Diplopia is an infrequent complication after blepharoplasty. T ransposing native eyelid fat to the nasojugal groove tear trough has become a standard adjunct to lower blepharoplasty in the appropriate patient. Many authors use retroseptal approach in blepharoplasty procedures and in treatment of orbital fractures, because of direct access to the orbital floor 4, 7. In this article, we present a case of horizontal diplopia following cosmetic upper blepharoplasty. Lower lid blepharoplasty transconjunctival blepharoplasty is the surgical procedure for removal of excess fat and tissue around the upper and lower eyelids. The transconjunctival approach to lower eyelid blepharoplasty involves a precise incision made on the inner lining of the lower eyelid the conjunctival surface rather than the outer skin surface of the eyelid. Therefore, in modern society, where many people believe that initial impressions count for so much, the difference. Fat has been repositioned through a transcutaneous 3,4 or a transconjunctival 5,6 access and into the supraperiosteal 7,8 or the subperiosteal plane, 1,5,6 depending on the. The main benefit of transconjunctival blepharoplasty over traditional blepharoplasty with external incision is that the support of the lower eyelid is maintained.
In the patient with minimal fat pseudoherniation, this approach may not be best. From an incision inside the eyelid away from the eye itself, the lower eyelid septum can be reached, and behind that septum is the lower lid fat. Specifically, we have compared the results of this blepharoplasty. Transconjunctival blepharoplasty recovery recommendations. Transconjunctival lower lid blepharoplasty with fat resection duration. Zoumalan is an eyelid plastic surgeon and exclusively performs cosmetic eyelid surgery. In the lower lid, it can be used successfully for orbital fat excision, redistribution, or septal tightening.
Instead, these patients have fat deposits that have collected under their eyes that cause their eyes to look puffy or swollen. Transconjunctival versus transcutaneous approach in upper and lower blepharoplasty. Where there is excess skin as well as fat, surgery is performed using an incision that runs just underneath the eyelashes and out into the crows feet lines. Transconjunctival lower blepharoplasty enables the surgeon to reposition fat, effectively blending the lidcheek junction and filling the tear trough deformity. Transconjunctival upper lid blepharoplasty sciencedirect. The removal of orbital fat for the cosmetic modification of the lower eyelid. It offers the best method for tailormade, deeplayer fat manipulation, such as fat removal or fat repositioning. Despite the fact that transconjunctival approach to lower eyelid blepharoplasty is not a new technique, the indications, patient selection, technique, and results using this technique have not previously been widely reported. In patients with significant skin laxity and redundancy, and in patients with hypertrophic orbicularis oculi muscle, the transconjunctival approach can offer little. A 40 silk suture is placed through the lower lid at the level of the meibomian gland orifices to provide traction during the case.
Compared to the transcutaneous approach, the transconjunctival approach has resulted in no roundeye deformity, ectropion, or bleeding in the perioperative period. Blepharoplasty eyelid surgery blepharoplasty is surgery designed to sculpt the tissues around the eyes to give them a more youthful, open appearance. Blepharoplasty surgery is customized for every patient, depending on his or her particular needs. Transconjunctival lower blepharoplasty request pdf. Transcutaneous approach article pdf available in modern plastic surgery 55. Transconjunctival blepharoplasty can be performed under local or general anesthesia conditions.
Through a transconjunctival incision, the preseptal space was entered and excess orbital fat pads were excised. Transconjunctival approach in lower eyelid blepharoplasty. Transconjunctival approach to lower eyelid blepharoplasty. Transconjunctival blepharoplasty of the lower eyelids consists of removal of just the inner fatty tissue. Mar 20, 2017 transconjunctival lower eyelid blepharoplasty lower eyelid bags excision made easy. With normal tone, the lower eyelid should return to the globe immediately. Also, if the skin was pinched under the eyes, she had more than a transconjunctival lid correction in order to reduce skin excess. Various procedures can be performed using this method including septal. Every patient that he examines for cosmetic eyelid surgery presents with variations in eyelid aging, and each surgery has to be customized and tailored to that specific patient. Extended transconjunctival lower eyelid blepharoplasty. Transconjunctival blepharoplasty for upper and lower. Transconjunctival blepharoplasty eye bags specialist in new.
