Eyelid Scarring Denver | Eyelid Retraction Boulder CO

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Eyelid Scarring and Retraction

Damage to the eyelids can prevent them from working properly to protect and lubricate the eye. When scars or injuries pull the lower eyelid downward (or the upper eyelid upward), it is called eyelid retraction and interferes with blinking, which can cause eye irritation, pain, blurry vision, tearing, and permanent damage to the cornea.

In addition to repairing initial eyelid traumas, Dr. Fante and Dr. Goecks also perform revisional eyelid surgery to enhance the outcome in patients who have undergone previous eyelid repair or cosmetic surgery. Most patients with eyelid retraction are upset about their chronic dry eyes, tearing, blurry vision, and general discomfort. Most are also concerned about the poor appearance and facial deformity inherent in eyelid retraction, even if it is mild.

What Causes Eyelid Damage?

Damage to the eyelids can be caused by surgery nearby. Cosmetic and non-cosmetic eyelid or facial surgery, and skin cancer (Mohs) reconstruction are common causes of eyelid retraction. A traumatic injury (such as dog bite, car accident, or fistfight) can also lead to eyelid retraction. Due to the unique anatomy of the eyelid, a repair can be a challenge. However, it is crucial that the injured person receives proper treatment to address cosmetic and ocular concerns. Dr. Fante and Dr. Goecks have extensive training in ophthalmic and oculoplastic surgery and has many years of clinical experience treating simple to complex cases of eyelid trauma.

Although previous damage from surgery or trauma accounts for most cases of eyelid retraction, Thyroid Eye Disease (Graves), and even old age itself will sometimes cause eyelid retraction. The symptoms are usually the same (eye irritation and tearing especially) but since they come on gradually, patients may not realize that something is wrong. Fortunately, treatment for age-related and thyroid-related retraction is available, just as it is for the traumatic and post-surgical types of retraction.

What Is Eyelid Scarring?

Eyelid or facial surgery or trauma can cause the eyelids to lose normal mobility and position. In some cases, this scarring may make it impossible to properly close the eye(s) so that drying, irritation, and infection can result. When the lower eyelid is affected, there is “too much white showing,” and the eye often alternates between feeling gritty and then watering excessively. Outpatient surgical repair can usually restore more normal appearance and function. Careful examination during your consultation with Dr. Fante or Dr. Goecks will determine the exact details of the repair that will be required.

What Is Eyelid Retraction?

Eyelid retraction is a term that describes an abnormally high position of the upper eyelids or unusually low position of the lower eyelids. Usually, the lids should rest just above or below the iris, the colored part of the eye.

Eyelid retraction may result from poor surgical healing, trauma, old age, and thyroid eye disease. The latter, also called Grave’s disease, is usually responsible for upper eyelid retractions, but may also cause lower lid retraction depending on the degree of bulging. Lower eyelid retraction is a possible complication of cosmetic lower blepharoplasty. Genetics may also cause retraction of the lower eyelid, allowing too much sclera to show.

What Treatment Options are Available for Eyelid Scarring/Retraction?

Upper eyelid correction usually involves adjusting the levator muscle that lifts the upper eyelid. Adjusting this muscle allows the eyelid to close over the ocular surface.

Lower eyelid retraction surgery may be a bit more involved, depending on the condition of the skin and the degree of retraction. When possible, surgery is limited to the tightening of the lower lids with canthoplasty and adjustment of the tendons that hold the eyelids in normal position. However, in some situations, a midface lift or tissue grafting may be necessary to achieve the most desirable outcome.

Patients whose eyelid retraction is related to bulging eyeballs may also benefit from orbital decompression. This technique is performed as part of the complete rehabilitation of patients who need it, and before eyelid surgery so that we can observe how the eyelids respond when the eyes’ protrusion is reduced.

Are Non-Surgical Options Available?

Initially, treatment for eyelid scarring and retraction may center around controlling the symptoms of poor ocular protection and coverage. Conventional approaches include eye drops and ointment, bandages, and other methods of comfort. While these strategies can manage symptoms, they cannot correct the problem causing them. Only surgery can do that.

Will Surgery For Eyelid Retraction Alter My Vision?

It is very rare for eyelid surgery to affect vision adversely. In most cases, vision improves as a result of adjusting the eyelids.

What is the Recovery from Eyelid Scarring/Retraction Treatment?

To achieve optimal results from eyelid surgery, it is necessary to assess not only the tissue that has been damaged or is otherwise abnormal, but also to evaluate the eyeball, tear ducts, and orbital bones. Dr. Fante & Dr. Goecks understand the complex nature of the eye area. He has obtained double board-certification and is a Fellow of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Ophthalmology, and the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Corrective eyelid surgery may be conducted in an outpatient setting, so patients usually return home the day of their procedure. Commonly, pain is so minimal that patients can return to most normal activities the day after their surgery. Any discomfort that does occur can be managed with oral medication. The eye may be covered with a patch for a few days, and patients should expect some bruising and swelling during the first week. These side effects typically disappear within two weeks.

A post-operative follow-up is usually scheduled a week to ten days after surgery, at which point stitches will be removed. After this visit, patients may be able to resume wearing makeup and contact lenses. More strenuous activity such as heavy lifting or intense aerobics can resume a few weeks after surgery.

Schedule a Consultation

If you are experiencing symptoms of eyelid scarring or retraction, contact our Denver office today! Call (303) 839-1616 to schedule a consultation with oculofacial plastic surgeon Dr. Robert Fante and Dr. Tara Goecks.

To learn more about Dry Eye Disease, click here.

For tips and prevention on Dry Eye Disease from The American Academy of Ophthalmology, click here.

Blepharoplasty Scars After Surgery | Healing Upper Eyelid Scars

As people age, the skin around the eyes loses its elasticity, especially on the upper eyelids. This can make a person look tired and unfriendly.

Blepharoplasty, or eyelid surgery, removes the excess skin in the upper and lower eyelids. This cosmetic procedure helps improve the appearance of the eyes by reducing sagging and puffiness.

But like any other surgery, blepharoplasty leaves scars. Although upper eyelid scars are almost unnoticeable, they still need to be appropriately cared for in order for them to heal as well as possible. To learn more about undergoing upper eyelid surgery in Los Angeles, consult with Dr. Zoumalan today.

Taking Care of Your Eyelids After Surgery

Blepharoplasty can make the eyes look more rested and rejuvenated since it removes the excess skin that makes the eyes look droopy. There is usually minimal scarring when the procedure is done correctly. Moreover, the incision is made along the natural folds of the eyelids, so blepharoplasty scars are practically invisible.

That said, it’s important to choose a skilled and board-certified Oculoplastic surgeon to perform this delicate operation. If the technique is incorrect or if the wrong suture is used, the risk of having unsightly scars becomes much higher.

However, the surgery is just the first step to having younger-looking and more expressive eyes. Proper care of the wound is important to reduce the appearance of scars:

• After the surgery, some bruising and swelling may occur. Icing the area helps reduce the swelling and manage the pain.

• Keep the surgical area clean and dry. You may take a bath immediately after surgery but be sure not to get the wound wet. If water gets into the surgical site, pat it dry with a soft towel. Do not rub. Dr. Zoumalan uses the finest quality micro-sutures to allow your skin to heal as well as possible.

• Dr. Zoumalan has a very strict regimen of icing and after care remedies to ensure rapid recovery. He will also prescribe anti-bruising medications and antibiotic ointments to help your eyelids heal while the sutures are in place.

• Once the sutures are removed at day 6 or 7 after surgery, Dr. Zoumalan will start having you begin using his own formulated scar cream, Skinuva™ Scar, which has clinically been shown to be the most advanced scar cream yet to be clinically tested. This scar cream will continue to allow your incisions to heal as best as possible during the next several months after surgery.

• Avoid any strenuous activity for two weeks after your surgery. This includes lifting objects (no matter how lightweight or small) that require you to bend from the waist. Always keep the head upright.

• If your eyes are swollen shut, you may remove the crusts on the eyelashes by using a Q-tip dipped in water. Don’t force your eyes to open as this could affect wound healing.

