Pressure Dressings After Transconjuctival Blepharoplasty?
- Asked by Annabel V. in London, UK
- 4 years ago
I am about to have lower transconjuctival Blepharoplasty with fat removal. My surgeon recommends that tight compresses should be used for at least 12 hours post-op. I have read a medical paper that recommends no pressure dressings as they increase intraorbital pressure and prevent early detection of bleeding. Any views on this? Feeling quite anxious about the surgery!
There should be no reason to use a pressure dressing underneath the eyes after lower eyelid surgery. Perhaps your surgeon just meant cold compresses, not compressive dressings per se.
If bleeding should occur, it might be trapped in a tight space, or go unrecognized. This could lead to very damaging pressure on the eyeball and optic nerve.
Usually doctors recommend ice, elevation, decreased activity postoperatively. Surgery should be carefully performed, to minimize bleeding. The patient should be medically optimized before surgery, to reduce the chance for high blood pressure (a leading cause of bleeding). The surgery should be performed in a monitored setting in an accredited surgical facility, to see if potentially dangerous early warning signs of changes to the vital signs are there.
Web reference: http://www.drbrent.com/eye-rejuv.php
There is no need to put pressure dressings after transconjunctival blepharoplasty. It will increase intraorbital pressure and will prevent early detection of a hematoma around the eyelids. Patients usually just wear sunglasses to hide the bruising and swelling that occurs with the procedure.
The information you have is correct. There is absolutely no use for pressure dressing in eyelid surgery. Fat removal must be done carefully to avoid any bleeding. Bleeding can lead to significant problems. So all surgeons who do eyelid surgery must be 100% sure that the field is dry at the end of the case. I have never heard of this before so I would be suspicious.
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Pressure dressings have no role in eyelid surgery.
Pressure is neither effective nor safe in the eyes. The outcome is determined only by how the surgery is done.
With blepharoplasty in NYC, we use cold compresses, elevating the head, and Arnica and Bromolein, to minimize bruising and sweelling.
Many different ways to minimize bleeding
There are many other ways to minimize bleeding around the eye other than pressure that tend to be preferred by surgeons. Some of these include:
- Avoidance of blood thinner medications preoperatively
- Good intraoperative technique and hemostasis
- Control of blood pressure
- Pain management
- Head elevation
- Ice compresses
I have a difference of opinion
Having read my well-trained and experienced colleagues comments, I agree with the basics of what they have said. However, I suspect that what your surgeon may have proposed, and what I frequently do myself, is to place a moist cotton dental roll on the lower eyelids with a horizontal piece of paper tape to hold it for about 24 hours.
This provides a minimal amount of pressure and seems to decrease the amount of bruising. The incision with a transconjunctival lower eyelid blepharoplasty is typically not closed, so bleeding, should it occur, would still leak out of the open incision. My suggestion is that you speak with your surgeon to further clarify the issue.
Please cancel your surgery and find a surgeon who makes sense!
There is absolutely no reason to patch the eyes after blepharoplasty. Patching will not prevent orbital bleeding after eyelid surgery but it will make it more likely that you can go blind if your suffer bleeding following surgery. A very important sign that prompts immediate post operative re-assessment by the surgeon is loss of vision after surgery. If your eyes are patched after you cosmetic eyelid surgery, you will never know if there is a problem with the vision. I should stress that we are talking about rare events. So it is possible that your surgeon has gotten away with a bad habit simply because he has yet to experience an orbital hemorrhage after surgery. However, this is such a profound departure from what reasonable surgeons do I would strongly recommend that you find another surgeon. This is a red flag.
Definitely avoid pressure after this procedure
Swelling after a transconjunctival Blepharoplasty should be minimal and bleeding negligible so there is really no reason for a dressing. Perhaps you misunderstood the surgeon in that we always recommend ice compresses for the first 12 hours after surgery.
Cancel surgery if you are anxious or uncertain about Blepharoplasty
I do transconjunctival blepharoplasty exclusively (have for 14 years--2400 cases) and have never used compression dressings. I would worry that compression could interfere with blood supply to the eyelid and also worry about the effect on intraocular pressure.
I do use a small steri-strip tape support for the lower eyelid but it exerts no pressure.
You sound anxious and uncertain. I recommend that you cancel your surgery until you are comfortable and confident in your doctor. Uncertainties pre op almost always result in anxiety and difficulties post op.
You need to have a very positive confident attitude to achieve the best result and post operative course.
Pressure dressings ineffective for lids
Any pressure applied to the lids will get transmitted to the eyeball and surrounding soft tissue structures such as blood vessels and nerves. It would be hard to imagine enough pressure being applied to the fat compartment where the surgery takes place to stem any bleeding problem that isn't great enough to cause potential harm to the surrounding orbital structures. Post-op bleeding is controlled by meticulous intra-operative technique. Post-op swelling is best controlled by simple light cold compresses and elevation of the head.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.