Transconjunctival incision was popularized by tessier in 1973. The eyes are the first part of the face that show the tell tale signs of ageing, as well as the part of the face that give most away about how we may be feeling. Transconjunctival blepharoplasty remains a popular and safe technique to treat periorbital aging. Jeffrey epstein markup for upper eyelid blepharoplasty. Intervention transconjunctival lower blepharoplasty with fat repositioning. Transconjunctival lower lid blepharoplasty with fat reposition. It is important to make sure there are no underlying preexisting medical conditions such as high blood pressure. With the excision and the removal, or the repositioning or both of excess tissues, such as skin and adipocyte fat. This innovative procedure is relatively quick with a speedy recovery time, and no visible scarring. Jul 11, 2011 transconjunctival surgery does not directly address excess lower lid skin or eyelid laxity.
Transconjunctival lower lid blepharoplasty with fat resection. Transconjunctival surgery is a more complex procedure than the traditional transcutaneous approach. May 07, 2020 transconjunctival blepharoplasty is a kind of plastic surgery that is performed on the lower eyelid to make the area look smoother and less puffy. A skinmuscle flap is raised to the level of the orbital rim. Transconjunctival blepharoplasty is a type of lower eyelid surgery, which is performed without any external incisions. With the excision and the removal, or the repositioning or both of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle. Transconjunctival blepharoplasty is the keycomponent in a fully customisable modular approach to aesthetic and functional eyelid surgery. This technique not only is a safe and effective manner to rejuvenate the lower eyelid but also results in virtually nonexistent ill effects. The advantage of the transconjunctival technique is the preservation of the orbital. From december of 2012 to december of 2015, 54 patients underwent this procedure. Pdf bolsas palpebrales inferiores y blefaroplastia estetica. It is an efficient surgery taking less than approximately 30 minutes to complete in a straight forward case. This approach avoids violating the inferior orbital septum, which may result in less postoperative eyelid retraction, scleral.
Post operative instructions blepharoplasty any sudden decrease in vision or pain unrelieved by medicine or large swelling, especially if only on one side, or sudden onset of bright red bleeding should be reported to the office immediately 877 481 face 3223 general instructions. We approach the study of the inferior palpebral adipose bags from two points of view. Transconjunctival blepharoplasty eye bags specialist in. Autoestima em pacientes submetidas a blefaroplastia. Conclusions transcutaneous lower eyelid blepharoplasty with fat excision is a timetested method of correcting the undesirable sequelae of the aging eye.
The transconjunctival fat repositioning procedure is performed with the patient under local or general anesthesia. Transconjunctival blepharoplasty is an ideal way to approach those unsightly bags below your eyes. Transconjunctival blepharoplasty my plastic surgeon. Transconjunctival blepharoplasty eyelid surgery new. Transconjunctival blepharoplasty is a type of eye surgery often performed on people of ethnic backgrounds or with darker skin. In this blog ill discuss what is transconjunctival blepharoplasty and how it can rejuvenate your look. In lower eyelid blepharoplasty, surgeons report using one or more of the following approaches. Transconjunctival blepharoplsty is a method to reach the septum and fat in the lower eyelid without making a skin incision. Local anesthesia requires the use of a topical anesthetic oxybuprocaine, merck sharp and dohmechibret, france in the inferior fornix before a cutaneous injection of 1 to 2 cc of xylocaine 0. In transconjunctival lower lid blepharoplasty, performed after upper eyelid suture, we infiltrate the anesthetic 12 hour before the procedure for the adrenaline to take affect we inject 1 to 2 ml of a of 2% lidocaine solution with epinephrine at 1. External eyelid incision blepharoplasty can damage the lower eyelid support and result in a pull down or sag of the lower eyelid. Transconjunctival lower blepharoplasty with skin resection. To help reduce the swelling and bruising, take your arnica montana and bromelain as directed, starting before and continuing after surgery.
