Recently our fellow and I reviewed my long term data on results to lower lid blepharoplasty. I could not find such an extensive review of data with this case number in the literature. The surgical series is over a 10 year period and includes 640 cases. Important to consider is that I only perform transconjunctival surgery so the information only applies to this approach. Appropriate surgical adjuncts were included when clinically deemed necessary. These additional procedures included: canthal suspension, skin excision, fat transposition (repositioning), oseocutaneous ligament release, fat grafting and orbicularis plication (suspension).
Below are the results identified from the data collected:
- 640 cases total
- Women – 505 cases; Men – 135 cases
- Average age - 56 years
- Average F/U - 14 months
- Transconjunctival blepharoplasty only - 60 cases (9%)
- Transconjunctival blepharoplasty with fat repositioning - 580 cases (91%)
- Chemosis - more than mild at more than two weeks post-op 41 case (6.4%)
- Trichiasis - 9 cases (1.4%) - all needed intervention
- Revise fat re-excision - 9 cases (1.4%)
- Hollows - 30 cases (4.6%) - most lateral lid/cheek junction – 25 of the 30 cases (83%) were pre-warned this may occur, but refused interventions to prevent.
- Complaints of wrinkles or skin excess post-op - 14 cases (2.2%)
- Cicatricial entropion requiring buccal graft - 3 cases (0.5%) - All had fat transposition.
- Ectropion (no skin manipulation) - 1 case - related unaddressed laxity
- Lower eyelid retraction (all mild) - 6 cases ( 1%); 4 cases (0.6%) had skin/muscle manipulation (ie. pinch); 2 cases (0.3%) had no skin/muscle manipulation – but did have prominent eyes with gradient (vector) worsening (even with fat transposition)
- Periorbital fat grafting - 83/640 patients (9.6%). 7 of these (1.4%) developed contour issues (most with older larger (2 mm) harvest cannulas). 4 of these patients were revised and happy. 2 patients tolerated their final outcome. 1 patient unhappy and actually angry.
- Infection/severe inflammation - 7 cases (1.4%).
- Satisfaction study not done
- Satisfaction study of last 86 patients with fat transposition only was done with 4.8/5 average score on 5 point Likert scale: 1: Very unsatisfied, 2: unsatisfied, 3: neutral, 4: satisfied, 5: Very satisfied. The procedure found to be safe and effective
What this has taught me is that 79% of surgery is on woman in their mid 50’s. In general complications are rare and treatable. Fat grafting contour issues occur in 8.4% of cases, which I feel is unacceptably high – but not surprising. This complication rate is most assuredly lower with the newer (smaller port) harvesting cannulas. As expected, patient satisfaction is high.
I certainly learned a lot from this lower blepharoplasty data. I hope it is of help to others.
Ptosis surgery is a procedure that lifts an upper eyelid that has dropped. It is surgery on the elevating muscles of the eyelid (Mueller’s muscle or the Levator muscle/aponeurosis). This is very different than blepharoplasty surgery which is the more simplistic removal of variable amounts of skin, muscle and fat from the upper lids (typical cosmetic eyelid surgery).
Dr. Guy Massry is a Beverly Hills oculoplastic surgeon who specializes in ptosis repair surgery. Patients fly in from around the world to have surgery with Dr. Massry because he is internationally recognized for his ability to provide patients suffering from droopy upper eyelids with the best results possible.
With this basic framework in mind, Dr. Massry will tell you how to attain the best results to ptosis surgery:
1. Only have a qualified and experienced ptosis surgeon do your repair. This is always a board certified oculoplastic or ophthalmic plastic surgeon – the only surgeons with specialized ptosis training. Dr. Massry has this training and experience.
2. Have the correct surgery selected - ptosis repair, not a blepharoplasty. Dr. Massry will help you with this. Surgery can be performed from inside the eyelid (no skin cuts/scars) which requires no patient cooperation during surgery. Alternatively, it can also be performed through the skin (more complex and requires patient cooperation during surgery). To do it from inside of the eyelid (which most surgeons prefer as it is easier on patient and surgeon) some findings on examination must be present – Dr. Massry will identify this.
3. Make sure your surgeon has vast experience with ptosis surgery, as Dr. Massry does. Ptosis surgery complications can be troublesome, but you can avoid this by choosing a surgeon with extensive expertise in this area of surgery.
4. Make sure your surgeon has an aesthetic eye. In addition to his surgical techniques, Dr. Massry has an artistic eye to provide his patients with not only functional results, but also with fantastic aesthetic results.
5. Get the most out of your consultation. It is the time for you to ask a lot of questions and get a very thorough understanding of the procedure. You should leave feeling 100% comfortable and confident with your surgeon and the upcoming ptosis repair. Dr. Massry will spend as much time with you as necessary to make sure this is achieved. "The only bad question is the one not asked," Dr. Massry.
Schedule Your Ptosis Repair Consultation Today!
If you are experiencing droopy upper eyelids and are ready to learn more about your surgical options, please call us to schedule your consultation with Dr. Massry today - 310.657.4302!
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