Blepharoplasties

Antoszyk JH, Tucker N, Codere E Orbital decompression for Graves disease exposure through a modified blepharoplasty incision. Ophthalmic Surg 1992 23 516-521. 

If surgical blepharoplasty is not combined with a facelift, Lip Eyelid formula can be applied on the eyelids at the same time as the face-lift. 

On the eyelids, however, the fat hernia around the orbit was removed through the transconjunctival approach and combined - in expert hands - successfully and safely with a local phenol peel. McCollough and Maloney combined surgical blepharoplasty with a phenol peel, but left the skin to rest for 3 months before doing the eyelid peel. 

McKinney P, Zukowski ML, Mossie R. The fourth option a novel approach to low lip blepharoplasty. Aesth Plast Surg 1991 15 293-6. 

We will look at the chemical blepharoplasty and/or cheilo-plasty (labioplasty) technique in detail in Chapter 36. 

Normal face-lift scars are not usually too unsightly, but some patients want a treatment to soften them or get rid of them completely. A full-face phenol peel is the best option (Figure 30.19), but a local application of phenol precisely on the scar is also a possibility, in combination with another more superficial peel (to the papillary dermis, the Grenz zone or the basal layer). Standard scars from an upper blepharoplasty do not seem to respond as well to a... 

Typical abnormalities of the upper eyelid after several surgical blepharoplasties. 

Occlusion of the upper eyelid, which is only indicated to increase the depth of action of the peel, will always be essentially extratarsal (Figure 36.6). In the large majority of cases, a chemical blepharoplasty is done without occlusion. 

Application of bismuth to all four eyelids chemical blepharoplasty and evening-out peel (Unideep ). The Unideep post-peel cream is applied to the face immediately after the peel, the evening of the peel and the following morning. This photograph was taken on day 1. 

Normal edema over the first 2 days that has spread to the cheek area, (a) Chemical blepharoplasty of the four eyelids, (b) Chemical blepharoplasty of the upper eyelid only, (c) Chemical blepharoplasty of the lower eyelids only. 

Examples of the results of chemical blepharoplasty. (a,b) Chemical blepharoplasty of the upper eyelids and Easy TCA as an evening-out peel. (c,d) Chemical blepharoplasty of the lower lids and Easy TCA as an evening-out peel. 

Benign delayed healing after chemical blepharoplasty. 

When a chemical blepharoplasty is performed without occlusion, the increased depth of action of the phenol sometimes translates into a persistent moist scab in the inside corner of the upper eyelid (Figure 36.16), where the phenol has macerated more intensely. Applying an antibiotic cream or ointment remedies the problem, and it should resolve before the 15th day. There are no sequelae from this slow healing. If the scab persists for more than 2 weeks, the doctor should remain alert and monitor the patient more closely. 

Chemical blepharoplasty of the upper and/or lower eyelids with Lip Eyelid formula is a relatively simple technique... 

A chemical cheiloplasty or labioplasty treats wrinkles around the lips. The principle of the treatment is identical to that of a chemical blepharoplasty, but it is easier to treat wrinkles on the upper lip than on the eyelids. It is also less stressful for an inexperienced doctor. 

A full face deep peel should not be done at the same time as a face-lift however, it is possible to do a chemical cheiloplasty or a chemical blepharoplasty at the same time as a surgical face-lift, for example. 

Surgical treatment it is in fact the most common complication after surgical blepharoplasty. Particular care should be taken when doing a peel if the patient has a history of blepharoplasty and even more so in cases of multiple blepharoplasties. Patients with lagophthahnia should in principle be ruled out from deep peels, although some cases can be treated cautiously. 

Cryoanesthesia with a cold pack during combined chemical blepharoplasty (Lip Eyelid ) and TCA to the papillary dermis... 

Chemical blepharoplasty and cheiloplasty are ideally carried out with Lip Eyelid formula its action is more gradual than that of Baker-Gordon or Litton phenol, and it can be applied locally without any anesthetic since the pain only lasts 12-15 seconds. 

Chemical blepharoplasty is treatment of the eyelids with a localized deep peel. Chemical cheUoplasty is treatment of the lips with a localized deep peel (see Chapter 36). 

The high risk of focal or widespread facial necrosis contraindicates a phenol peel immediately after a face-lift. If a face-lift and a deep peel have to be combined, the surgical face-lift must be done first and the chemical peel afterwards to avoid the demarcation line being surgically lifted to the cheek. Caution usually dictates a gap of 6 months between a surgical face-lift and a deep peel. It is of course possible to perform a face-lift without blepharoplasty and a phenol peel around the mouth and eyelids at the same time... 

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