Reduce the Appearance of Blepharoplasty Scars with Skinuva™ Scar

Skinuva™ Scar was formulated by Dr. Zoumalan and his team of chemists and scientists. IT is a patent-pending scar cream that uses selective growth factors. It is a revolutionary scar cream that is the first to use selective growth factors to help improve the appearance of scars. When used within a few weeks after surgery, the cream can further prevent scars from becoming noticeable.

Once the wound has healed completely, you may start applying the Skinuva™ Scar cream on the area. Massage it gently using your ring finger to avoid putting too much pressure on the delicate eye area.

Although the Skinuva™ Scar cream is recommended for use on new scars, you can also use it for scars that are less than one year old. Scars mature in their first year, so using the cream within 3 to 6 months of scar formation may prevent it from thickening and becoming deformed.

The great thing about this topical cream is that you can wear sunscreen over it. The damaging UV rays may enhance pigmentation of scars. Putting on sunscreen over the cream helps prevent scar discoloration.

Finding the Right Doctor for the Job

Scar formation is inevitable whenever there’s surgery involved. However, you can minimize its appearance by applying a scar cream within a few weeks after surgery.

The good news is eyelid skin heals faster than the skin on the rest of the face. But this depends on what kind of suture was used and how well it was placed. Naturally, this boils down to the skill and technique used by the doctor.

Eyelid Surgery in Los Angeles

Dr. Christopher I. Zoumalan, MD FACS is a board-certified cosmetic eyelid surgeon. He specializes in Aesthetic and Reconstructive Oculoplastic Surgery and has treated patients for various aesthetic procedures, including eyelid surgery in Los Angeles. Contact Dr. Zoumalan’s clinic to schedule an appointment.

Entropion – Diagnosis and treatment

Diagnosis

Entropion can usually be diagnosed with a routine eye exam and physical. Your doctor may pull on your eyelids during the exam or ask you to blink or close your eyes forcefully. This helps him or her assess your eyelid’s position on the eye, its muscle tone and its tightness.

If your entropion is caused by scar tissue, previous surgery or other conditions, your doctor will examine the surrounding tissue as well.

Treatment

The treatment approach depends on what’s causing your entropion. Nonsurgical treatments are available to relieve symptoms and protect your eye from damage.

When active inflammation or infection causes entropion (spastic entropion), your eyelid may return to its normal alignment as you treat the inflamed or infected eye. But if tissue scarring has occurred, entropion may persist even after the other condition has been treated.

Surgery is generally required to fully correct entropion, but short-term fixes can be useful if you can’t tolerate surgery or you have to delay it.

Therapies

• Soft contact lens. Your eye doctor may suggest that you use a type of soft contact lens as a sort of corneal bandage to help ease symptoms. These are available with or without a refractive prescription.
• Botox. Small amounts of onabotulinumtoxinA (Botox) injected into the lower eyelid can turn the eyelid out. You may get a series of injections, with effects lasting up to six months.

• Stitches that turn the eyelid outward. This procedure can be done in your doctor’s office with local anesthesia. After numbing the eyelid, your doctor places several stitches in specific locations along the affected eyelid.

  The stitches turn the eyelid outward, and resulting scar tissue keeps it in position even after the stitches are removed. After several months, your eyelid may turn itself back inward. So this technique isn’t a long-term solution.

• Skin tape. Special transparent skin tape can be applied to your eyelid to keep it from turning in.

Surgery

The type of surgery you have depends on the condition of the tissue surrounding your eyelid and on the cause of your entropion.

If your entropion is age related, your surgeon will likely remove a small part of your lower eyelid. This helps tighten the affected tendons and muscles. You’ll have a few stitches on the outside corner of your eye or just below your lower eyelid.

If you have scar tissue on the inside of your lid or have had trauma or previous surgeries, your surgeon may perform a mucous membrane graft using tissue from the roof of your mouth or nasal passages.

Before surgery you’ll receive a local anesthetic to numb your eyelid and the area around it. You may be lightly sedated to make you more comfortable, depending on the type of procedure you’re having and whether it’s done in an outpatient surgical clinic.

After surgery you might need to:

• Use an antibiotic ointment on your eye for one week
• Use cold compresses periodically to decrease bruising and swelling

After surgery you will likely experience:

• Temporary swelling
• Bruising on and around your eye

Your eyelid might feel tight after surgery. But as you heal, it will become more comfortable. Stitches are usually removed about a week after surgery. You can expect the swelling and bruising to fade in about two weeks.

Lifestyle and home remedies

To relieve the symptoms of entropion until you have surgery, you can try:

• Eye lubricants. Artificial tears and eye ointments help protect your cornea and keep it lubricated.
• Skin tape. Special transparent skin tape can be applied to your eyelid to keep it from turning in. Place one end of the tape near your lower eyelashes, then pull down gently and attach the other end of the tape to your upper cheek. Ask your doctor to demonstrate proper technique and placement of the tape.

Preparing for your appointment

If you have signs and symptoms of entropion, you’re likely to start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in treating eye disorders (ophthalmologist).

Here’s some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• All medications, vitamins and supplements you take, including the doses
• Symptoms you’ve been having and for how long
• Other eye conditions, injuries or surgeries you’ve had
• Questions to ask your doctor

For entropion, some basic questions to ask your doctor include:

• What’s the most likely cause of my symptoms?
• What kinds of tests do I need? Do they require any special preparation?
• Is this condition temporary or long lasting?
• Can entropion damage my vision?
• What treatments are available, and which do you recommend?
• What are the risks of surgery?
• What are the alternatives to surgery?
• I have other health conditions. How can I best manage them together?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• Have you had any previous eye surgery or procedures on your eye or eyelid?
• Have you had any other eye problems, such as an eye infection or an injury?
• Are you taking any blood thinners?
• Are you taking aspirin?
• Are you using any eyedrops?

Jan. 14, 2021

How Do I Manage Lower Eyelid Malposition Following Lower Eyelid Blepharoplasty?

September 23, 2020

5 min read

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What abnormalities of the lower eyelid do you see after blepharoplasty? What causes them and how are they avoided? How do I know if a tarsal trip procedure will be helpful? How long do you wait before considering surgical intervention?

In my experience, the most commonly encountered complication of lower eyelid blepharoplasty is eyelid retraction. Other forms of malposition include ectropion and contour abnormalities such as blunting of the lateral canthal angle. Successful intervention for eyelid malposition after blepharoplasty is dependent on identification of the type and mechanical nature of the distortion.

I would first like to touch on eyelid laxity. Failure to recognize and treat horizontal laxity at the time of surgery is a contributor to all varieties of malposition. Ideally, eyelid laxity is identified preoperatively and managed at the time of surgery. Preoperative evaluation should include assessment with horizontal distraction and snap-back tests. These tests assess the laxity of the canthal tendons and the intrinsic loss of elasticity that occurs with involutional changes in soft tissue. Canthal tendon tightening may be accomplished with lateral and medial canthoplasty techniques. The most commonly performed procedure for correction of horizontal laxity is the tarsal strip procedure—discussed in detail in Question 5. Having no cure for loss of elasticity, judicious use of horizontal shortening of the lower eyelid can improve the horizontal tension on the eyelid and elevate (or prevent retraction of) the lower eyelid margin.

Globe prominence should also be assessed preoperatively. Prominent globes predispose the eyelid to displacement/retraction. Blepharoplasty should be approached conservatively in terms of skin excision in such patients. Consideration should also be given to elevation of the suborbicularis oculi fat pad (SOOF) to counter any tendency toward retraction (Figure 49-1). One last consideration surrounds correction of horizontal laxity. In patients with prominent globes, horizontal laxity should be addressed; however, care should be taken not to overtighten the eyelid, which results in paradoxical lowering of the eyelid.

Figure 49-1. (A) A patient with prominent globes before lower eyelid blepharoplasty. (B) To avoid retraction, fixation of the SOOF and a lateral tarsal strip procedure were performed in addition to a standard transcutaneous blepharoplasty.

