Upper and Lower Blepharoplasty

IndIcatIOnS Indications are as follows: dermatochalasis, skin laxity, eyebrow descent, prominent fat compartments, lacrimal gland descent, suborbicularis brow fat, prominent orbital rim, laxity of the tarsoligamentous sling, and hypertrophic or atrophic orbicularis oculi. 1 Evaluating medical history, brow stability, and levator function will help determine if ptosis is a contributing factor or if a browlift is needed. Unsatisfactory results occur when untreated brows compensate asymmetrically because of Herring's law of equal innervation (See BLOCKINVideo BLOCKIN1, Supplemental BLOCKINdigital BLOCKINcontent BLOCKIN1, which displays a standard examination of a patient's upper and lower eyelids when planning for blepharoplasty, available in the " Related Videos " section of the full-text article on PRSGlobalOpen. com or available at http://links.lww.com/PRSGO/A217). PReP The face is prepped with dilute betadine solution, and the eyes are irrigated with balanced saline solution. StePS upper BLOCKINBlepharoplasty 1. Lidocaine 2% with epinephrine injected into the eyelids and the lateral orbital rim periosteum. 2. The crease is marked 8 to 10 mm above the central lid, tapering medially and laterally, and leaving 10 to 15 mm of skin between the upper incision and the brow. Markings vary according to sex and ethnicity. 3. Open-sky incisions are made with a scalpel. 2 4. Cautery and Westcott scissors dissect through the orbi-cularis and septum. 5. Preaponeurotic fat is resected. Avoid injuring the lacri-mal gland or overresecting the transitional fat between the nasal and central compartments. 6. Beveled straight iris scissors are used to excise the skin– muscle flap. 7. A 6-0 Vicryl suture through the pretarsal orbicularis to the levator aponeurosis provides supratarsal fixation. Trans-cutaneous sutures create an unnatural adynamic crease. 8. Skin–muscle is closed with 6-0 nylon. See Video 2, Supplemental digital content 2, which shows and discusses upper and lower blepharoplasty techniques , pearls, and pitfalls, available in the " Related Videos " section of the full-text article on PRSGlobalOpen. com or available at http://links.lww.com/PRSGO/A218. Lower BLOCKINBlepharoplasty 1. Skin is incised below the lateral canthus. 2. Straight scissors dissect the skin from the pretarsal muscle 3 mm below the lashes. 3. The muscle is divided in a stair-step fashion. 4. Preseptal to preperiosteal undermining of the skin– muscle flap and release of the orbitomalar ligament are performed. 5. The septum is excised to expose protruding fat compartments for resection. 6. Excised fat can be grafted to blend the lid–cheek junction. 7. Canthopexy is performed with a 4-0 Mersilene or 5-0 polydioxanone suture passed …