Analysis of indications and the treatment of 100 patients samieh s. Results we included 40 patients 27 women and men with a mean age of 57 years and mean followup of 10 months. This sort of surgery is usually performed on younger patients who do not have a great deal of sagging skin to remove. Most of the cases are in its vertical form due to trauma of the extraocular muscles. At the conclusion of the case, antibiotic ointment is place over the incision and in the eye. Request pdf modified lower blepharoplasty with fat repositioning via transconjunctival approach to correct tear trough deformity background over the years, many techniques have been described. Transconjunctival blepharoplasty permits access to the orbital fat by an incision through the inferior conjunctiva and capsulopalpebral fascia without any disruption of the skin and orbicularis muscle of the lower lid. The results are more aesthetically pleasing than topical creams or ointments and last much longer, up to a lifetime in most patients. Upper blepharoplasty overview i what is the goal of upper blepharoplasty. Transcutaneous lower eyelid blepharoplasty with fat.
Transconjunctival blepharoplasty eyelid surgery london. Philippe levan, md the author shows how he performs transconjunctival lower blepharoplasty. Modified lower blepharoplasty with fat repositioning via. The patient returns in approximately one week for reevaluation. Often plastic surgeons classify blepharoplasty into upper lid surgery upper blepharoplasty, and lower lid surgery lower blepharoplasty. It can be performed alone involving upper, lower or both eyelid regions, or in conjunction with other surgical procedures of the eye, face, brow, or nose.
May 20, 2019 transconjunctival blepharoplasty has been recognized as useful in patients with fat excess and fine skin wrinkling and in those with apparent skin and fat excess in whom fat excision alone allows for redraping of the lower lid skin into an acceptable contour with elimination of the skin laxity. Lower blepharoplasty can be performed under local or general anaesthesia. A blepharoplasty is an operation on the eyelid that improves the external cosmetic appearance. Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags. In the lower eyelids, we performed lower transconjunctival blepharoplasty. Transconjunctival approach in lower blepharoplasty youtube. Fat has been repositioned through a transcutaneous 3,4 or a transconjunctival 5,6 access and into the supraperiosteal 7,8 or the subperiosteal plane, 1,5,6. Transconjunctival preseptal approach for orbital floor and. The recovery from a transconjunctival blepharoplasty is approximately 1014 days of swelling and bruising underneath the eyelids. It can use the transcutaneous or transconjunctival approach. Facial plastic surgery clinics of north america 2000. Selfesteem in patients undergoing blepharoplasty scielo. How much does lower eyelid blepharoplasty surgery cost for. Transconjunctival blepharoplasty is a kind of plastic surgery that is performed on the lower eyelid to make the area look smoother and less puffy.
Infection and bleeding can occur as of any surgical procedure. Any increase in the distraction distance or delay in snap test indicates laxity in the tarsus or horizontal laxity. Longterm results of lowerlid suspension blepharoplasty. Rejuvenate your eyes with transconjunctival blepharoplasty. He recommends the procedure in patients with excessive lower eyelid fat, poor lower eyelid tone, revision blepharoplasty, and patients who object to a lower eyelid scar. Transcutaneous lower blepharoplasty the lower eyelid is infiltrated with local anaesthesia. Protruding central, nasal and lateral fat pads are removed or redraped over. Main outcome measures intraoperative findings, postoperative course, complications, and aesthetic results. Request pdf transconjunctival lower blepharoplasty there is no secret to achieving successful results with lower belpharoplasties. This video demonstrates a lower lid blepharoplasty with transposition of the medial and central fat pads through a transconjunctival incision. Transconjunctival blepharoplasty is indicated in young patients with baggy eyes, puffiness and dark circles under eyes with no skin wrinkles and in hyperthyroid patients. If significant bleeding occurs in the lower lid, it can put pressure on the eye. Lower lid transconjunctival blepharoplasty, aesthetic resurfacing of the periorbital. This procedure is internal, producing no outside scars and preserves eye shape.
Autoestima em pacientes submetidas a blefaroplastia researchgate. The transconjunctival incision is then closed with interrupted 70 vicryl sutures. This includes patients who have had no previous blepharoplasty procedure or those undergoing secondary revision to correct excess medial fat. Comparison of two transconjunctival and transcutaneous approaches in the incidence of scleral show during lower eyelid blepharoplasty. Comparison of two transconjunctival and transcutaneous. Nas palpebras inferiores, foi realizada blefaroplastia inferior transconjuntival. Blepharoplasty is a surgical procedure will the sole purpose of repairing droopy eyelids that may involve removing excess skin, muscle and fat. Transconjunctival upper lid blepharoplasty, or transconjunctival removal of medial upper eyelid fat, also has a role in rejuvenation of the upper eyelid. Transconjunctival versus transcutaneous approach in upper and. Can transconjunctival blepharoplasty also lift, remove or. Patients and methods of 4395 patients who underwent lowerlid blepharoplasty, 3988 had muscle suspension. In some cases of excess tissue in the upper eyelids the vision may be diminished.
