Jul 02, 2017 transconjunctival approach wearesurgeons loading. Preseptal transconjunctival approach to the orbital floor. Transconjunctival approach to lower eyelid blepharoplasty. Feb 29, 2016 transconjunctival blepharoplasty is a technique that best addresses pseudoherniated orbital fat. The transconjunctival approach is used for the exploration and the treatment of the orbital floor fractures. Request pdf modified lower blepharoplasty with fat repositioning via transconjunctival approach to correct tear trough deformity background over the years, many techniques have been described. Several authors have proposed that the transconjunctival approach decreases the risk of postoperative eyelid retraction, which varies from scleral show to persistent ectropion. If a canthotomy is performed in conjunction with the approach, the only visible scar is the lateral extension, which heals leaving an inconspicuous scar. Methods the lateral wall was approached ab interno through a swinging eyelid approach lateral canthotomy and lower fornix incision and an extended periosteum incision along the inferior and lateral orbital margin. Jun 22, 2017 evaluation of transconjunctival approach in management of orbital tumors the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. There was only one case of ectropion in the transconjunctival group. While the retroseptal approach offers a more direct and. There are a variety of adjunctive techniques canthoplasty, skin pinch, muscle strap which may be included in surgery which warrant cutaneous incisions and muscle manipulation. The studies done by wray et al,7 appling et al,5 and patel et al6 have all found signi.
Lower eyelidmidface aging is a multifactorial process involving degenerative changes in the skin and muscle, loss of soft tissue volume, bone remodeling, and tissue descent. Pdf y modification of the transconjunctival approach for. What is transconjunctival lower eyelid blepharoplasty. As long as your high blood pressure is well controlled i recommend you see your medical doctor to confirm and that you dont have dry or wet eyes following your previous eye procedure, you should do well. Fatrepositioning lower blepharoplasty via a transconjunctival approach is increasingly applied due to its satisfactory rejuvenating effect. Four of the 45 eyelids treated by the subciliary approach required subsequent surgery to manage ectropion. Prasad uses transconjunctival laser blepharoplasty to remove, sculpt and reduce the fat under the eye. Feb 14, 2018 this case demonstrates fourpoint fixation with scleralsutured iols.
Transconjunctival approach to peribulbar block opth. Fat has been repositioned through a transcutaneous 3,4 or a transconjunctival 5,6 access and into the supraperiosteal 7,8 or the subperiosteal plane, 1,5,6. How to combine files into a pdf adobe acrobat dc tutorials. In the typical transconjunctival buried suture procedure for double eyelids, the adhesion between the skin and the pretarsal tissue or conjunctiva through the tarsal plate and the sling with the skin, the levator, and mullers muscle are obtained by suturing.
The results are more aesthetically pleasing than topical creams or ointments and last much longer, up to a lifetime in most patients. The transconjunctival blepharoplasty is my favorite approach to lower eyelid surgery. Transconjunctival upper lid blepharoplasty sciencedirect. Transconjunctival subconjunctival approach refers to the surgical technique where the globe, nictitating membrane and lid margins are excised while leaving as much soft tissue as possible to minimize the orbital depression. Surgical outcomes of transconjunctival anterior orbitotomy. Choose from a variety of file types multiple pdf files, microsoft word documents, microsoft excel spreadsheets, microsoft powerpoint. Modified lower blepharoplasty with fat repositioning via. A subciliary approach supplemented by the lateral brow incision is currently the. Transconjunctival lower lid blepharoplasty, first described in 1928, 1 gained tremendous popularity in the 1980s 2 because it significantly reduced the risk of lid retraction associated with the traditional skinmuscle approach. May 20, 2019 the transconjunctival blepharoplasty is receiving increasing attention as an alternate technique to traditional transcutaneous blepharoplasty. Transposing native eyelid fat to the nasojugal groove tear trough has become a standard adjunct to lower blepharoplasty in the appropriate patient. Orbital floor fractures may be reached through 2 types of conjunctival approaches.
