Definition
Excision of a protrusion of periorbital fat, and resection of excessive redundant skin of the eyelids.
Discussion
- The procedure may be performed on both the upper and lower lids, and may be both cosmetic and functional, since sagging skin from the upper lids may interfere with the patient’s eye sight.
- The amount of tissue removed depends on the severity or deformity and the age of the patient.
- Local anesthesia with conscious I.V. sedation is usually the anesthesia method of choice.
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Positioning
- Supine with arms tucked in the sides.
- The head may be supported on a headrest.
- A nasal preparation is usually performed prior to begin the skin preparation.
Packs/ Drapes
- Head and neck pack or basic pack with split sheet and head drape.
Instrumentation
- Basic plastic tray
Supplies/ Equipment
- Small basin set
- Suction
- Local anesthetic with epinephrine
- 10-ml Control Leur-lock syringes
- 25-or-27 gauge needles
- Blades
- Needle counter
- Cotton-tipped applicators or cellulose sponges
- Solutions
- Sutures
Procedure Overview
- An elliptical incision is made in the recess of the upper eyelid, following the premarked lines.
- Grasping the subcutaneous fatty tissue with a fine forceps, the tissue is gently dissected with a small scissors and removed.
- The upper lid incisions are covered with moist saline sponges (or eye pads) while the resection of a portion of the lower lid is performed.
- Small bleeders are controlled with cautery.
- The skin edges are approximated and closed with fine interrupted sutures.
- A topical antibiotic ointment or dressing (nonpressure) is applied.
Perioperative Nursing Considerations
- Do not allow the preparation solution to pool in or around the eyes or ears.
- A head drape should be used for all facial surgery.
- The table may be flexed for added patient comfort.
- A foam mattress should be used for extra support.
