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Improving the effectiveness of blepharoplasty due to low-traumatic laser dissection

Blepharoplasty today is a radical and effective method for correcting age-related changes in the skin of the periorbital region.

It is known that the skin of the eyelids is most strongly affected by external factors accelerating the loss of elasticity and the manifestation of signs of aging.

The omission of the zygomatic fatty tissue also contributes to the formation of folds of skin and ectropion of the lower eyelid, the manifestation of the so-called masking bags.

In plastic aesthetic surgery, there are a number of techniques and techniques aimed at restoring the elasticity of the skin in the middle third of the face with the reconstruction of muscle-aponeurotic systems.

As a rule, classical surgical techniques are traumatic and require a long postoperative period of rehabilitation using hardware and injection reconstructive techniques, while they do not always provide the best result.

Our task was to find a minimally invasive and less traumatic alternative method for performing lower eyelid blepharoplasty with fixation of the mask fat pack and the muscular aponeurotic system to the periosteum of the lower edge of the orbit and the zygomatic arch.

Since 2015, we have been successfully using the DEKA SmartXide2 DOT laser system in clinical practice for the gentle (less traumatic) separation of the skin flap during open blepharoplasty with the fixation of the mask fat pack and the underlying muscle aponeurotic systems to the periosteum of the lower edge of the orbit and zygomatic bone.

The examination of patients was carried out according to generally accepted methods and tests: sitting and lying, looking straight and up, eyes closed. The true hernial protrusions were determined, the state of the circular muscle of the eye, as well as the external and internal ligaments of the eyelids, was evaluated.

Photographs of patients were taken before and after the operation in different projections. The results obtained were analyzed.

A thorough ophthalmological examination was performed before and after the operation: visual acuity with correction, the field of view, refractometry and ophthalmometry were determined, an intraocular pressure study and Schirmer’s test 2 were performed.

Patients were interviewed in consultations prior to surgery to assess the degree of influence of appearance on quality of life. Patients were informed about the course of the operation, the necessary manipulations, as well as about alternative methods and possible complications. A contraindication for such operations, we consider the imbalance of the psyche and the presentation of excessive requirements for the result. Absolute contraindications for performing blepharoplastic surgery are general acute somatic diseases of organs and systems, as well as acute and chronic eye diseases.

Operation progress
Before the operation on the lower eyelid, a preliminary marking of the cut line was performed. The conjunctival sac was treated with a gel with a non-steroidal anti-inflammatory and antibacterial property (hydrocortisone + tetracycline). Local infiltration anesthesia with anesthetic solution in dilution was performed: 1% Lidocaine 2.0 solution with the addition of 0.1 Adrenaline 1: 1000 for each eyelid.

Using a SmartXide2 DOT laser beam (fractional CO2 laser) using a DekaPulse pulse (D-Pulse) with parameters power 5.0 * 5 Hz, an incision (surgical attachment) of the skin of the lower eyelid from the lacrimal opening was performed, then at a distance of 2 mm from the ciliary edge to the external angle of the eye (0.5-1.0 cm beyond the outer corner of the eye) along the middle groove of the “crow’s feet”. A single-layer skin flap in the lower eyelid region carefully peeled off to the required boundaries, namely, to a masking fat pack, with complete preservation of the vascular network (Fig. 2a).

The subcutaneous ligaments of the nasolacrimal sulcus were dissected with a laser beam. A thin perforation tunnel was made over the infraorbital fat pack on the circular muscle of the eye. Excess lobed fat is resected (Fig. 2b).

Muscle-aponeurotic tissue and a fatty pack to the periosteum of the zygomatic bone and the lower edge of the orbits were fixed with suture material monocryl 5.0 using separate interrupted sutures. Separated skin flap freely covered the underlying tissues after treatment with an antiseptic solution (an aqueous solution of chlorhexidine 0.05%). Sutures were sutured with PDS 6.0 thread, which were removed on the 3rd day after surgery. Skin compression was performed using a Strip-strip patch (1.0 cm).

Blepharoplasty is essential in aesthetic surgery, so the need to improve the methods used by reducing the morbidity, shortening the rehabilitation period while maintaining and increasing the effectiveness of the result is extremely urgent.

To achieve these goals in clinical practice, a DEKA CO2 SmartXide2 DOT laser system was used.

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