The revision blepharoplasty is an upgraded complexity level ordeal above the traditional blepharoplasty eyelids and narrowly below the borderline reconstruction blepharoplasty, aggravated due to some very specific injuries, damage to tissues, absence of anatomical elements, excessive resection or trimming of some essential parts, devascularization, massive fibrosis, necrosis, calcifications, loss, shrinkage or contraction of the outer skin cover or the inner eyelid lining, missing absence or wrong indication, graduation, calibration or execution of techniques applied, wasted or damaged grafting donor sites, poor aesthetic judgement, loss of critical support pillars, unsuitable balance, unforeseeable intraoperative findings and other factors, requiring meticulous debridement and cleansing of unstable, fibrotic and necrotic tissue to indentify viable structures and remove those not, perform a final diagnosis of situation to plan the definitive technical repair strategy and achieve a healthy and well vascularized recipient bed for grafting, plus requirements of additional structure supply with cartilage and skin grafting often involving the ear as donor site, fascia or tendon grafting and others; those patients with mixed post-traumatic and post-surgical sequels may present technical challenges belonging to both groups; the deeper and more extensive the damages of the inner structures, outer cover and inner lining of the eyelid the higher the complexity, the more demanding in invention and creativity, the lesser the chances of complete repair, the longer the surgical time and the more escalated the costs are bound to be.
Some of the most common techniques applied in the revision blepharoplasty are skin and mucosa grafting, simple cartilage or composite cartilage-mucosa and cartilage-skin grafting harvested from nasal septum or ear's concha bowl, grafting of wrist tendons, deep or superficial temporalis fascia grafting and others, canthoplasty, canthopexy, lateral tarsal strip procedure, suspension sling, wedge resection, plication or suturing, plasties and local flaps, forehead suspension, tendon transfer motorization, gold plate weighing, tarsorrhaphy and other custom or ophtalmic plastic surgery or oculoplastic procedures.
Typical scenarios where a revision blepharoplasty is performed are the persistent excess or excessive removal of skin, muscle and fat bags, wrongly located scars, scleral show, ectropion, upper and lower eyelid tarsal retraction, round eye deformity, entropion, droopy upper eyelid, skin and mucosa shortfall or retraction and others.
This eyelid revision surgery is normally carried out by means of external approach at outer skin, patches, adjacent areas and others; additional well hidden scars inside the nose, behind the ear, within the hairy temple scalp, below the wrist and others which might be necessary as donor sites of any grafted material.
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