Condition: Post-blepharoplasty syndrome 2017-09-28T10:07:50+00:00

Post-blepharoplasty syndrome Overview

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The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

  • Lubricant eye drops

  • Gels

  • Silicone or gel plugs

  • Flaps

  • Graft

  • Mid-face lift

Learn more about treatment options

Post-blepharoplasty syndrome

What is a Post-blepharoplasty syndrome?

Post-blepharoplasty syndrome is a possible complication of a lower eyelid blepharoplasty. Not only does it affect appearance, it can also interfere with eyelid fucntion, such as closing the eye. The main cause is removal of too much skin from the lower lid together with excessive inflammation and scarring within the eyelid. Removal of the delicate orbicularis oculi muscle or damage to its nerve supply during the blepharoplasty can also affect eyelid closure.

Symptoms

If the lower lid is affected, the main problem is an inability to close the eye (lagophthalmos), as the lower lid is too short to cover the eye. There may be lower lid ectropion and sag with rounding of the outer corner (lateral canthus) of the eyelids. If the eye and cornea are not properly covered by the lid, it will cause irritation and corneal problems (the eyes will be dry, red, gritty and painful). The dry eye symptoms can be severe, causing keratitis.

Post-blepharoplasty syndrome can give a round eye appearance which is cosmetically very distressing for the patient as well impairing eyelid movement. If the orbicularis muscle (see diagram below) that closes the eyelid has been excised during a blepharoplasty, as well as the skin, this exacerbates post-blepharoplasty syndrome. In severe cases of ectropion, the conjunctiva will be visible with redness and inflammation, with an apparent fluid-filled blister (chemosis).

Treatment

As post-blepharoplasty syndrome can resolve itself over time, surgical treatment is only advised after 3 months. To prevent corneal damage during this time, lubricant eye drops and gels (see below) must be used. It is also paramount to have regular check ups with your oculoplastic surgeon to ensure there are no complications.

In all cases, the oculoplastic surgeon will carefully assess the cause of the post-blepharoplasty syndrome (there are many) in order to best tailor the treatment to the patient.

Non-surgical treatment

Lubricant eye drops and gels are the most common non-surgical treatment for post-blepharoplasty syndrome in the early stages.

Mild post-blepharoplasty syndrome can be treated with over-the-counter artificial tear solutions. There is a wide range of artificial tears available and it is a good idea to try several different ones to see what suits best.

Eye drops can be put in as often as every 15-30 minutes if necessary if they do not contain preservatives, but may only be needed as little as twice a day in a mild dry eye, depending on patient symptoms. Eye ointment can be used but this will blur the vision for a few minutes.

Silicone Plugs and Gel Plugs

The tear ducts can be blocked with tiny silicone or gel plugs to reduce tear drainage. Normally, the tears drain via the upper and lower punctum  at the corner of the eyelid nearest the nose, into the drainage ducts and into the back of the nose. By inserting plugs it increases the amount of time both natural and artificial tear solutions remain on the eye, keeping it lubricated and comfortable for longer.

Surgical Treatment

If the lack of skin in the lower lid is causing serious problems, the only way to correct it is by adding more skin. There are two ways to do so:

  • Flaps: A piece of tissue (skin and/or surrounding muscle) is taken from the forehead, eyelid or cheek to cover the area where more skin is needed.
  • Grafts: A piece of skin is taken from a different area of your body and sutured to add surface area. The best skin to use as a graft is skin from the other eyelid or around the ear, the inner aspect of the upper arm or the supraclavicular (collarbone) area.

A graft is a more common method of treatment than a flap in upper lid post-blepharoplasty syndrome.

If scarring within the eyelid is causing serious problems the only way to correct it is by dividing the scar and inserting a mucous membrane graft such as mucous from the oral palette or the nose, or, by putting in a graft of human donor collagen.

