Tuesday, August 2, 2016

Doc, Could You Balance My Eyes?

This 60 year-old woman presented with dermatochalasis (excess eyelid skin) and asymmetrical eyelids with the right eye appearing smaller. She sustained a right lateral eyelid trauma in a trauma one year ago. Unfortunately, the wound was not well reconstructed resulting in contracture with pulling of the upper eyelid skin over the lateral canthus. (See picture 1 and 2).

Figure 1. Excess skin in both upper eyelids and the right eye appears smaller 
due to wound contracture (red arrow) pulling down the upper lid (black arrow).

Figure 2. The scars (red arrows) are better seen the upper eyelid is lifted. 

She wanted her eyes to be made symmetrical and brighter. Bilateral upper blepharoplasty were performed together with reconstruction of the scars. The steps performed were shown in Figure 3.

Figure 3. a. Before the operation; b. Marking was done of the excess upper eyelid to be excised 
and a V-Y plasty planned for the contracted scar; c, d, e and f showing the construction 
of the V-Y plasty. g. At the end of the surgery. 

Figure 4. Appearance of the eye at 10 days postoperative.

Figure 5. Appearance of the lateral aspect of the eyelid at 10 days postoperative. 
10mg of triamcinolone and 4 units of botox was given over the lateral region of 
the eyelid at 5 days postoperative to prevent wound contracture.

Figure 6. Appearance of the eyelid at 4 weeks postoperative.

Figure 6. Appearance fo the eyelid at 4 weeks postoperative.