Key notes on plastic surgery/Adrian M. Richards

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294 AESTHETIC SURGERY
Preoperative counselling
Explanation
• The limitations of surgery should be explained.
• For example, it is important for the patient to know that the blepharoplasty
alone will not improve the appearance of any crow’s feet lateral to the orbit.
• The nature of the surgery should be explained. This should include:
• The type of anaesthesia
• The incisions and the technique of blepharoplasty
• The fact that the patient may wake up with eyepads on.
• The post-operative course should be explained. This should include:
• When the patient can go home
• What they will look like
• Any post-operative precautions, such as avoiding straining or leaning over,
avoiding non-steroidal anti-inflammatory drugs (NSAIDs), and the application
of damp pads to the eyes at night
• The arrangements for follow-up.
Possible complications
• It is important to discuss possible complications. These should be divided into:
• Intra-operative complications
• Early complications
• Late complications.
• It is important to mention the risk of blindness, although it should be emphasized
that it is extremely rare.
• Post-operative blindness is usually caused by a retrobulbar haematoma (a
haematoma behind the orbital septum).
• Once identified, this is a surgical emergency and should be managed with
orbital decompression by release of the septum or lateral canthus.
• The carbonic anhydrase inhibitor acetazolamide and mannitol should then be
administered in an effort to further decompress the orbit pharmaceutically.
Techniques of blepharoplasty
The traditional technique
Upper-eyelid blepharoplasty
• The patient is placed in a supine position with their head up.
• The lower border of the skin excision is defined.
• The upper border of the skin excision is assessed by gently pinching the eyelid
skin between the blades of a pair of blunt forceps.
• The upper border of the skin excision is defined at multiple points across the
upper eyelid.
• A strip of skin and the underlying orbicularis oculi muscle is then removed from
between the upper and lower borders of the skin excision.