| Popis: |
Dr. Jelks: The first patient (Figure 1) is a 55-year-old woman who had a previous blepharoplasty 10 years before her present consultation. She has palpebral aperture asymmetry and ocular irritation, which currently requires frequent application of ocular lubricants. Dr. Carraway, please evaluate this patient and tell us what blepharoplasty procedure you might consider. Figure 1 Fifty-five-year-old patient with palpebral aperture asymmetry seeks a secondary blepharoplasty. Dr. Carraway: First, I noticed that this patient has staring eyes with slight upper eyelid retraction. She also has some brow ptosis with very active corrugator muscles and mild lateral bowing of the lower lid with some asymmetry of the palpebral fissure, the right being larger than the left. She has mild, but definite, bilateral downward displacement of both lateral canthi, and she may have some mild herniation of the medial fat pads, although that might be residual muscle pull from her previous lower lid blepharoplasty. I would start with the Schirmer test. I would anesthetize the eye with topical anesthesia twice before placing the Schirmer strips to get a true reading of nonreflex tear production. This patient needs, at the very minimum, a bilateral canthopexy with bilateral tarsal strips to correct the lateral canthi. She has fairly flat malar areas, however, and a malar lift by the transforehead route or lower lid route might be helpful. Dr. Jelks: Dr. McCord, what criteria do you use to determine whether a lateral canthoplasty procedure, horizontal lid shortening procedure, or some form of midfacial cheek suspension will be used on a patient who requires secondary eyelid support? Glenn W. Jelks, MD Dr. McCord: First, regarding this patient, I agree with Dr. Carraway's assessment that she has some downward pull of the lower lids laterally and canthal asymmetry. She already has exposure symptoms, so any procedure performed on her should … |