With the transconjunctival technique, an incision is made through the lower lid conjunctiva, thereby avoiding an external incision through the skin and leaving no obvious scar. One eyelid in the transconjunctival group was lacerated by traction. Combined transconjunctival and transcaruncular approach for. However, those methods have disadvantages such as a complicated surgical approach, residual scar, and long recovery time.
These are assisted by the stab wound or a needle through the eyelid skin, and the skin wound takes several days to heal. Pdf lateral canthotomy transconjunctival approach to the. Compared to the transcutaneous approach, the transconjunctival approach has resulted in no roundeye deformity, ectropion, or bleeding in the perioperative period. Multiple surgical approaches to the orbits with the use of the eyelids have been used. Transconjunctival blepharoplasty is a reliable method for fat removal that has proven the test of time over and over. This procedure is internal, producing no outside scars and preserves eye shape.
The results are more aesthetically pleasing than topical creams or ointments and last much longer, up to a. Transconjunctival blepharoplasty eyelid surgery new. Transconjunctival blepharoplasty is a type of lower eyelid surgery, which is performed without any external incisions. Y modification of the transconjunctival approach for management of zygomaticomaxillary complex fractures. Transconjunctival lower blepharoplasty with and without. This innovative procedure is relatively quick with a speedy recovery time, and no visible scarring. Transconjunctival approach in orbital traumatology.
The transconjunctival approach to lower eyelid blepharoplasty involves a precise incision made on the inner lining of the lower eyelid the conjunctival surface rather than the outer skin surface of the eyelid. Infection and bleeding can occur as of any surgical procedure. Protruding central, nasal and lateral fat pads are removed or redraped over. Discussion has focused primarily on individual surgeon experience with a particular approach, but a singlesurgeon comparison of the 2 publications is lacking. Combined transconjunctivaleyebrow approach providing. The transconjunctival blepharoplasty is an elegant and secure technique especially in young people and helps to avoid the hazard of a scar.
Transconjunctival lower lid approach for orbital fractures. The retroseptal approach is more direct than the preseptal approach and. Soda pdf merge tool allows you to combine pdf files in seconds. Pdf merge combine pdf files free tool to merge pdf online. Combined transconjunctival and transcaruncular approach for repair of large medial orbital wall fractures. We will focus on the preseptal transconjunctival approach. The transconjunctival approach provides the surgeon with an ample. Also, if the skin was pinched under the eyes, she had more than a transconjunctival lid correction in order to reduce skin excess. Both preseptal and retroseptal approaches have been described. Transconjunctival approach to peribulbar block lindsay a mcgrath,1,2 christopher bradshaw3,4 1university of queensland, school of medicine, brisbane, qld, australia. Jul 02, 2017 transconjunctival approach in lower blepharoplasty. Transconjunctival blepharoplasty recovery recommendations. While the retroseptal approach offers a more direct and easier route to the orbital rim and floor, it is associated with a significantly higher rate of lower lid complications compared to the preseptal approach.
Transconjunctival orbital fat repositioning for tear trough. Pdf transconjunctival lower lid blepharoplasty made easy by. Transconjunctival refers to a surgical approach to handling lowereyelid fat. Lower lid blepharoplastythe transconjunctival approach. Both procedures are safe in the hands of a board certified facial plastic surgeon, plastic surgeon, or oculoplastic surgeon that has experience with. Loeb first introduced the concept of repositioning orbital fat along the infraorbital rim to address tear trough deformity. Evaluation of partial tarsal plate excision using a. Pdf preseptal transconjunctival approach to the orbital. In older patients, it saves them the possible sequelae such as rounding sclero show or possible ectropion after a classical operation. Orbital floor fractures may be reached through 2 types of conjunctival approaches, the preseptal one and the retroseptal one.
Cataract surgery posted 2142018 this case demonstrates fourpoint fixation with scleralsutured iols. Transconjunctival orbital fat repositioning for tear. Pouches can be treated through two surgical approaches figure 1. You can either select the files you want to merge from you computer or drop them on. Because there is no visible scar, the transconjunctival approach respects the integrity of the functional structure of.