On occasion, after lower eyelid blepharoplasty, mild foreshortening of lower eyelid skin limited to the lateral canthal area may result in blunting of the lateral canthal angle (Figure 49-2). As in all things, prevention is preferable to postoperative repair. When removing small amounts of lower eyelid skin, I would recommend that you elevate and attach the free edge of the remaining lateral skin-muscle flap. This can be sutured to the periosteum at the lateral canthus with a 5-0 Vicryl suture (Ethicon, Somerville, NJ). This supports the lateral aspect of the lower eyelid and keeps it from retracting inferiorly. When lateral blunting is encountered postoperatively, I take a stepwise approach to management. The usual initial step is releasing lower eyelid skin sutures to allow some relaxation of the wound. I also recommend massage and steroid injections into any focal areas of cicatrix. If the lateral blunting persists, then surgical correction is usually required. A lateral tarsal strip-type tightening of the lateral canthus will usually reform the blunted canthal angle (see Figure 49-2). When there is significant skin foreshortening, then one may need to augment the lower eyelid with a posterior spacer graft or augment the lower eyelid anterior lamella with a small skin graft (see Question 7). These usually leave a reasonable cosmetic result if limited in their extent. If there is a palpable scar band resulting in localized retraction of the eyelid, then a “V-Y” advancement of lower eyelid skin allows some vertical relaxation in exchange for some additional horizontal tightening of the skin (Figure 49-3).

Figure 49-2. Lateral canthal blunting following blepharoplasty before (A) and after (B) reparative lateral canthoplasty.

Figure 49-3. Contour abnormality due to focal scarring of the left lower eyelid (A). The area of scarring is released with a “V-shaped” incision (B). The eyelid is then able to be elevated to a normal position and the incision sutured in a “Y” configuration (C). The eyelid is in a more natural position (D) following the “V-Y” advancement flap.

Ectropion can be transient and self-limited. Facial and eyelid edema in the early postoperative period may cause reversible malposition of the lower eyelid. Anterior to posterior thickening of the eyelid may cause a mild mechanical ectropion that will resolve with time. Postoperative decrease in orbicularis function may also contribute early ectropion. The weight of the edematous tissue may cause downward gravitational traction on the eyelid. Elevation of the head of the bed while sleeping and massage/compression of the eyelid may speed resolution. If exposure and conjunctival edema are contributing to the patient’s discomfort or the eyelid malposition, a temporary suture tarsorrhaphy may improve comfort and diminish conjunctival edema via mechanical compression by the eyelids. In this early and reversible type of ectropion, the eyelid is just thickened by edema and remains vertically mobile. One may distinguish this from anterior lamellar shortening. If the lower eyelid distinctly resists upward movement with gentle vertical displacement with the index finger, vertical shortening of the eyelid may be suspected.

Occasionally, ectropion can be permanent and one of the most challenging complications following blepharoplasty. This occurs as a result of removal of too much skin and orbicularis. This can be very challenging to repair and I strongly encourage avoidance by cautious excision of skin. Ectropion due to anterior lamellar shortening may be apparent in the early postoperative period, or may not develop until years later. When mild skin shortage is identified in the immediate postoperative time period, I will sometimes release the sutures to open the wound and place suture tarsorrhaphies. By allowing the wound to granulate, small overcorrections may be compensated for. Unfortunately, in severe cases, skin grafting may be required (Figure 49-4).

Figure 49-4. (A) Ectropion following lower eyelid blepharoplasty. (B) Improved eyelid position
1 month following full-thickness skin grafting.

Eyelid retraction following blepharoplasty is discussed in detail in Question 7. I will just touch on the basics here. Causes include shortening of the vertical height, horizontal laxity, or mechanical distortion from cicatricial changes (ie, scarring). Initial treatment includes aggressive topical lubrication to decrease symptoms and prevent keratitis or ulceration. Middle lamella shortening occurs when there is fibrosis in the healing eyelid, or when there is iatrogenic incorporation of the orbital septum into the anterior or posterior lamella of the eyelid. The orbital septum is rigidly fixed to the arcus marginalis of the inferior orbital rim. Inadvertent suturing of the septum to the skin creates a rigid scar band that resists upward displacement. In selected patients, surgical trauma alone incites an abnormal fibrotic reaction that creates this same noncompliant scar band. Early identification of abnormal scar retraction may be treated with steroid injection, massage, and upward traction of the eyelid. When the problem persists or is identified later, correction typically requires release of the scar tissue and placement of a spacer graft to discourage reoccurrence. A posterior approach through the conjunctiva and lower eyelid retractors allows release and recession of the scar and lower eyelid retractors. The eyelid is then supported with a spacer graft such as hard palate mucosa.

In summary, it is better to avoid, rather than treat, lower eyelid malposition following blepharoplasty. Recognizing and addressing lower eyelid laxity, tailoring surgical technique to globe prominence, and use of judicious skin excision are key. When encountered, the management of lower eyelid malposition is tailored to the specific abnormality.

Additional Reading

Patel BC, Patipa, M, Anderson RL, McLeish W. Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip. Plast Reconstr Surg. 1997;99(5):1251-1260.

  Patel MP, Shapiro MD, Spinelli HM. Combined hard palate spacer graft, midface suspension, and lateral canthoplasty for lower eyelid retraction: a tripartite approach. Plast Reconstr Surg. 2005;115(7):2105-2114.

  Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg. 2000;106(2):438-453.

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Eyelid Malposition Treatment | Central Valley Eye Medical Group

What is Ectropion?

Ectropion is an eyelid malposition in which the lower eyelid turns outward and does not touch the eye. Consequently, the conjunctiva can become exposed and red. Ectropion usually affects one or both of the lower eyelids and rarely the upper eyelids.

Causes of Ectropion

Ectropion usually results from relaxation of eyelid tissues due to aging changes. It can also occur because of undetected skin cancers that pull down the eyelid. Other causes of ectropion include trauma, contraction of scar tissue of the surrounding skin, and eyelid or facial surgery. It may also occur congenitally or secondary to facial nerve palsy. The condition may be worsened by constantly wiping the eyes. Eyelid burns or skin disease may also result in ectropion.

Ectropion Symptoms

Many symptoms of ectropion are a result of chronic irritation of the eye and eyelid. Such symptoms include excessive tearing, crusting of the eyelid and mucus discharge, infection, corneal irritation, sagging skin around the eye, impaired vision, redness and pain of the eye, and sensitivity to light and wind. Ectropion may also result in poor drainage of tears through the nasolacrimal system. Also, the exposed inner lining of the eyelid becomes dry and inflamed, and the eye may be damaged.

Ectropion Treatment

Artificial tears and lubricating ointments can be used to moisten the cornea to prevent dryness of the cornea. When ectropion is caused by stretching of the eyelid’s supporting structures, surgery is the best treatment to repair the involved muscle and tendons of the eyelid. Depending on the cause of ectropion, surgery can be used to reposition the eyelid back to its normal position against the eye.

Ectropion Repair Before and After Photos

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What is Entropion?

Entropion is an eyelid malposition in which the lower eyelid and eyelashes turn inward towards the eye causing the eyelid and lashes to rub against the cornea and conjunctiva.

Causes of Entropion

Entropion usually results from relaxation of eyelid tissues due to aging changes. It may also be due to infection or scarring on the inner surface of the eyelid, eyelid injuries, or tumors. Entropion may also be congenital if the eyelids do not form normally.

Symptoms of Entropion

Many symptoms of entropion are a result of chronic irritation of the eye and eyelid. Such symptoms include excessive tearing, crusting of the eyelid and mucus discharge, corneal irritation, sagging skin around the eye, impaired vision, redness and pain of the eye, sensitivity to light and wind, and foreign body sensation. Corneal infection and scarring may also occur as a result of entropion.

Entropion Treatment

Several surgical procedures may be used to tighten the eyelid and eyelid attachments thus restoring some of its elasticity and repositioning it normally. Alternatively, tape or sutures can be used to reposition the eyelid and protect the eye temporarily. Lubricating drops and ointments are also helpful. Medications may also be used to control eyelid inflammation or irritation and to treat scars. Sometimes scar removal and tissue grafts may be needed.

Questions? Give Us a Call!

Bilateral Upper Eyelid Blepharoplasty & Ptosis Repair
Ptosis Repair

Ptosis Repair

What is Ptosis Repair?

