Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal tendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just as important as surgical technique. 1. Preoperative Assessment In the initial assessment, patients are encouraged to voice their desires and concerns regarding the aesthetic appearance and functional features of their eyelids. Reassuring the patient that privacy will be maintained helps facilitate the patient’s ability to articulate his or her desired outcome. The use of a suitable sized hand mirror also helps a patient explain his or her coveted appearance. If the patient continues to have difficulty describing or demonstrating what he or she desires changed, and into what, it obligates the surgeon to promote discussion or present alternatives until clear agreement occurs—otherwise, surgery should not be done. It is important to elicit particular concerns of each individual patient, and also for the surgeon to identify unrealistic expectations. Patients’ concerns can vary immensely, ranging from a particular dislike of lateral hooding, a “staring” or “overdone” look (very common), a sunken look (a common concern in younger patients), to a fear of blindness to concerns about the length of the recovery period and intra- and perioperative pain. Unrealistic expectations include those patients who desire no upper lid fold at all, operated patients (who already look over corrected) desiring further “improvement”, patients who plan to return to their high demand occupation the day after surgery or those who book travel within the first week of surgery. Patients who view cosmetic surgery as a commodity rather than a medical procedure with attendant risks should not be operated on. In the initial consultation, it is important for the surgeon to identify which unrealistic patients can be educated and operated on with confidence, and which ones cannot [1, 2]. Once patient’s concerns are identified, the surgeon
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