Preoperative analysis for blepharoplasty should begin with an evaluation of ocular function including visual acuity, intraocular pressure, tear production, preseptal and intraocular slitlamp examination, funduscopy, and extraocular movement (16). Brow position should be assessed next to determine the contribution of brow ptosis to upper eyelid skin redundancy.

Measurements and evaluation of symmetry of the vertical eyelid fissures are performed to detect congenital or acquired blepharoptosis or vertical eyelid retraction. This is done by measuring the distance between the upper eyelid margin and the lower eyelid margin in primary gaze. The range of normal in men is 8-10 mm, and 9-13 mm in women. Measurements below these ranges indicate blepharoptosis, while measurements in excess of these norms indicate vertical eyelid retraction. Incomplete closure of the eyelids with relaxed effort indicates lagophthalmos. Both the upper and lower eyelid margins normally overlap the corneal limbus in primary gaze; if the lower eyelid margin falls below the limbus some sclera will be exposed: this is termed scleral show. The lateral canthus is positioned above the medial canthus and should be in the same plane, or slightly above, the midpupillary line. Evaluation of lower eyelid laxity is commonly performed by assessing how far the lower eyelid can be pulled away from the globe (>10 mm indicates laxity) and observing its ability to spring back. Significant laxity may indicate a tendency toward postoperative ectropion and the need for a lid-shortening procedure.

The position of the superior palpebral eyelid crease is assessed in the midpupil vertical axis from the lid margin, determined by having the patient slowly look upward from maximal downgaze. The position of the crease varies for different populations and according to gender. Normative values for Whites are 8-10 mm in men and 10-13 mm in women (Fig. 11). Asian patients may have no or very low eyelid creases.

Analysis of the prolapsing fat and redundant skin in the lower eyelid is performed with the patient in primary gaze and in downgaze, although the removal of fat during blepharoplasty is highly individualized and subjective. Dermatochalasis -g refers to an acquired excess skin laxity due to aging. The amount of excess skin in the |

lower eyelid can be measured by grasping the putative redundant skin between for- ยป

ceps as the patient gazes upward: production of scleral show or ectropion with this maneuver indicates that a more conservative removal of skin is necessary. Bulging of orbital fat should be documented according to the underlying compartmentalization of the fat in the upper (central and medial) and lower (medial, central, and lateral) eyelids. Lateral hooding in the upper eyelid often indicates a prolapsed lacrimal o gland. Concentric folds inferior to the lower lid that may overlap indicate redundant |

orbicularis oculi muscle and possibly fat; these folds are known as festoons. Festoons

Redundant Upper Eyelid Multiple Folds
Figure 11 The position and height of the eyelid crease in a White woman. The vertical line corresponds to the midpupillary axis.

may be related to the presence of hypothyroidism (found in 2.6% of patients presenting for aesthetic blepharoplasty) (17). Malar bags form over the superior part of the malar prominence and may be due to dependent edema and fibrosis.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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