Ptosis repair is the adjustment of the eyelid so as to improve eyelid drooping. The procedure may be required on one or both eyes depending on patient characteristics.

The excess skin in the upper eyelids can be removed surgically by a procedure called blepharoplasty. It improves side vision and other symptoms. Removal of the excess skin in either the upper or lower eyelids may improve appearance.

Symptoms of Ptosis

Ptosis may be congenital or acquired as a result of paralysis, neurogenic, trauma or aging. Classic signs characterized by drooping of the eyelid with or without levator disinsertion.

Drooping of eyelid may be constant or intermittent, or occur with use. In levator dehiscence, the ptosis is constant and worse in downgaze. In neurogenic ptosis, the defect may be at the level of the neuromuscular junction, the third cranial nerve nucleus or peripheral nerve or the sympathetic chain. In myasthenia gravis, the symptoms are variable and aggravated with use. The ptosis is constant without significant variation in patients with a third nerve palsy, Horner’s syndrome, or levator dehiscence.

Treatment for Ptosis

Depends on cause. Myasthenia gravis: oral prednisone with or without Mestinon. Always involve a neurologist before initiating therapy. Third nerve palsy: do strabismus surgery prior to considering ptosis repair to avoid symptomatic diplopia that requires patching. Complete third nerve palsy is difficult to manage; observation rather than surgical intervention is wise. Horner’s syndrome: internal conjunctival – Muller’s resection can be effective.

Neosynephrine drops can be used pre-operatively to help guide the selection of surgical approach. The posterior (conjunctival-Mueller’s excision) approach is only effective if Neosynephrine results in elevation of the eyelid to normal height.

Before and After Ptosis Surgery

Bilateral Upper Eyelid Blepharoplasty & Ptosis Repair

Ptosis Repair

What is Lagophthalmos?

Lagophthalmos (lag-ahf-thal-mus) is a condition in which the globe (eyeball) is not entirely covered when the eyelids are closed. It can be caused from a facial nerve (Bell’s) palsy, a protruding eye, or from eyelid retraction from Thyroid eye disease.

SCHEDULE AN APPOINTMENT

If you would like to learn more about Eyelid Malpositions call 1-800-244-9907 to make an appointment at Central Valley Eye Medical Group.

Eyelid Incisions Stay Red, Raised, Or Firm? How long does it take?

Dr. John Burroughs practices cosmetic and reconstructive eyelid and facial plastic surgery in Colorado. One of his most popular procedures is the blepharoplasty surgery (eyelid lift). This patient is about 6 weeks out from her surgery. She is pleased with her result, but the redness of her incisions is still prominent at this point. There is considerable variability to how long the incisions remain red, raised, and/or firm. Skin type (e.g., fair; low Fitzpatrick score), what procedure was done, how much bleeding occurred and cautery required, sutures type used etc. Some patients even at a month have very little redness and elevation of the incisions while others the improvement only really begins at about 90 days postop and beyond. Most often the incisions have really “blended” in and mostly not visible between 3-6 months and rarely out to a year.

Once the sutures are removed, coverup makeup can be applied. Some redness can be improved by avoiding the sun and utilizing sunscreen protection and sunglasses when outdoors. Topical steroids may be used for a short period of time to improve the redness and even vaseline and other scar creams can be helpful. Additionally, massage of the incision lines can improve their appearance over time. Some patients that pull upward with their forehead tissues following surgery out of habit from before their eyelid lift will have wider and more redness to their incisions. Fortunately, the eyelid skin is very forgiving and when taken care of properly the incisions eventually flatten quite a bit and often turn a subtle paler color to the surrounding skin.

Many patients eventually have virtually imperceptible incision lines, and most of the incision for the upper eyelids in not seen when the eyes are open. The incisions do need to extend out far enough or too much tissue will remain in the lateral (outside) portion of the upper eyelids, which is a common problem Dr. Burroughs encounters with patients that are unhappy with their surgical results performed elsewhere. This patient also pulls upward with her right brow a bit more than the left making her left upper eyelid incision appear lower. With time this will even out or Botox can be used to help relax the eyebrows to a more symmetric appearance.

Before an eyelid lift, many patients unconsciously pull upward with their eyebrow tissues to clear the skin off their eyelashes. After surgery, this “habit” can be hard to break but with time most patients begin to realize they don’t need to pull upward on the eyebrows like they did before surgery. Asymmetric eyelid incisions may be improved surgically, but Dr. Burroughs has taught other surgeons it is best to make them right to begin with. This patient will continue to improve and she has been delighted with her surgical result and continued improvement. Dr. Burroughs is one of the busiest eyelid surgeons in all of Colorado, and improving patient appearances and visual function through eyelid surgery is his passion. If you found this interesting then share with others, and call if any further questions or to schedule a consultation.

Lower Blepharoplasty in Bethesda, MD & Northern Virginia

As we age, the tissues that tend to hold the fat of the eye socket in place weaken, thus allowing for the prolapse of fat into the lower eyelids. The surrounding skin also becomes “crepey” and lax in many cases, and tendons in the outer corner of the eyelid may fall. All of these changes can collectively create the appearance of puffy lower eyelids, potentially with dark circles manifesting around the eye socket. Furthermore, some individuals will lose facial volume underneath the dark circles, accentuating the appearance of fatigue.

When these aesthetic concerns—and any others pertaining to the lower eyelid region—manifest for both women and men, lower blepharoplasty can often be an excellent treatment option.

What Is Lower Blepharoplasty?

Also referred to as lower eyelid surgery, lower blepharoplasty is a cosmetic procedure designed to target and resolve underlying anatomical issues responsible for signs of aging in and around the lower lids, ultimately creating a more youthful and refreshed appearance. With over two decades of experience in eyelid surgery, our skilled oculoplastic surgeon—Dr. Albert Cytryn—can custom-tailor lower blepharoplasty to effectively treat:

• Under-eye bags
• Displaced fat pockets
• Dark circles
• Excess tissue
• Wrinkles and crepey skin

In many instances, lower eyelid surgery is combined with treatments such as upper blepharoplasty, midface lift, and/or laser skin resurfacing to achieve a more comprehensive improvement of the eye region.

Before

After

How Is the Lower Blepharoplasty Procedure Performed?

In a traditional lower blepharoplasty procedure, the fat of the lower eyelid is sculpted away to achieve a more rested appearance. When the aesthetic issue is more related to facial atrophy and hollowing, however, Dr. Cytryn will gear the correction towards moving the fat around into areas of the midface that lack volume—which is a technique called fat transposition. In younger patients, the fat can be removed from the inside of the eyelid, while in older patients the fat is generally removed with an incision made just under the eyelashes so that surrounding skin can be sculpted and the underlying muscles and tendons tightened. When extra skin and wrinkles are present, Dr. Cytryn meticulously removes a small amount of skin while ensuring not to over-excise lower eyelid tissue, which could lead to unsatisfactory aesthetic and functional results.

Lower eyelid surgery is typically performed under light intravenous sedation. When conducted alone, the procedure usually takes an average of about 30–50 minutes to complete. That said, many patients also elect to have their upper eyelids and cheeks/midface addressed at the same time as lower blepharoplasty, which can extend the total treatment time.

I was referred to Dr. Cytryn after I unexpectedly developed (unsightly)unilateral scar tissue following a lower lid blephoroplasty with another surgeon. A second surgery was indicated and from what I understand the procedure was somewhat complex in that a graft was required. Now, almost a year out, I could not be more pleased with the symmetry and overall appearance of my eyes. I was grateful to my initial doctor for referring me to Dr. Cytryn-as someone who ONLY does eyes, he is very capable of more complex work. A surgeon’s surgeon…

Is Lower Blepharoplasty Painful?

Due to Dr. Cytryn’s meticulous surgical technique, the vast majority of lower eyelid surgery patients report experiencing minimal to no discomfort following treatment. During the procedure, Dr. Cytryn takes great care to limit trauma to tissues of the eyelids and surrounding areas, as well as to prevent bleeding before it ever starts—both of which help to significantly diminish the potential for postoperative pain. Furthermore, he provides customized instructions on how to facilitate healing during the recovery process in order to help limit the duration of any possible irritation and/or soreness.

