Eyeworld

24 Ophthalmology Business • July 2018 Managing preop dry eye Although blepharoplasty does not typically cause dry eye, oculoplastic surgeons do try to treat it aggressively before surgery. 10. Test for dry eye preoper- atively and treat if necessary. "I don't think a carefully performed blepharoplasty causes dry eye, but it could certainly make dry eyes worse," Dr. Alford said. "I check all my patients preoperatively for corneal disease, corneal staining, and signs of dry eye." If a patient uses tears, common dry eye prescription medi- cations, or serum drops, he considers that a contraindication to surgery. A study 2 done at Stanford University showed no significant increase in dry eye after appropriately performed blepharoplasty and ptosis repair in patients with preexisting mild to moderate dry eye, Dr. Kossler said. "That being said, I recommend patients with severe dry eyes have their dry eyes optimally managed prior to eyelid surgery to minimize exacerbation of dry eye symptoms after surgery," she added. OB References 1. Kossler AL, et al. Current trends in upper and lower eyelid blepharoplasty among American Society of Ophthalmic Plastic and Recon- structive Surgery members. Ophthalmic Plast Reconstr Surg. 2018;34:37–42. 2. Chen T, et al. Effect of blepharoplasty and ptosis repair on dry eye. Poster presented at the 2017 American Academy of Ophthalmology (AAO) annual meeting. Editors' note: The physicians have no financial interests related to their comments. Contact information Alford: alfordmark@charter.net Allen: richardcutlerallen@gmail.com Kossler: akossler@stanford.edu Melicher: jsmelicher@mneye.com Nerad: jnerad@cincinnatieye.com period before surgery, Dr. Melicher advised. However, not all medica- tions need to be stopped. "I never stop medications from other doctors without their OK," Dr. Allen said. Pinpointing the right— and wrong—patients 7. Advise patients about other procedures they should consider for the results they want. "You must determine if blepharoplasty is the correct surgery to solve the problem. Sometimes eyelid ptosis repair and brow lift are required for a good result," Dr. Alford said. Laser resur- facing, a facelift, or onabotulinum- toxinA are also sometimes discussed during preop visits for blepharoplasty patients, Dr. Melicher said. 8. Watch out for physical lim- itations that could make blepha- roplasty less successful. Dr. Alford will typically avoid blepharoplasty in patients with heavy brows or skin that is damaged due to inflammation or sun exposure as well as in pa- tients with deep set eyes, blepharitis, eczema, or lupus. If a patient has a cardiac or stroke history, he will involve the primary care physician or cardiologist. Thyroid disease can also cause unpredictable postop results, Dr. Allen said. "If the patient has concomi- tant ptosis, lateral canthal tendon disinsertion, or brow ptosis, ensure these conditions are discussed and addressed as well," Dr. Kossler said. 9. Steer clear of patients with unrealistic expectations. "A novice blepharoplasty surgeon will save themselves a lot of heartache and time if they learn to say no to these patients," Dr. Kossler said. "Use your clinical judgment, and do not let patients convince you to do some- thing you do not think is in their best interest." "Always think, 'What is it about this patient that will lead to an un- satisfactory surgical outcome?'" Dr. Allen said. 5. Always take preop photos, and document informed consent, Dr. Melicher said. The surgeon should get informed consent, Dr. Alford advised. Inform patients of surgical risks, even if those risks are not common. Risks include asymme- try, lagophthalmos, bleeding, scars, infection, tearing, ptosis, dry eye, and blindness. When taking photos both pre- and postop, Richard Allen, MD, PhD, Baylor College of Medi- cine, Houston, aims for consistency in lighting and background. 6. Make sure patients are willing to follow any preop prep. This could include antibiotic use (although not all patients will need this), smoking cessation, and discon- tinuation of blood thinners and/or herbals and vitamins for a short-term continued from page 23 Blepharoplasty trends 1 Blepharoplasty is the third most common aesthetic surgical procedure in the U.S., ranking behind liposuction and breast augmentation in frequency. Americans spent almost $440 million on cosmetic blepharo- plasty surgery in 2013. More than 161,000 bleph- aroplasty procedures were performed in 2013, a 5.4% increase over 2012. Among patients 51–64 years old, blepharoplasty was about equal to facelift and liposuction in terms of frequency of cos- metic surgical intervention. 70% of blepharoplasties are functional, and 30% are aesthetic.

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