Use of corneal shields in blepharoplasty
Personally, I do not use eye Shields and upper blepharoplasty. Given that the eyelids are closed during this procedure, there is, at least in my mind, no good reason to use them.
In trans-conjunctival blepharoplasty, I routinely use shields to further protect the cornea. If skin tightening requires incisions under the eyelashes, I do not use shields.
In general, what your facial plastic surgeon prefers as his routine and time-proven approach needs to make you comfortable before undergoing eyelid lift surgery.
Eye Shields for Blepharoplasty
Eye shields are not absolutely necessary for a blepharoplasty, but they do make the procedure safer. It is like using leg massagers to reduce the risk of leg blood clots. Although not absolutely necessary, and most people do not develop blood clots, if they prevent blood clots in just one patient who could otherwise die from them, they are worth using them. If eye shields prevent just one corneal injury, they are worth using. As an aside, I would also ask about exactly what will be done through the transconjunctival incision. This procedure is only successful if you have minimal excess lower eyelid skin. Many surgeons using this incision simply remove fat through it. Today, this is unacceptable except for young patients with specific congenital excess fat. (These rarely need an upper blepharoplasty.) Modern transconjunctival blepharoplasty technique, instead of removing the fat, repositions it over the bony orbital rim to help hide the tear trough. I would also inquire about whether fat will be removed from the upper lids. Except for occasionally doing so in the most medial pocket, this also has been found to actually age the eyes.
Is an eye shield importance for upper and lower blepharoplasty?
Obviously I can't answer to what your surgeon's preferences are, but if there is any damage to your cornea during the procedure, it would not have happened with eye shields present.
Eye shields for upper and lower blepharoplasties?
I try to do my surgery and keep the patient safe at the same time. That said, I do not use eye shields during upper or lower blepharoplasties that are done via the skin route. Always use them though for all eyelid surgery done with lasers and with lower blepharoplasties done trans-conjunctivally. However eye shields themselves can scratch the cornea so make sure they are well lubricated to diminish this risk.
Corneal shields are very important for safety during blepharoplasty eyelid surgery
Thank you for your question. Even with the greatest care there are many possibilities for eye injury from instrumentation or lasers during eyelid surgery. In my opinion corneal shields should always be used during blepharoplasty surgery.
Eye shields for trans- conjunctival blepharoplasty
Shields are absolutely necessary if you're having laser work anywhere close to your eye. In our practice, we do not use eye shields when performing a blepharoplasty. There are too cumbersome and we have actually seen scratches of the cornea even while using them.
For uppers they are not as important as for lowers. With a transconj approach, I would use them with rare exception.
Are the eyes covered after blepharoplasty?
Shields are not necessary after blepharoplasty or most other eyelid surgeries. This provides the ability to perform surgery on both sides and the patient can see and function after surgery. This is different than when having intraocular surgery such as cataracts.
Upper blepharoplasty is generally not performed transconjunctivally.
Eyelid surgeons who are not board certified in ophthalmology (e.g. general plastic surgeons, facial plastic surgeons, dermatologic surgeons) are very uncomfortable operating near the cornea surface. They are also uncomfortable placing corneal shields on the cornea. Oculoplastic surgeons are board certified ophthalmologists who are also fellowship trained in eyelid and facial plastic surgery. They are very comfortable working near the eye. They have been extensively trained to perform microsurgery on the eye itself.
Generally a corneal shield is not specifically needed for corneal protection. The reason for this is simple. When performing transconjunctival lower blepharoplasty exposure of the back of the lower eyelid requires the eyelid to be pulled gently away from the eye. Also a retractor called an eye plate (think of a small flat spatula) is coated with opthalmic ointment and placed against the cornea, The plate protects the eye and is also used to move the eye back to make the room necessary, in conjunction with the eyelid retractor, to carry out the surgery. So protection of the eye is built into how this surgery is performed.
Upper blepharoplasty usually does not require a cornea shield because it is considered sufficiently far away from the eye that it is not necessary. However there are situations that change this. Primarily if upper eyelid ptosis surgery is also performed at the time of upper blepharoplasty, a shield may be used to protect the cornea when sutures are being placed in the upper eyelid tarsus.
Are eye shields always used during blepharoplasty?
My personal answer is no but you will likely see different responses here on RealSelf and during consultations. There are strong proponents of either practice and this is often based on training - what our mentors taught us to do, we continue to do. As far as I am aware there are no data or study results to suggest that one practice is superior to another. As with your question on anesthesia, if you trust your surgeon and they are experienced and produce great results, I would recommend following their advice.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon