thereby creating the proper dissection plane. C: One scissor blade is passed above the eyelid, and the other remains in the previously created plane. Then, the cutting follows the previously marked incision. D: A small double skin hook is used for gentle retraction of the open inferior edge of the lower eyelid.
A: A traction 4-0 silk suture is passed through the open superior edge of the lower eyelid. A small skin hook is used for retraction of the inferior edge of the lower eyelid. Note the open wound with a clear vision of the intact orbital septum. B: Gentle pressure with the finger applied over the superior eyelid aids in identifying the fat compartments located in the lower eyelid area. C: A strip of orbital septum is cut with small scissors and grasped with the assistance of a small forceps. D: The fat pad localized below the orbital septum is identified and grasped with a small forceps prior to dissection.
A: The fat pad is grasped and dissected. B: Cauterization of the fatty tissue is performed in this case without clamping. C: The assistance of a cotton-tip applicator is very useful in the dissecting maneuvers. D: All the fat pads are dissected in the same fashion.
A: This represents an open orbital septum in which the fat stalks have been cauterized and released into their previous positions. B: The skin-muscle flap has been tractioned superiorly for redraping and evaluation prior to possible excision. C: The wound is closed with interrupted 6-0 nylon sutures. D: Blepharoplasty is being performed in the opposite eye.
 
 
 
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