Facial Plast Surg 2021; 37(03): 333-339
DOI: 10.1055/s-0041-1722908
Original Research

Routine Postoperative Management of Blepharoplasty: A Review of Current Evidence-Based Practice

1   Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
,
Eamon Shamil
2   Department of Otolaryngology and Facial Plastic Surgery, University Hospital Lewisham, London, United Kingdom of Great Britain and Northern Ireland
,
Alwyn Ray D'Souza
3   Department of Otolaryngology, Lewisham and Greenwich NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Funding None.

Abstract

Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion “bleph*” was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4–5 evidence). Few randomized controlled trials were performed (level 2). Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.

Ethical Approval

Ethical approval was not sought as it was not required for this study.


Note

All authors and coauthors have contributed to the significant part of the article and, therefore, have taken part in writing the article, reviewing it, and revising its intellectual and technical content. All authors take responsibility and accountability for the results.




Publication History

Article published online:
24 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 BBC. Liposuction rise linked to gym wear trend. https://www.bbc.co.uk/news/health-48333806 Accessed March 3, 2020
  • 2 DeMere M, Wood T, Austin W. Eye complications with blepharoplasty or other eyelid surgery. A national survey. Plast Reconstr Surg 1974; 53 (06) 634-637
  • 3 Oxford Centre for Evidence-Based Medicine. OCEBM Levels of Evidence. https://www.cebm.net/index.aspx?o=5653 . Accessed on January 1, 2021
  • 4 Joshi AS, Janjanin S, Tanna N, Geist C, Lindsey WH. Does suture material and technique really matter? Lessons learned from 800 consecutive blepharoplasties. Laryngoscope 2007; 117 (06) 981-984
  • 5 Scaccia FJ, Hoffman JA, Stepnick DW. Upper eyelid blepharoplasty. A technical comparative analysis. Arch Otolaryngol Head Neck Surg 1994; 120 (08) 827-830
  • 6 Mommaerts MY, Beirne JC, Jacobs WI, Abeloos JS, De Clercq CA, Neyt LF. Use of fibrin glue in lower blepharoplasties. J Craniomaxillofac Surg 1996; 24 (02) 78-82
  • 7 Veloudios A, Kratky V, Heathcote JG, Lee M, Hurwitz JJ, Kazdan MS. Cyanoacrylate tissue adhesive in blepharoplasty. Ophthal Plast Reconstr Surg 1996; 12 (02) 89-97
  • 8 Kouba DJ, Tierney E, Mahmoud BH, Woo D. Optimizing closure materials for upper lid blepharoplasty: a randomized, controlled trial. Dermatol Surg 2011; 37 (01) 19-30
  • 9 Greene D, Koch RJ, Goode RL. Efficacy of octyl-2-cyanoacrylate tissue glue in blepharoplasty. A prospective controlled study of wound-healing characteristics. Arch Facial Plast Surg 1999; 1 (04) 292-296
  • 10 Pool SM, Krabbe-Timmerman IS, Cromheecke M, van der Lei B. Improved upper blepharoplasty outcome using an internal intradermal suture technique: a prospective randomized study. Dermatol Surg 2015; 41 (02) 246-249
  • 11 Jordan DR, Mawn L, Marshall DH. Necrotizing fasciitis caused by group A streptococcus infection after laser blepharoplasty. Am J Ophthalmol 1998; 125 (02) 265-266
  • 12 Klapper SR, Patrinely JR. Management of cosmetic eyelid surgery complications. Semin Plast Surg 2007; 21 (01) 80-93
  • 13 Ferneini EM, Halepas S, Aronin SI. Antibiotic prophylaxis in blepharoplasty: review of the current literature. J Oral Maxillofac Surg 2017; 75 (07) 1477-1481
  • 14 Perkins SW, Prischmann J. The art of blepharoplasty. Facial Plast Surg 2011; 27 (01) 58-66
  • 15 Zoumalan CI, Roostaeian J. Simplifying blepharoplasty. Plast Reconstr Surg 2016; 137 (01) 196e-213e
  • 16 Lieberman DM, Quatela VC. Upper lid blepharoplasty: a current perspective. Clin Plast Surg 2013; 40 (01) 157-165
  • 17 Weissman JD, Most SP. Upper lid blepharoplasty. Facial Plast Surg 2013; 29 (01) 16-21
  • 18 Will MJ. Upper eyelid blepharoplasty. Atlas Oral Maxillofac Surg Clin North Am 2016; 24 (02) 125-133
  • 19 Morax S, Touitou V. Complications of blepharoplasty. Orbit 2006; 25 (04) 303-318
  • 20 Lyle WG, Outlaw K, Krizek TJ, Koss N, Payne WG, Robson MC. Prophylactic antibiotics in plastic surgery: trends of use over 25 years of an evolving specialty. Aesthet Surg J 2003; 23 (03) 177-183
  • 21 Matiasek J, Kienzl P, Otti GR, Turk BR, Djedovic G, Rieger UM. Aseptic surgical preparation for upper eyelid blepharoplasty via full-face octenidine antiseptic without antibiotic medication shows effective prophylaxis against post-surgical wound infection. Int Wound J 2018; 15 (01) 84-89
  • 22 Fezza JP. The sigmoid upper eyelid blepharoplasty: redefining beauty. Ophthal Plast Reconstr Surg 2012; 28 (06) 446-451
