Pressure Dressings After Transconjuctival Blepharoplasty?

Question

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! Annabel

Brent Moelleken, MD · Answer

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.

Ronald J. Edelson, MD · Answer

Some surgeons blindfold their patients overnight to keep pressure on the eyelids and minimize swelling.  Either pressure bandages or cold compresses are acceptable.  Choose whichever surgeon you are comfortable with and follow their directions. I  personally place pressure bandages on my eyelid patients for about an hour after surgery but remove them prior to sending them home.

Otto Joseph Placik, MD · Answer

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
etc.

Darrick E. Antell, MD, FACS · Answer

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.

Kenneth D. Steinsapir, MD · Answer

Dear Annabel
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.

William Portuese, MD · Answer

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.

Christopher L. Hess, MD · Answer

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.

S. Randolph Waldman, MD · Answer

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.

Robin T.W. Yuan, MD · Answer

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.

Samson Lee, MD · Answer

Peronsally, I do not use compression dressings but it may be a good idea to try to help reduce swelling. I think using an ice pack works better. You are correct that anything that raises intraorbital pressure after surgery could potentially affect your vision, but if you are healthy, do not have hypertension and are not in any blood thinners, you should be at minimal risk.

Pressure Dressings After Transconjuctival Blepharoplasty?

Answers (14)

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