Blepharoplasty, although routine for the average oculoplastic surgeon, is a surgical procedure that can lead to complications. These complications can be avoided if certain considerations are made pre-operatively.
Many patients come to clinic with complaints of ‘heavy’ or ‘droopy’ eyelids. It is paramount to determine whether this feeling is secondary to brow ptosis. In such a case, it may be detrimental to perform a blepharoplasty, because in doing so, the brow can be pulled down further, leading to lagophthalmos. A blepharoplasty can be performed in some cases of brow ptosis, but careful measurements should be made with calipers in order to leave sufficient tissue between the lower edge of the brow and the upper skin marking. I usually leave between 11 and 13mm.
Pre-operative medical history is also essential. Does the patient have a systemic condition that requires blood thinners? In this case, it is important to communicate with the patient’s cardiologist or internist to see if it is reasonable to stop these blood thinners prior to surgery. If it puts the patient at systemic risk, then it is probably not worth it to perform this elective procedure.
Does the patient have a strong history of skin cancers? If so, consideration of keeping that excess skin for use in future reconstructions should be given. Also, is there an underlying systemic condition responsible for causing the excess tissue/edema that can be mistaken for straightforward dermatochalasis? Thyroid disease? Lymphatic drainage problem or kidney disease? Cancer requiring medication that can cause eyelid swelling? Lacrimal gland disease? A thorough examination can help uncover lacrimal gland tumors that can be causing a picture similar to dermatochalasis.
Finally, make sure your patient has realistic expectations of what you can offer. A thorough pre-operative discussion of the procedure and post-operative course is key so that they enter the experience with an educated mind. In general, patient satisfaction is more likely if you under-promise and over-deliver.