Dr. Maas talks about lower eyelid fat bulges and then performs a live blepharoplasty surgery. WARNING: graphic content follows Learn more about blepharoplasty San Francisco
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“I came across a what I think is a great video demonstrating what we do for lower lid fat bulging or what often people referred to as eye bags. These are the bags that happen under the eyelids. There is the result of the fat pads prolapsing or moving forward when the orbital septum’s weakens. The orbital septum is sort of the girdle of the lower eyelid and when it weakens as we age the fat pad prolapse or move forward and give us the eye bags and really this can happen to anybody and it’s not particularly age related, if you’re genetically predisposed for to it is it can happen in very a young age really on your 20’s or 30’s.
The treatment for has really evolve over the past few decades and really in today’s world i think there’s very few cases where you’d have to have an external incision on the eyelid one that was called a submaxillary incision back when I did my training in 25 years or more years ago and now we’re going behind the eyelid making small incisions, there’s no scar to be seen and if the skin quality is not good, if there’s wrinkles or fine lines we’ll do resurfacing to tighten skin and make it smooth. So there’s really the reason to excite skin to this patient. That said there’s some reasons why we might and when we do that, we do what we call it Pinch Blepharoplasty. So with that said we’ve talked a little bit about Blepharoplasty before but I thought I’d introduce this video. Now this one isn’t for the pain of heart, it’s actual surgery, it’s not gross or bloody or anything but it is an actual surgery that shows the incisions and it shows me identifying the 3 fat pads that make up the bulging of the lower lids and so if you’re interested as I have it or anatomist or a person considering it. You can see how gentle and how very precise the procedure is and the efficiency with which it’s done. It’s actually a long lasting result and the idea behind this is not taking out all of that fat bags, it’s about reducing the bulging so I’m only taking a small portion of the fat bags out to make the lower lid nice and flat. So I’m going to leave it at that as we move into the video and you get to see what we call transconjunctival which is behind the lid, lower eyelid blepharoplasty for fat bags or bulges of the lower eyelid. Another option for her would be to have a Laser Resurfacing done but because of her pigmentation skin type and the issue of hyper pigmentation, hypo pigmentation heal like it just have the inch blepharoplasty for the dramatic places and we’ll be taking care of the fat pads for the underneath the eyelid at the same which you can see by thing little pressure on this. (Look up at me). We put some drops in the eye here. Look up at me Miss Love. Does this one sting a little bit?
Dr. Maas: Ms. Love are you okay?
Dr. Maas: That’s good. We put some eyelid, some macro lubricant so that we don’t have any problem with injuring the cornea and then as I placed this over the cornea here in the globe, you can see and pressed down that you get the fat [Inaudible [00:03:48]. Last instrument i think is important to see is that we use the Colorado Needle tip here, this is the red tip, it’s coated with rubber all the way up to the very tip, it’s a fine needle points, it’s great for petting, it protects text the cornea and only clatterize as where you need it and I said it on the… We have a Valley Lab at SSE2L clattery we set a clattery and cutting settings on 2 1/2 for this procedure. Now I’m going to go on at a very depth of it as we fat pad [Inaudible [00:04:22] right across for the conjunctiva incision which a little bit of local fluid in the set conjunctiva. Set the conjunctiva purpose and we’ll make a nice incision here, we’ll going to be thanking about protecting the cornea. Some people continue with this kind of set up alone during the days, [Inaudible [00:04:45] make our incision and then come back as you’ll see in a moment and create a little bit of a conjunctiva left, we protect the surface. While this is still in placed at the fornix of the eyelid put a little 4-O vicro suture in through the [Inaudible [00:05:08] here this will allow us to pull the concept and over we protect it, protect the cornea of the eye and I think you can see that pretty nice.
The mid, this 3 fat pads in the lower eyelid, the mid medium lateral. Some people are very strict about finding certain ones that at them first and then identify in the other side, I don’t really have this from feeling about that one way or the other but I think you need to look for all three, there’s plenty and if you don’t find them, remedial and first that you’ll end up never finding it and it is the one that’s optimal medium size obviously. So I’m going to give a little bit more local right into the fat pad now and as we do that I’ll let you relieve the pressure filling the patient.
Dr. Maas: Are you in pain right now?
Patient: A little.
Dr. Maas: A little fresh, that’s great, thank you.
