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    Blepharoplasty – Eyelid Surgery Techniques

    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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