The preoperative evaluation of the patient for cosmetic eyelid surgery is extremely important. A preoperative evaluation provides a setting that creates a sense of comfort in the relationship between the Dr. Azizzadeh and the patient. An open relationship allows for discussions of the surgical procedure, aesthetic goals, and exceeding the patient’s needs.
The steps for evaluating a patient who desire cosmetic oculoplastic surgery include:
- Examination of abnormalities of the forehead, eyebrows, eyelids, cheeks, face, and skin condition
- Ocular (eye) assessment
- Tear secretion measurements
- Photographs and 3D Modeling
This preoperative evaluation allows the patient to clearly express certain wishes and achievable realistic accomplishments.
It is important to figure out the needs of the patient, so first a full medical history will be taken to review any illnesses, medications, allergies and/or previous surgeries. The reasons behind the patient’s desire allow Dr. Azizzadeh to differentiate patients who have realistic, mature reasons for requesting surgery from those who do not. The examination includes evaluation of the forehead, eyebrows, upper and lower eyelids, cheeks, face, and skin. It is important to view the entire face before focusing on specific structures. This examination allows us to determine which cosmetic problems are correctable in order to be compared with the patient’s expectations.
Types of Eyelid and Eye Consultations:
Forehead and Eyebrow Examination
When examining the forehead and eyebrows, Dr. Azizzadeh will look for drooping (ptosis), causing excessive upper eyelid folds. Forehead wrinkles and frown lines are also examined.
Patients with excessive drooping of the brows are best able to view the cosmetic problem when they are looking directly into a mirror and the surgeon measures from the middle of the eyelid to the middle of the brow.
One method used to measure the amount the brow droops is to line the zero mark of a millimeter ruler with the upper central brow edge. The brow is then lifted to an acceptable level with the examiner’s finger.
Repeated measurements are made over the temporal and nasal aspects of the brow about 10mm from the brow ends.
Another method uses the ocular asymmetry measuring device, consisting of: a headband, a ruler, and a T-shaped crosspiece. When the headband is placed on the patient’s forehead, it fixes a ruler vertically over the middle of the forehead. The crosspiece line cuts across the corner of each side of the eye and levels the crosspiece. The crosspiece is than lifted to the new upper middlebrow position; the digression of the indicator is noted.
To elevate the brow surgically it is important to measure the amount the upper eyelid droops in order to determine how much skin must be removed.
Examination of the Upper Eyelid
The upper eyelid is evaluated for: excessive skin, protruding orbital fat, abnormal eyelid creases, drooping, retraction, and falling of the lacrimal gland.
Eyelid Skin-fat Examination
The amount of excessive skin and whether there is more than usual amount over part of the upper eyelid are determined. Noting fullness in the upper eyelid is determined by the finding protruding orbital fat. Lifting the lid fold by elevating the brow while pushing on the eye through the lower eyelid can cause the fat to protrude into the suspected areas. Determining the amount of excessive and protruding orbital fat before surgery establishes candidates who would benefit from the removal of these tissues.
Eyelid Crease Examination
Dr. Azizzadeh will identify the upper eyelid crease by lifting the eyebrow and asking the patient to look downward, slightly upward, and then downward again. Dr. Azizzadeh will discuss the location of the upper eyelid crease with the patient preoperatively. Often times patients have different views and opinions of what looks cosmetically appealing. Therefore, it is important to discuss the results preoperatively to predetermine the desired level of the upper eyelid crease. This is especially true for Asian blepharoplasty.
Evaluation of Blepharoptosis
Some patients will have drooping of the eyelids (called blepharotosis) that may require simultaneous correction at the time of the blepharoplasty. This is important to determine preoperatively in order to obtain the best possible outcome.
Evaluation of Lower Eyelid Retraction
Some patients with thyroid history, experience lower eyelid retraction; the distance between the inside edge to the lower eyelid is used to measure retraction. This assessment is extremely important to identify preoperatively to avoid postoperative complications.
Examination of Lower Eyelid Laxity
Laxity of the lower eyelid is evaluated as Dr. Azizzadeh pulls the lower eyelid downward and observes how fast it snaps back to the eye. A redundant eyelid can also be evaluated by pinching full-thickness eyelid tissue together.
Examination of the Cheek and Face
The cheek and face should also be examined along with the upper and lower eyelids. Aging and thyroid disorders can produce cheek bags and cheek depressions. A cheek or mid-face lift can improve these problems through a lower blepharoplasty approach. A facelift and liposuction help treat sagging of the face and neck, caused by aging. Often times, fat grafting (FAMI Method) will be needed to fill in the hollows and depressions of the cheek and lower eyelids.
The condition of the skin should also be evaluated. Aging and sun exposure cause wrinkled skin of the eyelids, lip area, and face. Chemical peels and laser resurfacing (Fractional Star-Lux) are methods used to enhance and improve the texture of the skin.
Determination of Visual Acuity
Visual acuity is examined preoperatively.
Ocular Motility Testing
Having the patient follow a muscle light allows Dr. Azizzadeh to test motility of internal eye muscles.
Evaluation of Basic Tear Secretion
A basic tear secretion test is used to rule out dry eye syndrome. If the basic tear secretion is insufficient eye irritation may develop or increase following a cosmetic blepharoplasty. In the event of low tear secretion a more conservative blepharoplasty will be performed by Dr. Azizzadeh.
Evaluation of Visual Fields
The peripheral visual fields are evaluated if loss of peripheral vision is suspected. This evaluation is important in determining whether or not the loss of peripheral vision is due to upper eyelid or brow ptosis. Visual fields are also important for establishing the amount of peripheral vision loss in patients with drooping of the upper and lower eyelids.
Assessment by Photography
“The eyes are the window to the soul”
– Immanuel KaneEvery candidate for cosmetic oculoplastic surgery is required to take preoperative photographs. Preoperative photographs have several advantages: (1) visual record for preoperative assessment of the patient’s problems, (2) new aspects of the patient’s problems become apparent on photographs that were not visible in the initial examination, (3) the patient is able to see the changes postoperatively. Photographs are taken of both eyes in primary and up and down positions preoperatively and 2-4 months after surgery. Vectra 3D imaging brings a new dimension to photography, and Dr Azizzadeh is the first plastic surgeon in California to have the new vectra modeling system. Read more about 3D Imaging.
After the examination is completed, Dr. Azizzadeh will discuss all the pertinent findings. It is important to demonstrate ptotic brows and a wrinkled forehead, low upper eyelid creases, excessive skin, protruding fat, skin discoloration and wrinkles, upper eyelid ptosis, orbicularis muscle hypertrophy, check bags and depressions, nasolabial folds, and facial sagging. Demonstrating sites for surgical incisions and scars are shown to the patient and what can and cannot be accomplished surgically and non-surgically.
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It is important to have eyelid surgery performed by an experienced facial plastic surgeon, not just any doctor. Contact Dr. Azizzadeh today if you would like to schedule an initial consultation.