From a Cosmetologist to an Ophthalmologist: What and How to Treat? Clinical Examples. Part 1 — Blepharoplasty

In recent years, there has been a rapid increase in the number of patients with a history of cosmetic interventions in the periorbital area who applies to ophthalmologists with various complaints. Such interventions include the introduction of dermal fillers, blepharoplasty, botulinum toxin injections for aesthetic purposes, mesotherapy, eyelash extensions and eyelid tattooing. It should be noted that patients may present the most unexpected complaints, which, if the doctor is not informed in this widely used area, cannot always be associated with cosmetic procedures in the anamnesis. This article will discuss complications associated with blepharoplasty, present clinical examples illustrating the varying degrees of lagophthalmos severity at different observation periods after upper and “circular” blepharoplasty, in accordance with which indications are determined for choosing the tactics of managing this group of patients at an outpatient appointment with an ophthalmologist. Before carrying out cosmetic procedures in the periorbital zone, in particular before blepharoplasty, it is necessary to conduct a comprehensive examination of patients, including an assessment of the biochemical blood test, immunological and endocrine status of the patient. If complex cosmetic procedures in the periorbital zone are detected and/ or changes in the somatic status are present, it is necessary to inform the patient of the high risk of complications associated with these procedures. If lagophthalmos caused by blepharoplasty is detected during an ophthalmological examination, the patient should be referred to the operating plastic surgeon for a comprehensive rehabilitation, including eyelid massage, performed to increase the area of the skin surface of the eyelid and eyelid gymnastics. These procedures are effective for one month after blepharoplasty until the stage of formation of gross cicatricial changes in the skin. If lagophthalmos persists for more than 6 months, repeated reconstructive blepharoplasty is recommended to eliminate lagophthalmos. Blepharoplasty, especially “circular” blepharoplasty, which involves expanding the surgical intervention area, is recommended to be performed in specialized certified ophthalmological clinics, it will reduce the risk of complications associated with this type of surgical intervention.