And then were going to use our Colorado needle. [Inaudible [00:06:15] Have you used it on a cutting setting I don’t use this for a cutting setting for this [Inaudible [00:06:19] thing. The vessels that you can [Inaudible [00:06:22] here on the fat pad is slight prominent and it’s important if you get this cauterized with full operation here make sure to [Inaudible [00:06:35] fat pad [Inaudible [00:06:36] the minimum of [Inaudible [00:06:39] so if the patient can give quickly better. This and we’ll be less clattery if done appropriately even if optic nerve right here [Inaudible [00:06:51] injury than [Inaudible [00:06:54] to avoid it. The techniques just as this fat pad again this is the common [Inaudible [00:07:01] this is going to be the lateral up here and [Inaudible [00:07:05] my finger on the glove a little bit, a little pressure, can we have the [Inaudible [00:07:09] a little pressure, Cathy are you okay?
Dr. Maas: Let’s put some local numbing medicine just a second here. How is that showing up Cel?
Cel: It’s pretty good.
Dr. Maas: Okay. Okay I’m going to tease that fat pad out of the pocket here. Once it’s sets done we’ll give her a little bit more local directly into the fat pad. You can see how this procedure might hold up the way you can certain to get feedback and [Inaudible [00:07:37]. How was it going over there Cel? You got to give me some direction if I need to…
And these are for those nasty bags underneath the eyes that nobody likes. People ask me “Does this procedure take care of dark circles under the eyes?” and the answer to that is really “No” like most people believe that, that is from chronic edema, I have gotten some improvement in a couple of patients that is not something I ever promise the patient, dark circles. Some people confused dark circles that created by shadows from deep bags for the dark circles that are more wide spread. [Inaudible [00:08:32] keep the pressure but not to me I think we’re got it all taken care of. All these fat pads are gone. Let me check. Here we’ll check again, once we relax this while the suture, our retraction sutures are still in place. I’ll check with the lids on and look for the fatty bulge that we addressing earlier. You can see that the difference between the two eyes in terms of the bulging there and I’m just going to put a little glove pressure on here, you see we have a nice symmetric amounts of bulge here already. And here it is right here. We’ll begin just a single suture kind of directing the sharp points away from the cornea so we can’t damage it. Some people put nose sutures in this so it stays, i like to put one or two. So the idea behind this is that they have like an alice clamp like tip to them for grasping along the line and we’re just going to go grasp right in the immediate sub-axillary region and pinch a small amount and they we’re done in the skin here. Make it sure as we pinch it they were not seen any lid retraction, you see now I saw a little lid retraction there, I can start over, I don’t want to see any lid retraction anything pulling down on or where that lid margin is that’s the limit of what we can pinch on a transconjunctival blepharoplasty with a pinch and I’ll come right across again looking at the lid margin the entire time pinching at just the tissue that’s redundant and it is a good way to treat the hermetical laces. It is not as effective, i do not believe as see a two Laser Resurfacing we can really get all the fine wrinkles taken care of, but it doesn’t have of course the attendant hyper and hypo pigmentation associate with it. Once we pinch that we’re ready to make a direct tissue excision I’m going to have to take that a little it and with gentle traction on the lid and very sharp scissors we’re going to of course excise this and I’m try to stay to avoid the eyelid or the eyelashes, we want to preserve eye lashes and we’ve come across the lower lid and you can see that there’s absolutely no gaposis, no gap between the eyelid skin and the lashes that’s exactly how you want it to be. [Inaudible [00:11:27] As we close this I’ll do a little running, you can use derma bond if you want to but there’s all kinds of ways to close this things up for the couple stay sutures and of course we take this out within 3 days after surgeries so that we would do the incident it closes, i do a little running you can use derma bond if you want to but there’s all kinds of ways to close these things up for the couple of space sutures and here we take these out within 3 days after surgery so we reduce the incidents of milia and that’s all you can say about that, really. There’s very little raw surface so you don’t really need to separate. I gave her pre-op of Ativan 2mg, Histenol 50 mg, Benadryl 50mg and Zantac 150mg. [Inaudible [00:12:22] to be able to our product and analgesics enter operatively so we take care of the issue of that associated nausea and there’s this little tiny skin closure here, so we don’t draw much tension. So it’s a couple of graphs of [Inaudible [00:12:58] associated with this and of course it’s all anterior to the orbital septum, so anything in the outside is not reflective of intra-orbital tissues as it would come out in the conjunctival side of this. Pretty right away from our outstanding [Inaudible [00:13:28] tech. Michael, how’s that, is that better? We’ll compare two sides and we’re going to look at the mid. medium lateral fat pads and here’s the script of the skin we’ve taken a couple of millimeters of pigments.”