BLEPHAROPLASTY oleh dr Frederik Pembimbing Prof M Sjaifuddin

BLEPHAROPLASTY oleh : dr Frederik Pembimbing : Prof. M. Sjaifuddin Noer, dr. , Sp. BP-RE (K) 1

Anatomy Periorbital muscles The orbital bones Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 2

Tarsoligamentous sling and retinacular structure Anatomy of the deepest structures of the posterior lamella and orbital fat pad Codner MA, Ford DT. Blepharoplasty. Grab and Smith Plastic Surgery 6 th edition. Philladelpia: Raven, 2007 3

The anatomic variations in the upper eyelid Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 4

Anatomy Topography periorbital region (eyelid crease) • Superior tarsus is 10 mm in height at its center • Inferior tarsus 3. 8 -4. 5 mm in vertical height 5

Orbicularis Oculi Muscle Divided into three subdivisions § Pretarsal muscle § Preseptal muscle § Orbital muscle • Orbital septum § Fascial membrane that separates eyelid structures to deeper orbital structures § Neither thin nor elastic would make analogous to weakened fascia 6

Anatomical comparison between Oriental and Caucasian eyelid Deep set eye Average depth Oriental 7

Oriental eyelid Supratarsal fold is absent Eyelid thick and hangs down like pseudoptosis Palpebral fissure is narrow Eyelashes point downward Plica mongolia is present in 50% of cases Khoo Boo-Chai 8

In sagittal section 9

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Preoperative Evaluation General Condition § Clinical history and physical examination § Patient personality, expectations for surgery § Psychological assessment • Eye Function § Visus, Intraocular pressure, Muscle Function • Frame of the eyelid § Forehead (ptosis, wrinkles), shape &position eyebrow § Cheeks and depth of nasolabial folds § Upper orbital rim 11

Preoperative Evaluation Orbicularis oculi • Tarsal plate Stasior lid distention test Flower eyelid retraction test § Skin and subcutaneous Squinch test Pinch test 12

Surgical technique Anesthesia § Blepharoplasty is most frequently done under local anesthesia § Use lidocain 1% with 1: 100 - 200. 000 epinephrine with 27 gauge needle 13

Surgical technique Basic surgical technique Think in terms of three layer: § Skin (excision of redundancy) § Muscle (excision of an appropiate strip of orbicularis oculi) § Fat (removal of an appropiate amount of orbital fat if indicated) 14

Blepharoplasty superior - simple skin excision - Anchor blepharoplasty - Levator aponeurosis plication Blepharoplasty inferior - transconjungtival blepharoplasty - transcutaneous blepharoplasty - simple skin excision - lateral canthal anchoring - Kuntz-simanovsky 15

Surgery marking Upper blepharoplasty Lower blepharoplasty Codner MA, Ford DT. Blepharoplasty. Grab and Smith Plastic Surgery 6 th edition. Philladelpia: Raven, 2007 16

Upper Blepharoplasty Skin Marking § Supratarsal fold located at different distances from individual, varying 7 – 12 mm. § There is no uniform distance to locate the line § Usually 8 -12 mm above centrally, 5 -6 mm above medially and laterally canthal crease 17

Simple skin excision blepharoplasty Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 18

Anchor blepharoplasty technique Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 19

Lower Blepharoplasty Objectives § Correction of periorbital fat or skin, or both § Correction of 3 components lower lids: § Orbicularis muscle § The tarsus § The orbital septum • Transconjunctival approach • Skin Muscle Flap Technique 20

Lower Blepharoplasty (transconjungtival approach) Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 21

Lower Blepharoplasty (transconjungtival approach) Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 22

Fat pad removal-repositioning Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 23

Septoorbitoperiostoplasty for the treatment of palpebral bags Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 24

Skin Muscle Flap Technique 25

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Correction a ‘muscle roll’ 27

Post-operative care Bandaging of the eyes following operation is not essential Ice compresses (first 24 hrs to reduces edema and echymosis) Topical antibiotic ointment and oral during fifth day Suture removed on 4 -5 post op Squeezing eye lids after 1 week Makeup on about 10 post-op 28

Komplikasi Short Term § Loss of Vision § Retrobulbar Hematoma § Wound Dehicense Long Term § Dry eye Syndrome § Hypertrophic scar and Keloid § Epiphora § Infection § Asymmetry 29

Daftar pustaka • Few. J, Ellis. M in Neligan, PC. Blepharoplasty. Plastic Surgery 3 rd edition. Washington: Elsevier, 2013 • Codner MA, Ford DT. Blepharoplasty. Grab and Smith Plastic Surgery 6 th edition. Philladelpia: Raven, 2007 30