Transconjunctival blepharoplasty combined with fat graft ing and 88% phenol peel offers a unique and previously undescribed approach to establishing the ideal aesthetic to the lower eyelid and cheek. When these deficits are present, a skin pinch and canthal suspension can be added. It is surgical process can perform upper lids and lower lids, both surgery process can use the remove the dark circles, muscles around the eye and removing the excess skin. With age, your eyelids become loose as the muscles supporting them weaken. What is transconjunctival lower eyelid blepharoplasty. One drop of tetracaine ophthalmic solution is instilled in each eye. This surgery functional blepharoplasty may be covered by. Once the fat has been reposition or removed, the skin is redraped and any excess removed. Patients must discontinue any smoking, tobacco use, and blood thinners prior to the surgery. Blefaroplastia inferior transconjuntival associada a resseccao cutanea com. Blepharoplasty eyelid lift postoperative instructions after surgery, your eyes will be somewhat bruised and swollen.
If medical conditions have been ruled out, a transconjunctival blepharoplasty is then the appropriate choice for removal of fat in the 2 compartments of the lower lids. It is used to remove the appearance of bags and loose skin under the eyes which occur due to excessive bulging fat deposits in the lower eyelids. Lower lid transconjunctival fat blepharoplasty oculoplastic. The risks of transconjunctival blepharoplasty are very similar to those of other blepharoplasty techniques. This narrated video demonstrates the transconjunctival lower lid fat blepharoplasty. Preoperative preoperative evaluation should include a complete examination including. Prasad uses transconjunctival laser blepharoplasty to remove, sculpt and reduce the fat under the eye.
With the patient in the supine position, a surgical marker is used to mark the nasojugal groove. The transconjunctival approach in lower lid rejuvenation is great to correct fat, though the exposure is not one used for cheek lift. Transposing native eyelid fat to the nasojugal groove tear trough has become a standard adjunct to lower blepharoplasty in the appropriate patient. The transconjunctival upper lid blepharoplasty technique is designed to address the needs of patients whose periorbital aesthetic problem is limited to excess fat in the medial pocket of the upper eyelid. A detailed history concerning dry eyes recurrent herpes zoster or simplex infections thyroid disease 3. There are two different routes for the transconjunctival approach. Ppt blepharoplasty powerpoint presentation free to. The incision is carefully made inside the lower lid so that the skin is not directly cut and hence no visible scars. Lower lid transconjunctival blepharoplasty, aesthetic resurfacing of the peri orbital. Transconjunctival blepharoplasty eyelid surgery new york city. Sleep on your back with your head elevated at least 30. Blepharoplasty eyelid surgery at scottsdale blepharoplasty is the also known as eyelid lift. This is an increasingly popular approach to lower lid rejuvenation that avoids some of the risks inherent with anterior approach lower lid surgery and skin excision in the lower lid.
Transconjunctival blepharoplasty allows the surgeon to accomplish many of the esthetic goals of blepharoplasty while reducing the incidence of many of the associated problems, i. Because the scars are inside the lower eyelid where they cannot be seen, this procedure is often called scarless blepharoplasty. Transconjunctival approach in lower eyelid blepharoplasty ncbi. Feb 29, 2016 transconjunctival blepharoplasty is a technique that best addresses pseudoherniated orbital fat. Canthopexy or canthoplasty should be considered during blepharoplasty. Twentythree cases of inferior blepharoplasty performed through a transconjunctival approach are reported. Keywords transconjunctival approach, transcutaneous approach, blepharoplasty 1. The degree of bruising and swelling varies from person to person. In the upper lid, transconjunctival blepharoplasty has a role in removal of the nasal fat pad via an isolated, direct approach. Background muscle suspension blepharoplasty remains a reliable method to tighten the loose skin and muscle of the lower eyelid. However, reconstruction of the bony orbit has different goals than transconjunctival.
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