The transconjunctival approach provides excellent exposure of the orbit, leaves no visible scar, possesses a lower risk of the complications associated with transcutaneous techniques such as nerve or muscle damage, and allows for a shorter operation time usually 30 to 40 minutes compared to other techniques. The transconjunctival approach can be combined with a pinch technique to remove lower eyelid skin or a simultaneous lower eyelid chemical peel since there is no disruption of the. Laser blepharoplasty with transconjunctival orbicularis. With 25 or 23gauge transconjunctival techniques, the infusion line is snapped into the trocar and is ultimately taped to the drape. This webapp provides a simple way to merge pdf files. Over the years, many techniques have been described to correct tear trough deformity ttd.
The traditional transconjunctival incision, also called the inferior fornix incision, is a popular approach for exposing the orbital floor and infraorbital rim. Combined transconjunctival lateral canthotomy approach for. It offers the best method for tailormade, deeplayer fat manipulation, such as fat removal or fat repositioning. New internal fixation technique for transconjunctival fat. Incision although there are established techniques for the transconjunctival fornix approach 5, in our experience, 2performing a laser incision directly near the edge of the tarsus is more anatomically favorable. The transconjunctival approach is the most direct approach to the inferior orbital fat, located posteriorly to the orbital septum. The transconjunctival approach has a lower complication rate than the classic transcutaneous approach, with no visible scar and less risk of postoperative scleral show or ectropion. Transconjunctival lower lid blepharoplasty with fat resection duration. The orbital rim incision fell into disfavor because of esthetic considerations. It is an efficient surgery taking less than approximately 30 minutes to complete in a straight forward case. Sep 23, 2016 the significant advantage of transconjunctival approaches is that the scar is hidden in the conjunctiva. The use of preseptal transconjunctival approach in the surgical. If significant bleeding occurs in the lower lid, it can put pressure on the eye. In patients with significant skin laxity and redundancy, and in patients with hypertrophic orbicularis oculi muscle, the transconjunctival approach can offer little.
Pdf the transconjunctival approach for orbital bony surgery. Transconjunctival blepharoplasty eyelid surgery london. Transconjunctival approach to lowerlid blepharoplasty. Apr 01, 2010 another rare, but potentially devastating, complication of the transconjunctival approach is its increased risk of intraoperative choroidal effusion or hemorrhage. Combined transconjunctival and transcaruncular approach. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
The purpose of this work was to compare success, recurrence, and postoperative complications between the internal and external approach. The transconjunctival approach was first described in 1924 by bourget for the removal of lower eyelid fat. By utilizing a transconjunctival approach, we eliminate the need for peritomies at the start of the procedure. Pdf transconjunctival lower lid blepharoplasty made easy. Transcutaneous lower blepharoplasty the lower eyelid is infiltrated with local anaesthesia. Transconjunctival sutureless vitrectomy tsv was first introduced in 2002, using 25gauge instruments through a trocarbased system. Double eyelid procedure by removal of transconjunctival. Comparison of traditional pars plana vitrectomy to a transconjunctival approach marc j. Evaluation of transconjunctival approach in management of. The transconjunctival approach has frequently been used to treat orbital fractures of the medial wall and floor, as well as other types of cosmetic and pathological situations. Because the scars are inside the lower eyelid where they cannot be seen, this procedure is often called scarless blepharoplasty. The transconjunctival approach with lateral canthotomy is popular approach in orbital fractures because of minimal external scar.
Can transconjunctival blepharoplasty also lift, remove or. Wesley, md the transconjunctival approach provides a entire system of wide access to the orbit without surface scars. Prior to this date, the gold standard was the 20gauge threeport pars plana vitrectomy, which was introduced. In patients with excess skin, a minimal transcutaneous approach pinch technique can be combined with the transconjunctival approach to avoid wounding the septum. In our study, preseptal transconjunctival approach with lateral canthotomy and subciliary skinmuscle flap approach for the open. The incision is carefully made inside the lower lid so that the skin is not directly cut and hence no visible scars. A transconjunctival approach via the postseptal area is described. Transconjunctival approaches to the lower lid and orbit. Compared with transconjunctival lower lid blepharoplasty, transconjunctival upper lid blepharoplasty is relatively new. Transconjunctival approach in lower eyelid blepharoplasty.
