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Upperlid Blepharoplasty

PREOPERATIVE DIAGNOSIS: Upper lid asymmetry

POSTOPERATIVE DIAGNOSIS: Upper lid asymmetry

OPERATION: Upper lid blepharoplasty, anchor technique

ANESTHESIA: General(Local)

OPERATIVE PROCEDURE:
After induction of General(Local) anesthesia, the patient was prepped and draped in the usual sterile fashion. 3ml of 1% Lidocaine with epinephrine was injected to the upper lid. A total of 6ml were used. The patient had premarking of the upper lid excess skin prior to the surgery in a sitting position where 2 mm of skin was resected from the right and 2 mm was resected from the left. A strip of orbicularis muscle was taken out. The septum was opened, only a small amount of fatty tissues were excised. The medial fat pocket was opened, and a small amount of medial fat bulging was taken out. The flap of upper lid skin was anchored to the aponeurosis of the levator using a 6.0 Vicryl and 6.0 Prolene in multiple spots to secure the fixation. This was done bilateral.

Lowerlid Blepharoplasty/Subcilliary Approach

REOPERATIVE DIAGNOSIS:
1. Pseudo herniation of the lower lid, bilateral

POSTOPERATIVE DIAGNOSIS:
1. Pseudo herniation of the lower lid, bilateral

OPERATION:
1. Subcilliary lower lid Blepharoplasty, bilateral

ANESTHESIA: LOCAL

OPERATIVE PROCEDURE: After the induction of local anesthesia, the patient was prepped and draped in the usual sterile fashion. 2 ml of 1% Lidocaine with Epinephrine was injected to the lower lid bilaterally. Subcilliary incision was made using a needle-tip Bovie cautery and 15 blade. A Q-tip applicator was utilized as well as Desmarres retractor pulled the lower lid down where the septum was revealed. Three fatty compartments were released. Small amounts of fatty tissues were removed. Good hemostasis was obtained. This was done on the left side as well, using subcilliary incision and blunt dissection was carried out using Q-tip applicator. The septum was revealed. The three fatty compartments were released. Only small amounts of fatty tissues were taken out with good hemostatsis obtained. 2 mm of skin resection was done bilaterally. Incision was closed using 6-0 Prolene. 2 mm of skin was resected from the right eyelid and 2 mm was resected from the left eyelid, using a 15 blade and Bovie cautery. The incisions were closed using 6.0 Vicryl and 6.0 Prolene.

Lowerlid Blepharoplasty/Transconjunctival Approach

REOPERATIVE DIAGNOSIS:
Pseudoherniation of the lower lid fat pad, bilateral

POSTOPERATIVE DIAGNOSIS:
Pseudoherniation of the lower lid fat pad, bilateral

OPERATION:
Transconjunctival approach, lower blepharoplasty, bilateral

ANESTHESIA: General

OPERATIVE PROCEDURE:
After induction of general anesthesia in a supine position, she was prepped and draped in the usual sterile fashion. 2 ml of 1% Lidocaine with epinephrine were injected to the transconjunctival area bilaterally. A total of 4 ml were injected. The capsule of palpebral fascia was lifted using 5-0 silk, and the transconjunctival incision was made using the Bovie where the septum was exposed by peeling the connective tissues away from the septum using Q-tip applicators. Three fatty compartments were identified, and puncture incisions were made using the scissors where a small amount of fatty tissues were released and excised using the Bovie cautery. Good hemostasis was obtained. One 6-0 Vicryl was applied to the connective tissues of the lower lid above the septum to the capsule of palpebral fascia to reinforce the interior lining so that the herniation will be minimized. The left side of the lower lid was also opened transconjunctivally where the septum was opened in three different spots and the fatty tissues were released and cauterized. Only a moderate amount was resected, not the entire fatty tissues were taken out anticipating that the patient will require the fatty cushioning as he/she advances in aging. The transconjunctival lining was reattached without sutures, and good alignment was obtained.

BLEPHAROPLASTY (Eyelid)

Slight bruising, swelling, and minor eye irritation are normal following eyelid surgery. If eye irritation worsens, inform Dr. Byun so that appropriate medication can be prescribed. You may have small tapes at the corner of each eye which are used to hold the ends of the sutures in place. Do not pull them off. They will be removed, along with the sutures, at your follow-up appointment. Often, the healing process differs, so you may find some sutures still in place until Dr. Byun feels proper healing has transpired. Cleanse any uncovered incisions 3-4 times a day using clean gauze soaked in saline water (found at your local pharmacy) and keep incisions moist with Bacitracin.