Of course, pain tolerance is unique to every individual, so there may be instances in which analgesic medication is necessary to reduce any discomfort that might occur. That said, Dr. Cytryn’s patients rarely describe any considerable degree of pain after lower blepharoplasty—and most do not even bother with taking medicine.

What Can I Expect During Lower Blepharoplasty Recovery?

Following lower eyelid surgery, you can typically expect some swelling and/or bruising in the treatment area, but these side effects are temporary and should diminish with time. As previously mentioned, any discomfort experienced can usually be controlled with medication if necessary, though a notable degree of pain is uncommon. You will most likely look and feel well enough to return to normal, non-strenuous daily routines within five to ten days; however, Dr. Cytryn generally advises that all intense exercise, physical sports, and other vigorous activities be avoided for several weeks to help ensure proper healing.

Will I Have Visible Scars After Lower Blepharoplasty?

Scarring from lower eyelid surgery will depend on the specific maneuvers performed during the procedure, as well as factors such as genetics, sun exposure, and adherence to postoperative directions. When fat is being removed and/or repositioned for younger patients, Dr. Cytryn is often able to do so from the inside of the eyelids, therefore creating no external scarring. For older individuals—or in the event excess skin and/or wrinkles are present, regardless of age—a small incision placed just below the eyelash is typically required so that skin can be excised and muscles and tendons can be tightened in addition to fat removal and/or repositioning.

Fortunately, even when an external incision is necessary for lower blepharoplasty, it is usually made in a natural crease of the eyelid, and the scar tends to heal extremely well. Once scarring has faded to its final appearance, it is usually virtually indistinguishable from the surrounding skin—particularly when properly cared for during healing and maturation.

How Much Does Lower Blepharoplasty Cost?

The average cost of lower blepharoplasty at our practice ranges from $2,500–$3,500, with exact pricing being determined by the overall complexity of treatment and whether or not complementary procedures are also performed. While this price range can give you a good idea of what to expect, it is important to note that you will need to schedule an in-person consultation with Dr. Cytryn to receive a personalized quote. At this time, he can provide a cost estimate based on the custom plan created after a detailed evaluation of your specific needs and goals.

Book Your Consultation

If you would like more information about lower blepharoplasty, or if you wish to find out if this treatment is right for you, please contact us today to schedule a consultation with our experienced oculoplastic surgeon.

90,000 Scars after blepharoplasty – Appearance. Esthetic guide

Theory, diagnosis and clinical experience of correction.

Introduction

In terms of the frequency of blepharoplasty, it ranks third in the world among all types of plastic surgery. It is second only to breast augmentation and liposuction. According to ISAPS (International Society of Aesthetic and Plastic Surgery), 1,099,960 blepharoplasty operations were performed worldwide in 2018 [11].

The most frequent indications for this intervention are age-related changes in the skin of the eyelids: gravitational ptosis (dermatochalasis), overhanging of the skin of the upper eyelids and the formation of a double contour of the lower eyelid, displacement down the level of the eyebrow line.

This surgical procedure has a number of contraindications: high arterial or intraocular pressure, dry eyes, chronic diseases of the thyroid gland and cardiovascular system in the stage of decompensation, diabetes mellitus, oncological diseases, disorders of the blood coagulation system.

Aesthetic indicators of aging of the periorbital region are in direct proportion to the condition of the eyelids and surrounding tissues. In this area, the skin primarily undergoes age-related changes, loses its tone and sags. Deformities of the eyelids can cause severe functional disorders, and they also represent a clear cosmetic defect. These conditions can be the consequences of congenital pathologies, inflammatory diseases, injuries and burns, senile changes, postoperative complications.

Overhanging of the eyelid skin in the elderly often leads to narrowing of the visual fields. Eyelid surgery can expand the area of ​​peripheral vision or partially reduce intraocular pressure. Drooping of the upper eyelids can be associated with excess skin, hypertrophy of the circular muscle of the eye, hernias of fatty tissue, or a combination of both.

The rate of postoperative wound healing after blepharoplasty depends not only on the skill of the surgeon, the extent of the surgical intervention, but also on the patient himself.If the integrity of the skin is damaged, the healing process starts immediately, which ends with tissue restoration.

The classic variant of acute wound healing is a complex, dynamic and perfectly planned process, consisting of four main sequential and at the same time overlapping stages, regulated by several factors: hemostasis, inflammation, proliferation, remodeling [12].

The last stage of the healing process begins with the development of granulation tissue and takes the longest time.In the process of maturation of the matrix, the amount of fibronectin and hyaluronan decreases, and the bundles of collagen fibers increase in diameter, which contributes to an increase in the tensile strength of the wound. However, newly formed collagen fibers reach only 80% of the strength of intact skin.

Remodeling is a delicate balance between tissue formation and degradation, controlled by the activity of proteolytic enzymes, mainly matrix metalloproteinases (MMPs) and their natural tissue inhibitors [4].Violation or slowing down of this process, dysfunction of the extracellular matrix can lead to the formation of pathological scars.

In molecular biology, the extracellular matrix (ECM) is defined as a complex network formed by numerous structural macromolecules (proteoglycans, collagens, elastin). Interacting with each other and with cells, these structural macromolecules maintain the structural integrity of tissues [9].

It is the matrix that provides an organized environment within which migrating cells can move and interact with each other.All of the macromolecules that make up the ECM are produced by cells in the matrix. The most important component of the extracellular matrix is ​​a gel-like medium formed by proteoglycans – extremely stretched polypeptide chains with numerous polysaccharide chains of glucosaminoglycans attached through covalent bonds.

Numerous proteoglycan chains attach to a special type of glucosaminoglycan, a hyaluronic acid polymer called hyaluronan. Its threads hold the gel structure together, and this polysaccharide “gel” can resist compression and stretching of the ECM and at the same time ensure rapid diffusion of nutrients, building materials and hormones between blood and connective tissue cells, providing regulatory and plastic functions, especially topical for postoperative wound healing.

The mechanical structure of the gel is reinforced by means of different types of fibers:

1. fibers that form the skeleton of connective tissue,
2. flexible fibers that give elasticity to connective tissue,

90,039 mesh fibers that cross-link all other fibers and connect all other components of the fabric.

To date, 29 types of collagen have been described, the function of which is not fully understood.9 types of collagen fibers are identified in the skin [5], which impart strength and durability to the connective tissue. Each collagen fiber is a few micrometers in diameter and consists of thousands of individual collagen polypeptide chains tightly packed together.

Collagens are one of the most abundant proteins in the extracellular matrix and connective tissue. There are about 50 genes in the human genome that encode various collagens, and the products of these genes form about 30 types of collagen fibers found in a wide variety of tissues.An excess of collagen fibers or too little collagenase activity leads to an increase in fiber density and the formation of less flexible tissue. Conversely, excessive collagenase activity will lead to uncontrolled fragmentation of collagen, which will make the tissue more amorphous. Any violation of this complex multicomponent process entails a failure in the course of wound healing and can lead to the formation of pathological scars.

There is currently no clear separation of the terms “scar” and “scar tissue”.Used in a number of sources, the term “scar” is a connective tissue formation that is formed in the process of wound healing, and scar tissue appears in its last phase – the phase of epithelialization [1, 8].

On the other hand, all components of the dermis are connective tissue formations, and all repair processes accompanied by scar formation occur within the connective tissue of the dermis, while defects within the epidermis are not accompanied by scarring.

It would be more correct to speak not about “replacement by connective tissue”, as is done in some manuals, but about the disruption of the processes of intercellular interaction during the repair of connective tissue, leading to the formation of pathological scars.

Reliable reasons for the development of hypertrophic and keloid scars have not yet been established. However, it is known that the formation of pathological scars is based on abnormalities in the synthesis of structural components of the dermis, while intensification of the formation of collagen fibers, increased influence of growth factors on angiogenesis, fibroblast proliferation, increased activity of metalloproteinase inhibitors and changes in the normal apoptosis of fibroblasts are observed [8].In case of a violation of the regulation of the processes of synthesis, assembly, breakdown of collagen, elastin and glycosaminoglycans (GAGs), insufficient or, conversely, excessive scarring may be observed.

