Eyelid Complications: Revision Blepharoplasty
Eyelid surgery in experienced hands is usually straightforward. When the surgical preoperative assessment is accurate the results are usually predictable. However, sometimes the surgery produces an unexpected outcome that was not anticipated. These unfavorable eyelid plastic surgery results are often apparent and the outcome can be physically and psychologically devastating for a patient who has high expectations of success.Revision eyelid surgery is performed after a patient has already undergone a blepharoplasty.Patients who consult Dr. Kopelman for revisions require different types of surgical approaches compared to patients who have never had eyelid surgery before.Doctor Kopelman has extensive experience with eyelid revision surgery(secondary blepharoplasties) to correct complications.He employs special techniques that are specific to each individual problem.
Q: How did the primary surgery lead to an unfavorable result?
A: Dr. Kopelman believes that the source of many untoward results begins with the assessment of the patient prior to surgery. Most patients are under the false impression that complications occur due solely to technical error. It is true that mistakes may occur during surgery but in his opinion unfavorable results occur most commonly as a result of a flawed preoperative assessment where structural changes were not recognized and taken into account.
Q: If a surgeon is board certified how can that happen?
A: Board certification is no guarantee that your outcome will be perfect or satisfactory. Too often plastic surgeons are stuck with the same aesthetic judgment and techniques that they were taught many years ago during their residency or fellowship programs.Their board certification does not a guarantee that their judgment will be improved with time – some people never modify their techniques. Often their surgical assessment and plan are wedded to concepts that are no longer valid. Once their faulty surgical plan is set in motion these surgeons are destined to produce unfavorable outcomes. Not only is their ability to assess the patient outdated but their surgical techniques may also be antiquated.They have never stopped to critique their postoperative results with a “clear unbiased eye” therefore they have never updated or modified their surgical techniques to conform to unique situations or to update their surgical methods. Furthermore they have failed to keep abreast of new concepts of eyelid anatomy that may have a direct effect on the surgical techniques that are employed. They use a “cookie cutter” formula that they apply to everyone as a result they produce postoperative results that are less than ideal.
Q: What are the risks of incomplete eyelid closure?
A: Patients commonly fear that their eyelids will not close following eyelid surgery. Although this is a relatively rare complication the concern is warranted. If the ocular exposure is excessive the patient may experience a burning dry eye sensation, reflex tearing, and rarely corneal ulcers may develop.
Q: What can be done when patients cannot close their eyelids completely?
A: A skin graft placed on the upper eyelid will act as a spacer to allow complete closure of the eyelids. The donor skin is usually harvested from behind the ear where there are few hair follicles and then transplanted onto the eyelid at the site where too much skin has been previously removed.
Q: Hollow upper and lower eyelids, how does it happen?
A: Dr. Kopelman believes “it is often what you leave behind that counts not what you take away.” Intraoperative surgical judgment is critical when the surgeon has to decide how much skin or bulging fat to excise. In the past some cosmetic surgeons embraced the idea that “the more fat they removed the better”.Unfortunately, after surgery, patients were disappointed when they recognized that their eyelids appeared hollow and gaunt. The extraction of too much fat creates a deflated “skeletonized” appearance. These over operated eyelids actually made the patient look older. Doctor Kopelman currently endorses the concept that it is important to conservatively remove a precise amount of skin and preserve as much of your eyelid natural fat as possible. This may mean that some of the fat that is bulging may be shifted around to fill in depressions. This will help to improve the contours of your eyelids and restore a fuller more youthful appearance.
Q: What if I have already undergone an eyelid procedure where too much fat has already been extracted?
A: If too much fat has been extracted from either your upper or lower eyelids then Dr. Kopelman will probably recommend autogenous fat grafts, obtained from your abdomen or hip. The fat is then grafted below the skin and muscle to fill the hollow fat deficient areas. Doctor Kopelman may also recommend injections of hyaluronic acid gels like Belotero Balance®, Voluma®, or Restylane® to fill-in depressions.
Q: What are the limitations that you can expect following fat grafting?
A: Grafts will initially appear swollen and bruised for approximately two months or more and some fat may atrophy or become nodular.
Q: How long will it take before my eyelids appear normal again?
A: Fat grafts will produce swelling and associated bruising for approximately two months but there will be a period of longer recuperation in which the consistency of the fat changes from a a rubbery to more pliable state. The eyelid may also appear droopy because the fat may weigh down the internal eyelid muscle. However, the eyelid droop (ptosis) usually resolves over several weeks to months.
Q: Lower eyelids that are pulled down- eyelid retraction:
A: Just like complications that occur from removing too much upper eyelid skin,lower eyelid also may experience exposure when too much of the lower eyelid skin and muscle is removed. As a result the lower eyelid is vertically“shortened” and the eyelid is pulled down.In addition, surgeons who utilize too much cautery during the procedure may cause internal eyelid scarring. Both missteps produces scarring and lower eyelid retraction that expose the lower portion of the eye including the white sclera and cornea.This increased exposure will cause dry eyes,inflammation,irritation,and tearing. The cosmetic consequences of removing too much lower eyelid tissue is that the sclera( the white portion of the eyeball) is exposed and the outer corners of the eyelids may appear unnaturally round.
Q: How is eyelid retraction corrected?
A: Dr. Kopelman employs surgical and non-surgical techniques to correct the eyelid surgical complications. Depending upon the degree of eyelid retraction he will first inject medication into the scar tissue to help reverse and relax the scar tissue. This may involve a series of injections over several weeks. However, if the eyelid retraction is severe then surgery to correct the scar contraction is necessary. The first surgical step undertaken releases and removes internal eyelid scar tissue. Often patients will require tissue grafts to replace the overly aggressive removal of tissue which occurred at the time of the original surgery. These grafts consist of tissue taken from the roof of mouth (hard palate grafts) and are placed inconspicuously on the inside of the lower lid to support the sagging lower eyelid. This graft acts like a scaffold to raise the lower eyelid upward so that the white sclera and conjunctiva of the eye are not exposed. Occasionally, because too much skin had been removed during the original procedure, skin grafts are also necessary to reduce the exposure of the eye. The ultimate outcome will be a restoration of the natural contours of your lower eyelid and a reduced exposure of the eye. You will look and feel better.
Interested in learning more about how to remedy your eyelid complications ?
Contact Ms. Anne Lembersky our patient care coordinator at 201-444-4499 to arrange for an in-depth consultation to discuss the steps to rectify your eyelid complications.
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