Do not wear contacts if you have them. Glasses are appropriate if needed. Wait until your follow up appointment where Dr. Byun will tell you when it is safe to wear contacts again. Avoid bending your head forward as this increases swelling and bleeding. Use ice packs at 15-minute intervals, as much as you can, for the first 48 hours. Continual use of ice applications will serve to eliminate swelling much quicker! Avoid touching the swollen area as much as possible until your follow up appointment with Dr. Byun.

1. MEDICATIONS
   Use the pain pills and anti-nausea we provided, as needed. You can skip if you don’t need them. If you were prescribed an antibiotic, start taking this immediately following surgery and continue until bottle is finished. Dr. Byun will usually give you a one week course. Discontinued use could make you vulnerable to infection. Do not take blood thinners, aspirin, ibuprofen, multi-vitamins, vitamin E, anti-aging medications, herbal pills, and products containing these drugs for two weeks prior to surgery and for two weeks following surgery since they increase bleeding. Continue taking any other pills for blood pressure, cholesterol, birth control and hormone pills as part of your regular routine.
2. BANDAGES
   Leave all external bandages on for 48 hours following surgery. The term external bandages refer to bandages that are not directly applied to the skin then reapply them as instructed per surgery.
3. SWELLING
   Post Operative swelling is normal and peaks about 48-72 hours after the surgery. The majority of the swelling will go down within the first two weeks. Swelling is a part of the healing process, so it is normal for the surgical areas to be swollen for a few months after the procedure as the body heals. You can apply re-useable ice packs to the surgical areas for the first 24-48 hours to help reduce swelling in these areas.
4. BLEEDING
   Small amount of bleeding from incisions is part of the healing process and is normal. Expect bleeding from the incisions 24-48 hours after the procedure. If bleeding continues after this 48-hour period, apply gentle pressure to the area using clean gauze and call our office.
5. SHOWER
   You must shower 48 hours following surgery. At this time you may also remove external bandages (ace wrap, epi-foam, and gauze) as directed by the instructions below pertaining to your particular procedure. BAndages/tape applied directly to the skin, if any, especially those covering incisionsmust not be removed. At this time it is also important to allow soapy water and shampoo to run gently through the incision areas. Baby shampoo is recommended as regular shampoo may sting your incisions. Following your shower, re-apply clean/laundered ace wraps, epi-foam, compression garments, and binders as necessary depending on your particular procedure. Fresh gauze can be placed on incision sites if they are irritated by wraps, foam or garments. For patients who have undergone a procedure to the face: when applying shampoo or conditioner be mindful of the incisions along the hairline. Massage the scalp gently taking extra care to not irritate incisions. Also try to avoid snagging suture incisions with a comb or brush.
6. EXERCISE
   An increased heart rate and blood pressure increases swelling and compromises the healing process, so relax and take it east for the first two weeks following surgery. It is a MUST that you consult Dr. Byun before returning to regular physical activities. With each follow-up as the weeks go by, Dr. Byun will inform you on which activities are suitable for you at that time. Generally however, for the first two weeks light walking and movement is acceptable, while bending forward (as that increases blood pressure in the head and may cause bleeding), stretching the surgery area, and any activities that will raise your heart rate should be avoided.
7. SLEEPING
   Cover your pillow with an old towel or pillowcase as there will be dripping of blood from the incision in the first 24-48 hours after surgery. This is completely normal. For two weeks, sleep using two pillows to elevate your head, neck and shoulders for face related procedures. Should you have any sleeping difficulty, Tylenol PM is the recommended sleep aid. If the problem still exists, we advise that you call our office for a prescriptive drug, after speaking with Dr. Byun.
8. DRIVING
   Try not to drive for one week following surgery. If you must drive however, you may not while taking pain medications. Remember, your safety comes first.
9. SMOKING/ALCOHOL
   If you smoke, do not smoke for two weeks after surgery. Do not wear a Nicotine Patch or chew Nicotine Gum as this constricts your blood vessels and inhibits healing. Do not consume alcohol for at least ten days after surgery as this also raises blood pressure and causes late bleeding. If this will be a problem Dr. Byun can prescribe a medication to help you quit smoking prior to your procedure.
10. NAUSEA/PAIN
    Nausea is a common side effect. It is recommended by Dr. Byun to take Zofran, which was prescribed to you, as soon as you arrive home and one pill before you go to bed. Along with anesthesia, the pain medication may cause nausea. Therefore, you should stop or decrease the amount of pain medication intake. In order to decrease the nausea created by the pain medication, make sure to take it after meals.