Before carrying out surgical treatment, it is advisable to assess the reparative potential of the skin, as well as genetically determined mechanisms responsible for the subsequent tissue remodeling. At present, molecular genetic methods are being actively introduced into the practice of cosmetologists and plastic surgeons, which make it possible to analyze possible risks.Having carried out a DNA test, for example, “Cosmetology” from BGG [Fig. 1], before the procedures, you can build a program that takes into account the individual risk of the formation of defective collagen, reduced or increased activity of matrix metalloproteinases and will allow avoiding contraindicated procedures and / or additional preparation before blepharoplasty.

In complex therapy, it is advisable to include drugs that increase the regenerative potential of the dermis (PRP, placenta, collagen, GAG and others), normalizing collagenogenesis and the synthesis of other components of the dermal matrix.

Authors: Natalya Bychkova, Ph.D., cosmetologist of the highest category, Izhevsk. Irina Bykova, cosmetologist, Izhevsk.

You can read the article in Oblik magazine. Esthetic guide No. 2 (35), pp. 46-47

90,000 Why are scars so different from normal skin

• Jason G. Goldman
• BBC Future

November 17, 2016

Photo Credit, iStock

Scars tell the world about our past injuries – but why scar tissue looks like – to another, and so it stands out against the background of ordinary skin? BBC Future is looking for an answer to this question.

When I was 10 or 11 years old, I came to summer camp and injured my knee while running on the gravel path with my mates. The fall was quite serious, and several small pieces of gravel literally dug into the skin on my knee.

In the first-aid post, the nurses washed off the blood and pulled out gravel from under the skin, then placed a container under the knee and poured medical alcohol over the wound.

It hurt a lot, but at least it helped me avoid infection. What I couldn’t avoid was the scar.

One day when I was in college, I cut my hand with a knife while trying to open a box in a dorm room. Another scar appeared on his left hand between his thumb and forefinger.

Almost each of us can tell an impressive story about how we got a scar (and not even one) to show off to friends. But what exactly is a scar?

To begin with, a scar will inevitably form when any wound heals. The question is how exactly it will look.

The fact is that a scar is a natural result of a healing process initiated by the body to repair the skin or other organs.

Photo author, iStock

Photo caption,

A crust on a healing wound protects it from infection, and then a scar forms

At the same time, animals that can grow new body parts, such as limbs or tail, do not have scars …

In case of damage to the skin, including wounds, burns or trauma, bleeding begins first.

Then a blood clot forms, its upper part hardens and becomes covered with a crust that protects the wound from invasion of foreign organisms.

In the protected from the external environment of the lower part of the blood clot, cells called fibroblasts appear, whose task is to replace the crust with scar tissue.

The tissue that forms the scar has almost the same composition as ordinary skin – it is almost entirely composed of a protein called collagen. However, it looks different and has a different structure.

In a 1998 study published in the Bulletin of Mathematical Biology, mathematicians John C. Dallon and Jonathan A. Sherratt of the University of Warwick explained the reasons for this phenomenon.

“In humans, as in animals with dense skin,” they write, “in normal tissue, collagen fibers are intertwined crosswise, while in scar tissue they are stretched parallel to the surface of the skin.”

In other words, ordinary skin tissue consists of fibers oriented in all possible directions, while in scar tissue these fibers are oriented in the same direction and are parallel to each other.

From an evolutionary point of view, this is quite reasonable. In the presence of an open wound, the body is at risk, primarily of infection. Therefore, instead of slow recovery of the skin, the site of damage is quickly filled with scar tissue.

Author of the photo, iStock

Caption to the photo,

The structure of ordinary skin is very different from the structure of scar tissue. ready to come right now and get the job done twice as fast and cheaper.

It is better to protect the body from the outside world as soon as possible, even if the quality of work will be a little lame.

Someone is proud of scars, while others find them aesthetically unattractive. Scars cannot be completely avoided, but there are ways to reduce their size and make them less visible.

First, the larger the wound, the larger the scar. This is why doctors so often stitch. Reducing the distance between the edges of the wound allows you to reduce the size of the crust and, accordingly, the scar.

If the scar is really unsightly, the dermatologist may advise you to correct it. This procedure involves complete removal of the scar and re-suturing.

A new scar will inevitably form in its place, but the doctor can make it less noticeable.

Other methods of removing scars, including chemical peels and dermabrasion (mechanical abrasion), involve removing the surface layers of the skin.

After this controlled intervention, the healing process begins, and new, younger and more delicate skin may appear at the site of the scar.

Each of these methods produces certain results and may, under some conditions, make scars less visible, but none of them can completely remove them.

With their help, a scar can only be corrected, reduced, repositioned or otherwise improved.

The only way to get rid of the scar completely is with a skin graft, but even in this case, a scar will still form at the edges of the graft.

Perhaps in the future, scientists will come up with something better, and we have no choice but to share with friends exciting stories about the origin of our scars.

PINK FLOWER ON THE WINDOWSILL (or once again about the possible consequences of “plastic” surgery) -Our news

PINK FLOWER ON THE WINDOWSILL (or again about the possible consequences of “plastic” surgery)

Patient L. was admitted to the 15th ophthalmological department of City Clinical Hospital No. 15 with a complaint of drooping of the upper eyelid of the left eye and associated visual impairment.

As a result of the distribution and analysis of the medical documents presented by the patient, it became known that she had previously undergone plastic surgery (blepharoplasty) of the lower eyelids.It included dissection of the outer eyelid adhesions (canthotomy), in order to more effectively tighten the skin flap of the lower eyelid, after removing the excess fatty tissue.

On examination, a fusion of the outer layers of the eyelids was found, which entailed drooping of the upper eyelid (ptosis) almost to the lower edge of the pupil (photo 1), which caused obvious inconveniences: the patient could look with her left eye only with her head thrown back. The situation was aggravated by the presence of bilateral glaucoma, with decreased vision in the right eye.All this together significantly reduced the patient’s quality of life.

After the examination, it was decided to carry out an operation to correct the detected defect. Taking into account the pronounced cicatricial changes at the outer corner of the eyelids of the left eye, the outer edge of the eyelids was dissected with the removal of scar tissue. Then a lunate skin flap was cut from the upper eyelid, self-absorbable interrupted sutures were applied. Further, a triangular autograft was formed from the lunate flap, and sutured from the outer corner of the eyelids to the place where the scar tissue was previously excised (doctor ophthalmologist M.Valyakh).

The day after the operation, there was edema, hematoma formation in the upper eyelid and in the area of ​​flap suturing. The upper eyelid rose and the patient was able to see with her left eye without hindrance (photo 2).

A week after the operation, the swelling and hematomas disappeared, there is no scarring in the area of ​​the external adhesion of the eyelids, the pupil is three-quarters open (photo 3).

“What happiness, the next morning after the operation I saw a pink flower on my windowsill!” – the patient thanks the doctor.

Eyelid Surgery – Blepharoplasty | Medical center “Family Doctor”

The eye area is an indicator of age-related changes and environmental photoaging. Loss of skin elasticity, swelling of the eyelids, bags under the eyes give the face a tired expression and visually increase age even in the absence of other external signs of aging.

Upper eyelid plastic

Eyelid surgery – blepharoplasty, remains the most demanded operation.Age is determined by the eyes. The eyes are the most emotional part of the face, therefore, when communicating with each other, we look into the eyes and, willingly and unwittingly, assess the age of the interlocutor. What do we see around the eyes: drooping eyebrows, overhanging excess skin folds in the upper eyelids, many wrinkles, bags in the lower eyelids, overstretched skin of the lower eyelids.
Overhang of the upper eyelids occurs over the years as a result of constant contraction of the orbicular muscle of the eye and thin skin; excess skin of the upper eyelid region gradually forms, approaching the ciliary edge.As a compensatory mechanism, the patient begins to twitch the eyebrow upward, thereby reducing the overhang of the eyelid, this leads to the appearance of wrinkles in the forehead area. In addition, hernial sacs are often present in the upper eyelid area. All these age-related changes cannot be eliminated by a non-surgical method, the indication is upper blepharoplasty.
Upper blepharoplasty is always performed with an incision, excess skin is excised, fat bags are removed, in rare cases, a fragment of the circular muscle of the eye is excised in order to prevent drooping of the eyebrows.The images below clearly show age-related changes in the upper eyelids, which were an indication for upper blepharoplasty.

