Chapter 22 - Famona Site

Ectropion1. Minimal eversion of the lower eyelid skin is also relatively common followinglower lid blepharoplasty and will resolve as the edema and induration subside within the firstweek or two following blepharoplasty.2. Severe ectropion due to scarring or overzealous excision of the lower eyelid istreated conservatively for several months with taping and forceful eyelid closure.a. If the ectropion fails to resolve, full-thickness skin graft from the upper eyelid skin(if sufficient quantities exist) is the donor site of choice.b. Full-thickness skin grafts from the postauricular area and supraclavicular fossaprovide the next best texture and tissue match for the lower eyelid skin.c. A horizontal lid shortening procedure with skin grafting may be necessary to correctthe ectropion in atonic lids.Blindness1. This complication almost always follows fat removal and occurs in 1:25,000-1:50,000 cases.2. Postoperative instructions should include frequent checking of the visual acuity bypatient, nurses, and family.3. If the patieent complains of deep, unilateral eye pain that is similar to the painproduced with teasing the fat from the orbit, the surgeon should be notified immediately.4. Sudden onset of pain and blindness has been reported up to 5 days following ablepharoplasty. Therefore, the patient should be instructed to rest and recover from surgerywithout returning to normal activities for a minimum of 2 weeks.Hooding of the Lateral Canthus1. Develops when the upper and lower eyelid incisions are too close together.2. The incisions should be separated by at least 5 mm.Dry Eye1. Blepharoplasty may exacerbate a preexisting lacrimal disorder.2. Schirmer's testing preoperatively will identify those patients who should have aconservative skin excision of the upper eyelid skin.22