BLEPHAROPLASTY TECHNIQUES – A PERSONAL JOURNEY!

Upper eyelid-          PreOp Evaluation- Brow position and shape - Animated vs. Relaxed (eyes closed)          Relationship of brow to supraorbital rim          Dynamic/ Static forehead wrinkles          Markings- Precision – fine tip pen          Dotted line          Sitting – Medial point          Inferior aspect of lateral wrinkle          Center transposition of lid crease anteriorly          Supine – Lid crease – lash line to LC 7-10 mm          Takeoff from lateral canthus to lateral aspect of brow          Superior line 10-12 mm from inferior aspect of brow Technique- Excision of skin and orbicularis muscle          Adjust lateral skin discrepancy first with interrupted sutures          Closure with running subcuticular 6-0 prolene Lower Eyelid-          PreOp Evaluation- Shape of eye          Palpebral tilt – Medial vs. Lateral canthus          Lid laxity – Snap Test and Distraction Test          Vector – positive vs. negative          Fat ballottement and patient history          Mirror Test* Special Considerations – Fat pad preservation vs. conservation        -Negative vector and good quality skin         Canthopexy vs. canthoplasty        -Need for elevation of lateral canthus        -Blunted/rounded lateral canthus Technique- Skin muscle flap        Wide release at Arcus Marginalis        Dissect out medial middle and lateral fat pads        Division/release of inferior crus of lateral canthus        Skin and muscle excision        Dissect orbicularis of lower eyelid skin        Suture lateral orbicularis to lateral orbital periostium (4-0 polydek/ P-2 needle)        Closure with running subcuticular 6-0 prolene        EVALUATE PATIENT IN SITTING POSITION        Tarsorrhaphy suture in all quad blepharoplasties

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Dr. Chasan, a renowned San Diego plastic surgeon, takes great pride in helping San Diego breast augmentation, tummy tuck and facelift patients realize their aesthetic dreams.