If removal of fat has contributed to the problem, hyaluronic acid gel filler (eg. RestylaneR or PerlaneR) can be injected into the lower lid/upper cheek junction to reinflate the area and push the eyelid up vertically.

If there is eyelid laxity, this can be rectified by tightening the lid with, for example, a canthopexycanthoplasty or lateral tarsal strip.

Rarely a mid-face lift is required to raise the cheek and hence the eyelid.

Video: Post-blepharoplasty syndrome explained

Examination for Post-blepharoplasty syndrome

A full ophthalmic examination is carried out. The oculoplastic surgeon will first check visual function and determine if there are any related conditions such as dry eye and keratitis. Particular attention is paid to the cornea as it can be seriously affected.

The extent of incomplete eyelid closure (lagophthalmos), the ability of the orbicularis muscle to close the eyelid, the amount of eyelid laxity, the tightness of the skin and the middle layers of the eyelid are all assessed.

Photographs are taken to document the face and eyelids and then treatment options are discussed.

In some patients post blepharoplasty syndrome with resolve itself within 2-3 weeks and drops and creams can be used for comfort. If it persists for several months post-surgery, surgical intervention is required.

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Frequently Asked Questions

If the operation is just on the eyelids (eyelid tightening, grafting, flaps, etc) a local anaesthetic with sedation could be a good option. If the operation is bigger (mid-face lift) or the patient prefers, a general anaesthetic can be done.

Your surgeon will insert the plugs with local anaesthetic, in the form of eyedrops. No pain will be felt by the patient, only mild discomfort.

You will be given a consent form to sign and the surgeon will discuss possible complications with you. Some complications are very rare and some more common. If you do not understand what the surgeon is saying, you should say so and ask any questions or discuss any worries you may have about your proposed surgery before signing the form. Once you are satisfied that you understand the aims of the surgery, what will happen and the possible risks of surgery, then you should sign the consent form.

Serious complications are rare but may occur even in the hands of well-experienced and trained Oculoplastic Surgeons. Every effort is made to reduce the risk of complication, and oculoplastic surgeons are trained to manage these.

Although all complications are possible, patients must know that the surgical treatment of post-blepharoplasty syndrome is only undertaken if the Oculoplastic Surgeon decides the patient needs the operation. It is not just a cosmetic operation, but also an operation to correct a functional problem and sometimes damage to the cornea.

A list of possible complications is listed below:

• Eyelid and cheek swelling and bruising which may be noticeable for three weeks
• Blurred vision for a few hours or overnight, due to surface ocular drying during the procedure, from the effect of the local anaesthesia and the ointment instilled. If the blurred vision persists more than 48 hours, you should inform your Oculoplastic Surgeon.
• Watery eyes (reflex tearing) are common for 24-48 hours due to mild ocular discomfort and surface dryness.
• Dry, gritty eyes for two to three weeks post surgery is common due to reduced blinking. You will be prescribed artificial tears to use during the day (e.g. Hypromellose, Systane or Viscotears) and an ointment to use at night (e.g. Lacrilube or Simple Eye Ointment) to prevent this. Topical antibiotics such as Chloramphenicol are used for one week if surgery was been to the inside the eyelid.
• A scratched surface of the eye/minor injury to the eye surface can result in pain for 24 hours after surgery. If the pain persists or is severe, inform your Oculoplastic Surgeon.
• Eyelid bruising or haematoma is common. Bleeding behind the eye is rare and a haematoma can cause loss of vision if not dealt with urgently. Oculoplastic Surgeons are trained to prevent and manage this.
• You may see asymmetry between both sides.
• You may notice scarring.
• Wound infection is rare but can occur.
• Patients may need further surgery if the optimum result is not achieved, and the patient will be warned of this at signing the consent form. This is one of the main risks of post blepharoplasty syndrome surgery, as some cases are really difficult to treat.

This is according to the patient’s individual needs. It is easier to monitor the postoperative course if the patient stays overnight after the surgery.