MOC-PSSM CME article: Blepharoplasty

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Identify pertinent findings in the preoperative evaluation of the blepharoplasty patient that could affect operative management. 2. Describe different techniques of upper and lower lid blepharoplasty. 3. Describe ancillary procedures that could blend the lower eyelid-cheek junction and optimize the aesthetic result of blepharoplasty surgery. 4. Identify common postoperative complications and describe their treatment. SUMMARY: Blepharoplasty plays a vital role in facial rejuvenation, with direct aesthetic connection to the brow and the cheek. Upper and lower eyelid blepharoplasty may be indicated for the presence of excess skin and/or orbital fat. Preoperative evaluation should include a thorough medical and ophthalmic history, along with a vision examination. Symptoms of preexisting dry eye should be elicited preoperatively, as they directly correlate with postoperative complications. Physical examination should take into account brow position, eyelid ptosis, lower eyelid position, and cheek projection. Blepharoplasty is a broad topic with many operative approaches. Skin-only upper blepharoplasty with medial orbital fat excision is an effective procedure. Lower eyelid blepharoplasty is a more controversial topic. The senior author (R.J.R.) uses a transconjunctival orbital malar retaining ligament disruption along with a lateral retinacular canthopexy, and a lower eyelid skin pinch excision for his lower blepharoplasty. Postoperative care should include aggressive corneal lubrication with eye protection, eye drops, and ointment. Small amounts of lagophthalmos are tolerated postoperatively but usually correct within 7 days. Complications may include retrobulbar hematoma, lower eyelid malposition, dry eye, and need for revision surgery. In summary, blepharoplasty is a common procedure in cosmetic surgery, with important contributions to facial rejuvenation.