  • 23 Kashkouli MB, Jamshidian-Tehrani M, Sharzad S, Sanjari MS. Upper blepharoplasty and lateral wound dehiscence. Middle East Afr J Ophthalmol 2015; 22 (04) 452-456
  • 24 Whipple KM, Lim LH, Korn BS, Kikkawa DO. Blepharoplasty complications: prevention and management. Clin Plast Surg 2013; 40 (01) 213-224
  • 25 Lam SM. Asian blepharoplasty. Facial Plast Surg Clin North Am 2014; 22 (03) 417-425
  • 26 Davison SP, Iorio ML, Oh C. Transconjunctival lower lid blepharoplasty with and without fat repositioning. Clin Plast Surg 2015; 42 (01) 51-56
  • 27 Terella AM, Wang TD, Kim MM. Complications in periorbital surgery. Facial Plast Surg 2013; 29 (01) 64-70
  • 28 Putterman AM. Regarding comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg 2009; 124 (01) 313-314
  • 29 Oestreicher J, Mehta S. Complications of blepharoplasty: prevention and management. Plast Surg Int 2012; 2012 (09) 252368
  • 30 Weinfeld AB, Burke R, Codner MA. The comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg 2008; 122 (02) 579-586
  • 31 Rohrich RJ, Cho MJ. The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg 2018; 141 (02) 507-515
  • 32 Sakallioğlu Ö, Polat C, Soylu E, Düzer S, Orhan İ, Akyiğit A. The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Ann Plast Surg 2015; 74 (04) 392-396
  • 33 Ghavimi MA, Taheri Talesh K, Ghoreishizadeh A, Chavoshzadeh MA, Zarandi A. Efficacy of tranexamic acid on side effects of rhinoplasty: a randomized double-blind study. J Craniomaxillofac Surg 2017; 45 (06) 897-902
  • 34 Groenewold MD, Gribnau AJ, Ubbink DT. Topical haemostatic agents for skin wounds: a systematic review. BMC Surg 2011; 11 (01) 15
  • 35 Tscholl V, Spann F, Moses J. et al. Prospective randomized study evaluating the effects of PerClot® (Polysaccharide Hemostatic System) application in patients with high bleeding risk undergoing cardiac rhythm device implantation. Int J Cardiol 2017; 248 (0C): 84-91
  • 36 Bartley GB, Lowry JC, Hodge DO. Results of levator-advancement blepharoptosis repair using a standard protocol: effect of epinephrine-induced eyelid position change. Trans Am Ophthalmol Soc 1996; 94: 165-173 , discussion 174–177
  • 37 Mather C, Smith JH, Bloom PA. The efficacy of 0.75% bupivacaine with pH adjustment and hyaluronidase for peribulbar blockade: the incidence of prolonged ptosis. Eur J Ophthalmol 1994; 4 (01) 13-18
  • 38 Jehan FS, Hagan III JC, Whittaker TJ, Subramanian M. Diplopia and ptosis following injection of local anesthesia without hyaluronidase. J Cataract Refract Surg 2001; 27 (11) 1876-1879
  • 39 Neuhaus RW. Tips for local anesthesia in blepharoplasty. Ophthalmic Surg 1988; 19 (07) 525
  • 40 Ropo A, Ruusuvaara P, Paloheimo M, Maunuksela EL, Nikki P. Periocular anaesthesia: technique, effectiveness and complications with special reference to postoperative ptosis. Acta Ophthalmol (Copenh) 1990; 68 (06) 728-732
  • 41 Zoumalan CI. Managing periocular filler-related syndrome prior to lower blepharoplasty. Aesthetic Plast Surg 2019; 43 (01) 115-122
  • 42 Vick VL, Holds JB, Hartstein ME, Rich RM, Davidson BR. Use of autologous platelet concentrate in blepharoplasty surgery. Ophthal Plast Reconstr Surg 2006; 22 (02) 102-104
  • 43 Kondapalli SSA, Czyz CN, Stacey AW, Cahill KV, Foster JA. Use of kaolin-impregnated gauze for improvement of intraoperative hemostasis and postoperative wound healing in blepharoplasty. J Clin Aesthet Dermatol 2016; 9 (06) 51-55
  • 44 Hamawy AH, Farkas JP, Fagien S, Rohrich RJ. Preventing and managing dry eyes after periorbital surgery: a retrospective review. Plast Reconstr Surg 2009; 123 (01) 353-359
  • 45 Hilton S, Schrumpf H, Buhren BA, Bölke E, Gerber PA. Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients. Eur J Med Res 2014; 19: 30
  • 46 Neil-Dwyer JG, Evans RD, Jones BM, Hayward RD. Tumescent steroid infiltration to reduce postoperative swelling after craniofacial surgery. Br J Plast Surg 2001; 54 (07) 565-569
  • 47 van Exsel DCE, Pool SMW, van Uchelen JH, Edens MA, van der Lei B, Melenhorst WBWH. Arnica ointment 10% does not improve upper blepharoplasty outcome: a randomized, placebo-controlled trial. Plast Reconstr Surg 2016; 138 (01) 66-73
  • 48 Kotlus BS, Heringer DM, Dryden RM. Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study. Ophthal Plast Reconstr Surg 2010; 26 (06) 395-397
  • 49 D'Assumpção EA. DAssumpcao E. Blepharoplasty. Blepharoplasty: a personal tactical approach. Aesthetic Plast Surg 1999; 23 (01) 28-31
  • 50 Pool SMW, van Exsel DCE, Melenhorst WBWH, Cromheecke M, van der Lei B. The effect of eyelid cooling on pain, edema, erythema, and hematoma after upper blepharoplasty: a randomized, controlled, observer-blinded evaluation study. Plast Reconstr Surg 2015; 135 (02) 277e-281e