Such operations are most often performed under local anesthesia on an outpatient basis. For the operation, tests will be required: a clinical blood test, HIV, RW, hepatitis B, C. The operation must be performed between menstruation.

Preoperative markings are visible in the image.

The picture shows the markings drawn with a solution of potassium permanganate, the skin area inside the markings will be removed.

On the 3rd day, the dressing is performed, on the 7th day, the stitches are removed. Up to 2 months, the scar in the area of ​​the operation will be in the form of a pink strip, then the scar tissue matures and turns pale.

The picture shows what the scar in the upper eyelids looks like after surgery.

In the following pictures you can see the result of the upper blepharoplasty.

Scar correction

Correction or removal of scars by methods of plastic surgery

Modern plastic surgery offers several ways to correct or remove scar tissue.Despite this, it is impossible to completely remove the scar, this must be understood, it is only possible to significantly reduce it in size, redirect the tension, improve its appearance, make it almost invisible, but still it will remain forever on the body. The essence of surgical correction is as follows: the scar is excised, and then either sutured in the same place, removing diseased skin areas, or move a little of the surrounding skin, or even displace the scar completely to make it invisible. In each case, it is necessary to consult an experienced plastic surgeon who will conduct a complete analysis of the scar, its history, condition, location and which organs are still affected during the healing and formation of scar tissue.

Surgical methods for removing scars

There are several methods in plastic surgery for the correction of scars.The result of such operations is the removal of a terrible scar, instead of which a thin, barely noticeable scar remains, the scar tissue is removed, and healthy tissue is sutured, due to this, tension is reduced, the scar becomes more elastic and mobile.

Z-plastic

The Z-plasty method is used to change the direction of the scar to make the direction more natural, parallel to the natural lines and folds.The technology lies in the fact that the scar is excised, and new incisions are made at an angle of 60 degrees from each end, forming small triangles, this creates a zigzag shape of the incision, which is where the name Z-plasty came from. As a result, scar tension is redirected and redistributed, which reduces scar contracture. To improve the effect, multiple Z-plastics are performed in small pieces. This technology allows very rough scars to be reduced.

W-plastic

W-plastic is also used for rough scars, the technology is as follows: around the scar, the skin is excised with small triangles, the rough, sore skin of the scar is removed, and the triangular skin flaps are joined in the form of teeth and the wound is closed with a new piece of skin.Small versatile pieces do not allow the formation of a large thick scar, the tissue heals more evenly, without creating strong tension.

Skin graft

Skin grafting is used most often for burns or very large scars in size, it is a very complex and serious method of scar elongation. A scar or a whole area of ​​skin is excised, and a donor site is taken from another place and the sore spot is covered. With this technology, scars remain in both the transplant sites and the inferior sites.

Patchwork

This is the most difficult scar correction operation, as it involves the transplantation of not only a piece of skin, but subcutaneous adipose tissue with blood vessels and sometimes muscles. Not only plastic surgeons are involved here, but also vascular ones, since in order to restore blood supply, it is necessary to reconnect the vessels in a new place. But from experience, it is believed that flap surgeries give a better cosmetic result than skin grafting alone.

After operation

Removal of scars using any technology is accompanied by bruising, flow, redness and discomfort for some time. During this period of time, it is important to follow all the recommendations of the attending physician, be very careful in movements, the stitches will be removed in a few days, but the skin is a living organism and time must pass for its healing and rehabilitation. The total healing time of the skin after scar correction operations can vary from 6 to 12 months, depending on the size and location of the scar, the properties of the skin and the quality of adherence to the doctor’s recommendations.

Scar correction operations are the fruit of joint activities of surgeons of many specializations, whose level of competence must be at the highest level. In the Semeynaya clinic, on the basis of the Scientific and Practical Center for Surgery, the best surgeons from Moscow are concentrated, possessing the highest scientific titles, constantly improving their professional level, as well as engaged in research work, which means that we use only the latest technologies and methods treatment in all directions.

Stationary | Medical center on Kirov

Trachoma: description of the disease, causes, symptoms, cost of treatment in Moscow

Trachoma is a chronic chlamydial infection that affects the cornea and conjunctiva of the eyes.

The causative agent of the disease is chlamydia (Chlamydia trachomatis). This is a special kind of microscopic bacteria that penetrates cells very quickly. At the same time, it has the properties of viruses. Getting into a cell of a living organism, chlamydiae, like viruses, integrate their genetic material into the cell’s genome. Further, new parasitic microbacteria are formed in the affected cell. The destruction of the cell occurs, its shell disintegrates, new chlamydiae emerge and begin to infect other cells of the body.

The causative agent of trachoma, the intracellular parasite Chlamydia trachomatis, was first identified in 1907 by Halberstedter and Provachek. Now massive trachoma infection occurs among the inhabitants of Africa, South America, Southeast Asia. Only sporadic cases have been reported in Russia.

The initial stage of trachoma is similar in features to bacterial conjunctivitis. As the progression progresses, there is a clouding of the cornea, damage to the cartilage of the eyelids.They form tricomatous grains – follicles. In the absence of adequate therapy, trachoma causes scarring of the mucosa. As a result of the destruction of the cartilage of the eyelid, clouding of tissues, a complete loss of visual function is possible.

Actively progressive forms of trachoma are more often diagnosed in children aged 4 to 10 years. Complications of trachoma in the form of blindness, volvulus, trichiasis occur in people after 50 years. As for gender differences, ophthalmologists diagnose trachoma three times more often in women than in men.

Code according to ICD-10

In accordance with the international classification of diseases 10 revision, trachoma has the following designations and names:

• The initial stage of trachoma (A71.0).

• Active stage of trachoma (A71.1).

• Trachoma, unspecified (A71.9).

Causes

Trachoma is an anthroponous infection characterized by an epidemic spread.This means that the causative agent of the disease is capable of parasitizing in natural conditions only in the human body.

Trachoma is very easy to catch. Chlamydia transmission methods:

• By contact through clothing, hands, hygiene and household items that are contaminated with contaminated biological secretions, such as pus, mucus, tears.

• Mechanical transfer of the pathogen by insects, eg flies.

The sources of the spread of the pathogen are patients with active forms of infection, as well as carriers of chlamydia, people with atypical and erased manifestations of the disease. The highest susceptibility to trachoma in epidemic foci has been established.

Thus, from an epidemiological point of view, the main role in the spread of trachoma belongs to the low level of sanitary culture of the population and unsanitary living conditions.

The main reasons for the development and further spread of the disease:

• Failure to comply with the rules of personal hygiene.

• Poor social conditions.

• Weakened immunity due to the presence of chronic diseases, allergic reactions.

• Treatment of eye diseases with untested folk remedies.

There is a high susceptibility of the human body to infection with chlamydia. Immunity to these parasites after infection is not developed, so there is always a chance of contracting trachoma again.

How it manifests itself

Trachoma affects both eyes in most cases. In the beginning, one eye becomes infected, after about a week the other is involved in the inflammatory process.

From the moment of infection with chlamydia to the onset of the first symptoms of trachoma, on average, it takes 7 to 14 days.At first, the infection is asymptomatic, then inflammation occurs, which is manifested by edema and hyperemia of the conjunctiva. There are no other manifestations of the disease. At the initial stage, it is possible to diagnose pathology only by chance during a preventive examination by an ophthalmologist.

With the progression of the disease, the patient has the following manifestations:

• itching and burning sensation in the eyes;

• Sensation as if sand were poured into eyes;

• swelling and redness of the mucous membranes, eyelids;

• photophobia;

• mucopurulent discharge from the eyes, at first in small amounts, later – increasing in volume.

As the trachoma virus invades tissue cells, the mucous membrane of the eyes becomes rough, then the cartilage of the eyelids thickens, and specific ptosis develops. This means that the eyelids become lowered in appearance, and the face looks always sleepy.

