The purpose of this chapter on blepharoplasty is to familiarize the reader with relevant eyelid anatomy, appropriate preoperative evaluation, and the surgical fundamentals of upper eyelid blepharoplasty. In addition, modern modifications of blepharoplasty will be presented, with special attention to aesthetic blepharoplasty and surgical considerations in the Asian eyelid. Blepharoplasty defines a group of surgical procedures by which excess skin, orbicularis muscle, and orbital fat are removed from the upper eyelids. The ideal goal of blepharoplasty is to rejuvenate the eyelid and restore a youthful eyelid position without compromising eyelid function. A postoperative taut upper eyelid resulting in lagophthalmos and ocular surface compromise equates to an unsatisfied patient and surgeon. Likewise, excessive orbital fat excision can create a sunken superior sulcus and an eyelid contour with an undesirable cosmetic appearance. Similar to many other oculoplastic procedures, many variations in surgical technique in blepharoplasty have been employed over the years. Despite the differences, all these modifications rely upon the same underlying fundamental principles. Key steps in successful blepharoplasty surgery occur before the first skin incision is made. The eyelids are not islands unto themselves; rather, they are intimately connected to other facial structures, most notably the brow and forehead for upper lid blepharoplasty and the midface complex for lower lid blepharoplasty. Failure to preoperatively address pertinent nearby structures can yield unwanted postsurgical results. In addition to the assessment of facial structure, a preoperative blepharoplasty evaluation should include a proper medical and ocular history. Patients with a bleeding diathesis or a history of anticoagulation should be counseled and anticoagulation medications withheld if medically appropriate. A history of ocular surface issues or previous anterior segment surgery should be investigated and a slit-lamp examination performed to assess for dryness and corneal pathology. Conditions that can affect eyelid position, such as myasthenia gravis and thyroid-related orbitopathy, should be stable for a minimum of 6 months prior to blepharoplasty. Assessing brow position and function is essential when considering a patient for upper eyelid blepharoplasty. Normal brow position in males is along the superior orbital rim, and in females normal brow position is about 1 cm superior to the orbital rim.
Subconjunctival Orbital Fat Prolapse: Case Report