Aims a modified surgical technique is described to perform a one, two, or three wall orbital decompression in patients with graves ophthalmopathy. With this option, you can create a separate pdf file containing all the pages in even number of count. A transconjunctival approach to the orbit, using a lateral canthal and inferior fornix incision swinging eyelid, was first described by mccord8 in 1981 and recently popularised by rootman and coworkers. By combining upper vestibular and transconjunctival approaches, the. Lower eyelid retraction occurred in 5 patients after surgery, although only 1 of them required surgical repair. Transconjunctival approach in lower blepharoplasty youtube.
Listing a study does not mean it has been evaluated by the u. The transconjunctival approach to lower lid blepharoplasty provides access for both fat resection and transposition to soften tear trough deformities and correct infraorbital fat herniation. The transconjunctival approach avoids incision of these tissues, and minimizes the retraction risk. Philippe levan, md the author shows how he performs transconjunctival lower blepharoplasty.
Transconjunctival lower blepharoplasty with fat repositioning. Of these cases, 1 patients underwent fourlid blepharoplasty, 59 underwent upper lid blepharoplasty only, and 24 underwent lower lid blepharoplasty only. Transconjunctival orbital fat repositioning incorporating preseptal dissection and supraperiosteal pockets is a safe and effective. The transconjunctival approach in lower lid rejuvenation is great to correct fat, though the exposure is not one used for cheek lift. The preseptal dissection plane is performed through a conjunctival incision, 2 mm under the inferior edge of the tarsus. Endoscopic approach interest in the endoscopic approach to the floor and medial wall has increased as surgeons try to avoid eyelid. This free online tool allows to combine multiple pdf or image files into a single pdf document. The transcaruncular approach is very popular because it easily combines with the transconjunctival approach. Transcutaneous approach article pdf available in modern plastic surgery 55. Transconjunctival preseptal approach for orbital floor and. In the patient with minimal fat pseudoherniation, this approach may not be best. These approaches vary in the relation of the orbital septum to the path of dissection see fig. The aged lower eyelidmidface demonstrates true or relative fat herniation, septal. A number of different techniques have been introduced to fix fat pedicles within the subperiosteal or supraperiosteal pocket.
Pdf preseptal transconjunctival approach to the orbital floor. Procedures to correct these deformities include orbital fat removal, 10,11 fat grafts, 5 fat injections, 12 plication or tightening of the orbital septum,14 and alloplastic implants. A, surgical rake retracting the lower eyelid demonstrates subperiosteal dissection. A skinmuscle flap is raised to the level of the orbital rim. There are 2 main approaches for blepharoplasty that you describe, the transcutaneous approach incision on the lower eyelid skin and the transconjunctival approach incision inside the eyelid. Evaluation of partial tarsal plate excision using a transconjunctival approach for the treatment of distichiasis in dogs. The technique of transconjunctival lower blepharoplasty with fat repositioning.
Transconjunctival blepharoplasty eyelid surgery new york city. The transconjunctival approach allows for direct access to the prominent fat pockets. Transconjunctival blepharoplasty my plastic surgeon. The transconjunctival approach gives a wide view of the orbital floor and of the inferior orbital border similar to the palpebral approach, but without secondary scarring jackson et al. Full text learning curve of sutureless transconjunctival 20. The access not only includes the inferior rim and orbital floor but. Patients who had a transconjunctival blepharoplasty were excluded. Ciarallo, ziccardi, and ochs 79 j oral maxillofac surg 52. A total of 35 patients, average age 32 years, had 45 transconjunctival incisions performed. Healthy people do well with planned cosmetic surgery. Patients presenting with eyelid bags typically have agerelated structural alterations to the eyelid and its adjacent middle face. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. C, origin of the levator labii superioris muscle tip of forceps.
Transconjunctival blepharoplasty is an ideal way to approach those unsightly bags below your eyes. B, forceps point to the suborbicularis oculi fat soof below the orbicularis muscle. Retinal physician comparison of traditional pars plana. Transconjunctival blepharoplasty is the keycomponent in a fully customisable modular approach to aesthetic and functional eyelid surgery. The author shows how he performs transconjunctival lower blepharoplasty.