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Topic 27 - 2
Refractive Surgery
and Blepharoplasty
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As refractive surgery has grown in popularity, the number of people seeking blepharoplasty who have either had or are actively considering having LASIK or a similar vision procedure has increased dramatically. Fortunately, the two procedures are compatible. To maximize the chance for a good refractive result, however, several general guidlines related to proper timing and selection of eyelid surgical approach should be considered:

• While either refractive eye surgery or blepharoplasty may be performed before or after the other, the two procedures should not be performed simultaneously.

If blepharoplasty is performed first, several months should elapse before undergoing preliminary calculations. Precise measurement of corneal shape and refractive status are critical to the success of vision improvement procedures. Following eyelid surgery, both of these parameters may be temporarily altered by slight but persistent swelling on the eyelids and/or on the conjunctival surface of the eyeball.

If refractive surgery is performed first, blepharoplasty should be delayed for about six months or more. No matter how gentle your eyelid surgeon's touch, there is some stress placed on the cornea during the operation. Furthermore, temporary interference with normal eyelid closure and positioning during healing may aggravate symptoms caused by the tear deficiency and dryness often experienced by those who have undergone recent LASIK.

Since some refractive surgeons may prefer a longer interval (especially, for instance, if a secondary "enhancement" procedure is being contemplated), it's best to check with the ophthalmologist before scheduling a blepharoplasty.

• To lessen the chance of corneal stress after cosmetic eyelid surgery, it is more important than ever that any blepharoplasty overcorrection be avoided. Poor lid closure, even if temporary, can be irritating to the operated cornea.

Since the most common adverse reaction following lower eyelid blepharoplasty performed by the traditional skin approach is eyelid retraction, this version of the operation should be undertaken with added caution. The transconjunctival approach to lower eyelid blepharoplasty is safer in this regard in that it rarely results in a pulling down of the lower eyelid.

A good way to avoid surgical overcorrection in upper eyelid blepharoplasty is to have the procedure under local anesthesia with sedation rather than general anesthesia. This allows for patient feedback during the operation and helps the surgeon be more precise.

• Following refractive eye surgery, some patients may experience temporary or even permanent reduction in the production of the natural tears that lubricate their eyes. Since the force of blinking in the immediate post-blepharoplasty period is decreased thus resulting in a less efficient distribution of this already decreased lubrication, the feeling of dryness and some blurring of the vision may be noticed. The liberal application of artificial tears can be helpful.

Once eyelids are no longer hidden behind thick glasses, it's nice to have looking attractive. Just remember that the eyes and eyelids do interact. After a lifetime of waiting, there is no urgent reason to rush from one surgical procedure to the next.

Next: Blepharoplasty Risks
and Complications

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