I have a lower bleph and skin pinch scheduled in December and will get it done subciliary meaning the incision will be on the outside, just under the eyelash instead of inside. I will be awake with local anesthetic. I was reading about subciliary being common reason for lower eyelid ectopion, or sagging of the lid, post op. This is because the surgeon has to cut through skin and muscle instead of just skin. How common is this post subciliary lower bleph? Is ectopion repairable without surgery?
Answer: Lower lid surgery The subciliary approach to lower lid surgery can increase the risk of lower lid retraction if too much skin is removed. This pulling down of the eyelid is different than ectropion. Lower lid retraction generally needs surgery to repair it. In my hands, I perform all my surgeries via a transconjunctival approach.
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Answer: Lower lid surgery The subciliary approach to lower lid surgery can increase the risk of lower lid retraction if too much skin is removed. This pulling down of the eyelid is different than ectropion. Lower lid retraction generally needs surgery to repair it. In my hands, I perform all my surgeries via a transconjunctival approach.
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November 1, 2023
Answer: Ectropion A quick literature search suggests that rates of ectropion after a subciliary lower bleph are somewhere around 20% (+/- maybe 10% depending on what article you are reading). Some surgeons can do it well, others less so. It is important to ask your own surgeon what his/her rate of ectropion is in his/her practice. As for whether it is repairable without surgery, if it is caught early enough, a surgeon can be very aggressive with certain injections afterward, but from my experience, usually it will require surgery. This is why I personally do not do this approach for my lower blephs, although I know that there are some excellent surgeons who do!
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November 1, 2023
Answer: Ectropion A quick literature search suggests that rates of ectropion after a subciliary lower bleph are somewhere around 20% (+/- maybe 10% depending on what article you are reading). Some surgeons can do it well, others less so. It is important to ask your own surgeon what his/her rate of ectropion is in his/her practice. As for whether it is repairable without surgery, if it is caught early enough, a surgeon can be very aggressive with certain injections afterward, but from my experience, usually it will require surgery. This is why I personally do not do this approach for my lower blephs, although I know that there are some excellent surgeons who do!
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October 31, 2023
Answer: In my opinion, this surgery is not appropriate for local anesthetic. It is primary done this way to save the expense of accrediting an office operating room. Without that accreditation, the surgeon can cut many corners on the adequacy safety, cleanliness, and staffing requirement. Doing this surgery under local is rough. Doing this under iv sedation makes the performance of this surgery much more controlled. That control can make the difference between getting sufficient support for the lower eyelid or not. Surgeons offering a skin pinch often fail to understand that they are creating a much more significant lower eyelid injury than they are. Using the nice sounding euphemism of "skin pinch," is a marketing strategy soft selling surgery. You might be fine or you may end up with a lower eyelid retraction. Lower eyelid retraction after these procedures continues to be quite common.
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October 31, 2023
Answer: In my opinion, this surgery is not appropriate for local anesthetic. It is primary done this way to save the expense of accrediting an office operating room. Without that accreditation, the surgeon can cut many corners on the adequacy safety, cleanliness, and staffing requirement. Doing this surgery under local is rough. Doing this under iv sedation makes the performance of this surgery much more controlled. That control can make the difference between getting sufficient support for the lower eyelid or not. Surgeons offering a skin pinch often fail to understand that they are creating a much more significant lower eyelid injury than they are. Using the nice sounding euphemism of "skin pinch," is a marketing strategy soft selling surgery. You might be fine or you may end up with a lower eyelid retraction. Lower eyelid retraction after these procedures continues to be quite common.
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October 31, 2023
Answer: Ectropion following lower eyelid surgery So you are actually giving two conflicting procedures. I suspect that your surgeons intentions are to perform a transconjunctival lower eyelid bleph with a skin pinch at the end. The risks of ectropion in these cases is less than 1% unless there is significant lower eyelid laxity, If the surgeon is cutting through the muscle then they are not performing a skin pinch, but a true lower lid skin muscle flap.
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October 31, 2023
Answer: Ectropion following lower eyelid surgery So you are actually giving two conflicting procedures. I suspect that your surgeons intentions are to perform a transconjunctival lower eyelid bleph with a skin pinch at the end. The risks of ectropion in these cases is less than 1% unless there is significant lower eyelid laxity, If the surgeon is cutting through the muscle then they are not performing a skin pinch, but a true lower lid skin muscle flap.
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October 31, 2023
Answer: Lower eyelid surgery In our practice for over 30 years, we remove all fat through the inside of the lower lid, which is the gold standard to prevent ectropion. If there's loose and extra skin present on the lower lids, then we make an incision just underneath the eyelashes only remove a small pinch of the skin itself. The reason for the incision on the inside, and the incision on the outside is to prevent any disruption of the lower eyelid muscle, which can cause an ectropion.
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October 31, 2023
Answer: Lower eyelid surgery In our practice for over 30 years, we remove all fat through the inside of the lower lid, which is the gold standard to prevent ectropion. If there's loose and extra skin present on the lower lids, then we make an incision just underneath the eyelashes only remove a small pinch of the skin itself. The reason for the incision on the inside, and the incision on the outside is to prevent any disruption of the lower eyelid muscle, which can cause an ectropion.
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