The main sign indicating trachoma is the formation of follicles and capsules around them, inside which the causative agent of the disease remains. This can lead to the fact that after many years of inactivity, chlamydia begins to multiply under favorable conditions.There is a violation of the integrity of the capsule and the disease recurs, that is, it develops again.

The danger of trachoma is not so much in its course as in the development of the consequences. The most unfavorable ones are cicatricial changes, for example, in the form of a twist of the eyelids, the development of dry eye syndrome. Complete fusion of the conjunctiva of the eyeball with the conjunctiva of the eyelids is possible.

The attachment of secondary bacterial or viral infections is dangerous by the formation of an inflammatory process in the conjunctiva, lacrimal sac, lacrimal canals, diseases such as chronic and acute conjunctivitis, dacryoadenitis, dacryocystitis develop.

Ophthalmologists consider corneal ulcers to be the most severe complications. It can be accompanied by perforation, the development of an inflammatory process in the iris and other tissues of the visual apparatus.

Basically, complications appear in the complete absence of treatment or incorrectly prescribed therapy, its insufficient volume or violation of the doctor’s recommendations, for example, non-compliance with the dosage of taking medications or self-completion of the treatment course.

Stages of the disease

Depending on the pathogenetic changes, the disease is characterized by 4 stages of development.

Initial or first

Inflammatory processes in the conjunctiva are characteristic. Symptoms are similar to those of common viral conjunctivitis:

• The membrane acquires puffiness, becomes thinner, redder due to the expansion of small blood vessels – capillaries.

• A pus-mucous, abundant secret begins to emerge from the eyes.

• The eyelashes clump and partially fall out.

• There is a feeling of sand in the eyes, patients notice photophobia, visual acuity gradually decreases.

• The eyelids become swollen, infiltration appears in the eyes.

Inflammation and enlargement of the cervical and submandibular lymph nodes are possible.At the same stage, trachomatous grains or follicles are formed in the area where the conjunctival membrane from the stratum corneum passes to the inner surface of the eyelids – lower and upper.

All these symptoms persist for no longer than 7 days, in individual cases they can be delayed, for example, with weakened immunity, the presence of concomitant chronic or acute diseases in the body.

Treatment of trachoma in the first stage can take place at home under the supervision of a doctor.

Second or active stage

At this stage, the following happens:

• increase in the total number of trachomatous follicles and their maturation, they are filled with purulent contents;

• papillary follicular hyperplasia;

• some follicles merge, causing severe swelling and redness of the eyelids;

• development of pannus and corneal infiltrates;

• necrotic processes of single follicles;

• beginning of follicular scarring;

• uncontrolled severe lacrimation;

• transition of the pathological process to the cornea.

The patient becomes dangerous in terms of infection for the people around him. Therefore, trachoma treatment at this stage is carried out only in a hospital setting.

Third (scarring) stage

What is typical for the third stage:

• begins active scarring of the conjunctiva and transitional folds of veins against the background of a decline in the infectious and inflammatory process;

• new follicles appear, but there are significantly fewer of them than scars;

• , the cornea is involved in the process;

• scars become visible with magnification (with the help of instrumental examination, they visually look like white stripes).

At the scarring stage, the eyelid is gradually deformed, and its volvulus occurs. As a result, the growth of eyelashes is directed into the eyeball, which leads to trauma to the cornea.

Due to damage to the cornea, the patient’s visual acuity decreases.

Fourth (cicatricial) stage

There is a complete opacity of the cornea, the inflammatory process disappears. Follicles and infiltrates are completely replaced by the formed scar tissue, which covers the entire surface of the eye.Surgical removal is required.

The lacrimal canal loses its patency, the conjunctival membrane is scarred. The cornea is compacted, ulcers form on its surface. The patient loses partially or completely vision, which depends on the degree of growth of the veil on the cornea.

The fourth stage of trachoma, depending on the degree of visual impairment, has 4 groups:

1. 0 – vision is preserved;

2.I – vision decreases to 0.8;

3. II – vision is reduced to 0.4;

4. III – vision less than 0.4.

Deformation of the eyelids and eversion of the eyelashes inside the eye damage the outer surface of the eyeball. This leads to the development of local inflammation and ulceration.

Forms of the disease

Trachoma has the following forms, depending on the predominant pathological elements:

• Follicular.It is characterized by the formation of a large number of follicles.

• Papillary. Papillary growths prevail, which are quantitatively larger than follicles.

• Mixed. Both follicles and papillary growths are formed, which are combined with each other.

• Infiltrative. The prevalence of infiltration of the affected structures of the eyeball is characteristic.

Preventive measures

Trachoma of the eye is an infectious disease. To prevent infection, it is important to follow the rules of sanitation at home and personal hygiene.

Recommended:

• Use clean water for washing.

• While observing personal hygiene, use antibacterial agents.

• Regularly carry out wet cleaning of the premises, do not leave debris.

• Prevent insects from entering the premises, as they are carriers of many infections. And if they are available, get rid of them in a timely manner, for this it is necessary to install mosquito nets on all windows.

• In the presence of eye diseases – conjunctivitis, barley – treat eyes with clean hands, use drugs prescribed by a doctor.

It is important to consider the risk of complications of trachoma.Therefore, if similar symptoms appear, even if conjunctivitis is suspected, it is necessary to visit an ophthalmologist. You should be attentive to your well-being after visiting countries with an unfavorable epidemiological situation for this pathology.

Diagnostics

To detect the disease, the following diagnostic methods are used:

• Visual examination of the organs of vision by an ophthalmologist. The doctor examines the eyes using a slit lamp or binocular loupe.This allows you to determine the follicles, infiltrates in the conjunctival membrane, pannus, ptosis of the upper eyelid.

• Cytological examination. Carried out to detect chlamydia. To do this, take a scraping from the mucous membranes of the eye.

• PCR or polymerase chain reaction. To identify the pathogenic pathogen, a smear is taken from the affected tissues of the eyeball. The method makes it possible to detect the presence of a parasite even with small quantities.

• Immunofluorescence reaction. Determines the presence of chlamydia in the epithelial cells of the eye.

• Culture sowing. It involves placing the obtained biomaterial from the affected eyeball into a nutrient medium, which makes it possible to identify the type of causative agent of the disease.

Features of treatment

The patient is prescribed the following drugs:

• Ointments and solutions with antibiotics – Erythromycin, Oletetrin, Tetracycline, sulfonamides – Etazol.

• Drops with antibacterial action – Erythromycin, Tobrex, Chloramphenicol, Levomycin.

• With the development of a strong inflammatory process, hormone-containing ointments are shown:

• Prednisolone;

• Hydrocortisone;

• Dexamethasone.

Chlamydia is an intracellular parasite, therefore, to combat it, it is advisable to prescribe systemic antibacterial drugs in tablet form for oral administration:

• Tetracyclines – Minocycline, Metacyclin, Tetracycline.

• Fluoroquinolones – Ciprofloxacin, Ciprolet, Zoflox.

• Macrolides – Sumamed, Azithromycin.

Complex therapy is necessarily supplemented with immunomodulators, vitamin complexes to strengthen the body’s immune forces.

The duration of therapy can be up to six months, depending on the symptoms and stage of the disease. On average, 4 weekly courses are required, a break between them is 10 days.

Trachoma is characterized by a chronic course, has a tendency to frequent relapses. Therefore, in case of a disease and after its cure, patients are put on a dispensary account. Then they undergo regular preventive examinations by an ophthalmologist once every 3 months.

Removal of follicles

The method involves mechanical removal or extrusion of follicles. The procedure does not require general anesthesia; it is performed under local anesthesia.

By removing the follicles, you can shorten the duration of the course of the disease, eliminate its symptoms, provoke a speedy recovery with faster scarring of the affected tissues.

During the procedure, the inflammation is pressed with special tweezers. Purulent contents with waste products of chlamydia come out of the follicles.

The procedure is done twice with a break of 10 – 14 days.

• In case of persistent deformation of the eyelids, their volvulus, the surgeon performs excision of the healed tissues, makes the plastic of the changed eyelid.