ARTICLE | OPHTHALMOLOGY |
was present, or a lower eyelid skin excision was necessary, a canthopexy was performed.
Indications During the preoperative consultation the author studied the type of ageing present in the orbital region: ■ Ageing skin and excess fat ® patients received a traditional blepharoplasty (for this study, n=45)
■ Ageing with low-melting fat and hollow eyes ® patients required a combination of blepharoplasty and fat grafting using the Coleman technique (n=33)
■ In cases of melasma or spider veins, three preoperative sessions of intense pulsed light, 3 weeks apart, was recommended (n=15)
■ In the case of fine lines, two sessions of radiofrequency (RF) were performed preoperatively, 10 days apart (n=21).
Figure 1 38-year-old male patient who underwent upper-lid blepharoplasty and transconjunctival lower-lid blepharoplasty. (A) and (B) before treatment, and (C) and (D) after treatment
Techniques Radiofrequency The author used a monopolar RF device (Surgitron , Ellman). The application of RF using a dome handpiece and an ultrasound gel applied topically helps to increase skin tautness without heat damage to the epidermis. Before surgery, 21 patients received two sessions of RF (power 20 W) for 10 minutes per zone in the periorbital area.
Phototherapy The flash lamp, emitting between 350 and 1100 nm, was used to treat fine lines, solar elastosis, and age spots. Variables were used at fluences of approximately 10 J/ cm2
, calculated directly by the machine and depending
on patientÕs Fitzpatrick skin type: ■ I ® always burns, never tans ■ II ® always burns, tans less than average ■ III ® sometimes burns, average tanning ■ IV ® rarely burns, tans easily ■ V ® moderately dark skin, always tans ■ VI ® strongly dark or black skin, never burns. The flash lamp should not be used on those patients
with tanned skin and Fitzpatrick phototypes IV and V owing to the risk of residual hyperpigmentation. The best results using this mode of technology are obtained in phototypes I and II. An ultrasound gel was applied to the patientÕs skin;
patient and staff wore protective glasses, and then applied intense pulsed light to the treatment area in a double flash, and one run in the periorbital area for two or three sessions at 3-week intervals.
Blepharoplasty The technique used was classic with a skinÐ muscle resection using an RF scalpel. In the upper-lid the author used a RF scalpel for skin and muscle excision as this type of scalpel is very thin and precise, and also allows coagulation at the same time. Only 3 mm of muscle is excised, and the quantity of skin to resect will depend on preoperative planning and marking. Excision of the fat hernia is only moderate to preserve fat around the eye and avoid a hollow-eye appearance. When skin excision is necessary on the lower lid, a canthopexy may also be performed to avoid skin retraction with the added risk of ectropion; BottiÕs1 technique is used for muscle suspension of the orbicularis flap on the orbital periosteum of the external orbital wall.
Periorbital ageing is multifaceted, 22 ❚
depending on the anatomical element concerned. Excess skin, for example, can be a cap that can sometimes interfere with vision; it can be wrinkled, faded, and stained.
March 2012 |
prime-journal.com
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