Regarding blepharoplasty, which of the following statements about the normal Caucasian eye is incorrect?
Typically the eyelid crease measures more in men than women. This statement is incorrect; the eyelid crease is significantly less in men than women (7-8mm vs 10-12mm), which must be accounted for when planning surgery. The lower lid retractors consist of the capsulopalpebral fascia and the inferior tarsal muscle, and their cutaneous insertion forms the lower lid crease. It is important to know the normal position of the eyelid margins and the eye.
Which of the following is not true for a patient seeking lower lid blepharoplasty?
Excess skin below the level of the orbital margin is usually corrected by lower lid blepharoplasty. This statement is incorrect. Schirmer’s test is for lacrimation. The Schirmer I test is performed without anaesthesia and tests for reflex and basic secretion. Less than 10mm of moistening of the paper at 5 minutes is considered positive. It is worth noting that McKinney and Byun showed that Schirmer’s test did not correlate well with postblepharoplasty dry eyes challenging the rationale for routine use of this test prior to blepharoplasty. Anecdotally, few surgeons actually perform this test routinely. The snap test is for excessive lid laxity and must be assessed prior to surgery. Skin folds below the inferior orbital margin (sometimes called ‘festoons’) are rarely improved by blepharoplasty alone. Hamra described the redistribution of lower lid fat to restore the contours of youth to the lower lid and avoid the risk of a ‘cadaveric’ eye.
1. McKinney P, Byun M. The value of tear film breakup and Schirmer’s tests in preoperative blepharoplasty evaluation. Plast Reconstr Surg 1999; 104(2): 566-9; discussion 570-3.
Which of the following techniques of facelift has the highest rate of facial nerve damage?
Deep plane. The facial nerve branches travel in the sub-SMAS plane. The deep plane technique requires release of the facial ligaments and resuspension between the branches of the facial nerve and thus carries the highest rate of damage. The subperiosteal plane is at all times deep to the nerve.
Which of the following combined procedures is most appropriate:
1 and 3 are correct. Aggressive lower blepharoplasty excision is associated with damage to the structural integrity of the lower lid (and can cause a hollowed out appearance), lower eyelid malposition, dry eyes and/or ectropion. Brow lift may influence the outcome of upper blepharoplasty and thus should be done prior.
Which of the following techniques of brow lift has the highest rate of skin necrosis?
Subcutaneous. In the subcutaneous technique, skin perforators are divided and skin necrosis is a significant risk.
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