Guidance before Blepharoplasty Surgery

1. Blepharoplasty surgeon will gather some or all of the following requirements well in advance of blepharoplasty date. These requirements are as follows:

a. You need to gather your health history and prepare questionnaire before blepharoplasty surgery.
b. Go for a basic physical examination for medical clearance with your regular physician.
c. Have some special physical testing or electrocardiogram.

2. Do not use any type of aspirin at least three weeks before blepharoplasty. Do not use other aspirin like baby aspirin, some cold remedies containing aspirin, any coated aspirin, or any medication related to ibuprofen like Motrin, Advil, Alleve, etc. These medications should be avoided at least three weeks before blepharoplasty. One tablet can hinder with your blood clotting before blepharoplasty. You can take tylenol at any time.

3. If you are advised for "blood thinners" like Coumadin or Plavix, discuss the same with your blepharoplasty surgeon in advance of blepharoplasty. You may need to follow some special instructions.

4. Stop using any type of separate Vitamin E supplement. You should stop Vitamin E atleast two weeks before blepharoplasty. A small amount of Vitamin E is not concerned.

5. Try to limit your over-the-counter supplements which are meant to protract bleeding to a lesser degree than the above medications. These over the counter supplements include gingko biloba, ginseng, glucosamine/ chrondroiton sulfate, and some herbs. So, try to limit the drinking of herbal teas or any over-the-counter supplements specifically which are not recommended by your regular doctor.

6. Talk to your blepharoplasty surgeon well in advance if you are taking any special regular medication. If you are using any diabetic dosage try to adjust it on the day of blepharoplasty.

7. It would be better if you stop smoking and alcohol intake atleast two weeks before blepharoplasty.

8. You should have some supplies before blepharoplasty. Sterile gauze pads, extra strength Tylenol and a little bottle of artificial tears.

9. You should purchase few supplies in advance which are ready for use after your blepharoplasty upon arrival at home. 2-3 tray of ice cubes, several clean washcloths and a small bowl for water. Also purchase a package of frozen baby peas or Ziploc bags to use ice packs.

Lower Blepharoplasty Functional Complications Treatment

“Malposition” is the most common functional complication of lower blepharoplasty. Malposition is a variation of the lower eyelid position, thus interaction with the relationship of eyeball with lower eyelid. This functional complication is due to:

1. Lower eyelid retraction
2. Cicatricial ectropion

Lower eyelid retraction is the pulling down of the eyelid thus exposing white of the eye “excessive sclera”. This excessive sclera creates a surgical looks. This functional complication commonly occurs when blepharoplasty is performed using a transcutaneous incision. The excessive scarring in the middle layers of the eyelid caused retraction. This mainly caused in lower blepharoplasty when transcutaneous approach is used as well as by the excessive skin and fat removal.

The Classical surgical approach for the correction of lower eyelid retraction is quite challenging and may require more than one operation. These are as follow:

1. Scar tissue severing
2. Lateral canthus tightening procedures
3. Dermal fat graft, ear cartilage grafting, hard palate tissue, decellularized tissue matrix called as spacer graft
4. Silicone cheek/orbital rim placement

These classical operations are often for a short duration only. In lower blepharoplasty, orbital fat deficiency has been observed as a major contributor to eyelid collapse.

Cicatrical ectropion is a functional complication in which lower eyelid is pulled away from eyeball. It is a common complication of lower blepharoplasty. Cicatrical Ectropion is caused due to excessive removal of fat and lower eyelid skin and it’s common in transcutaneous lower blepharoplasty. People those have stretched and weakened supporting tendons have high risk especially the smokers because the tightness is poorly tolerated and results in eyelid eversion.

Surgical treatment for cicatricial ectropion includes a difficult reconstructive operation in which grafting of donor skin with full thickness is require. Donor skin is taken from behind the ear. Some tightening techniques may also be required at lateral canthus or midface.