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    Achieving the lower eyelid ideal

     

    Patient & Surgical Nuances

    Dr. Brock says his and Dr. English’s combination blepharoplasty patients have been Fitzpatrick types I and II with a Glogau scale of 2 to 3.

    “I can’t tell you with any science that it would work for any patient. I think it would probably be safe for the higher Fitzpatrick skin types, even in skin of color, just because of what I know using peels on skin of color,” he says. “The transconjunctival blepharoplasty is very well established for all patients. The fat grafting is established for all patients. With the phenol peel, you’d follow the standard protocols for peels. You’d use your basic precautions that you’d use for anybody that you’re doing a deeper peel on.”

    Patient shown before and after combination of transconjunctival lower lid blepharoplasty, fat grafting and 88% phenol peeling. Photos courtesy of Jim English, M.D.

    Dr. Brock says surgeons shouldn’t get carried away when making the transconjunctival blepharoplasty incision.

    “Take what presents easily. No need to chase the fat behind the orbital rim,” he says.

    Related: Tarsal sling for post-blepharoplasty repair

    With regard to fat grafting, many choose the umbilical fat. It offers pretty easy access. But that’s not the fat Dr. Brock usually uses.

    “Dr. English’s experience is that the fat from the abdomen can grow, and there’s certainly documentation that it has hormone receptors that can grow. I started choosing the leg fat mainly based on some of the publications and chapters written by Timothy Martin, and he found that he liked the quality of that fat. I’ve been very happy with it. It’s not difficult to harvest that fat,” Dr. Brock says. “I’ve found a very effective way to quickly harvest fat from the leg is [to] place the patient in a semirecumbent position, so you can have access to the inner thigh. That’s quick and easy, so you don’t have to reposition the patient.”

    Patient shown before and after combination of transconjunctival lower lid blepharoplasty, fat grafting and 88% phenol peeling. Photos courtesy of Jim English, M.D.

    Finally, don’t underestimate the peel, he says. While the phenol peel is safe when done the way Dr. Brock describes it, he says surgeons need to understand how to manage a burn. In other words, know how to manage a patient and recognize when the patient needs more acute attention to avoid scarring.

    NEXT: Recovery and Results

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...

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