5 Non-Surgical Suture Blepharoplasty Complications and How To Manage It
In our study, we have examined the comprehensive review by Young and Kim (2020), which provides valuable insights into the complications associated with Asian double eyelid surgery and emphasizes the importance of effective management strategies to ensure optimal patient outcomes and satisfaction (Young & Kim, 2020). Non-surgical blepharoplasty has increasingly emerged as a preferred option for individuals seeking to enhance or establish eyelid creases without resorting to invasive surgical techniques. This minimally invasive procedure predominantly utilizes sutures to achieve the desired aesthetic modifications. Despite its advantages, such as minimized recovery time and reduced risk compared to traditional surgical methods, it is not devoid of potential complications.
Overview of Suture Techniques
Non-surgical blepharoplasty employs various suture techniques to create or enhance eyelid creases. The choice of technique can significantly impact the durability and overall appearance of the results.
Single-Thread Sutures: A single strand of suture material is used to form the crease. This method is simple and straightforward but may not offer long-lasting results for some patients.
Double-Thread Sutures: This technique involves using two threads to reinforce the crease, providing better stability and definition. It is particularly useful for patients seeking more durable results.
Permanent Sutures: Made from non-resorbable materials, these sutures are designed for long-term retention. They offer long-lasting results but require precise placement to avoid complications.
Biodegradable Sutures: These sutures gradually dissolve over time, making them suitable for temporary crease creation. They offer flexibility for patients who might wish to adjust their eyelid crease later, but requires careful monitoring post-procedure.
Complications and Management Strategies
While non-surgical blepharoplasty offers a less invasive option compared to traditional surgery, complications can still occur, affecting both the aesthetic outcomes and patient satisfaction. Proper management of these complications is essential for achieving the best results.
Disappearance or Loosening of the Eyelid Crease
This issue often arises from the use of sutures that are either not securely anchored or that absorb too quickly if biodegradable sutures are used. Excessive eyelid movement, such as rubbing or blinking, can also contribute to the loosening or disappearance of the crease. Patients may experience dissatisfaction with the procedure if the intended eyelid contour is not achieved or maintained, potentially leading to a need for additional procedures and impacting their confidence.
Management Strategies:
Initial Assessment: Evaluate whether the crease issue stems from suture dislodgment, absorption, or other factors. Use visual and physical examinations to determine the underlying cause.
Re-suturing: For cases where sutures have become loose or dislodged, re-suturing may be necessary. Use non-resorbable sutures if previous biodegradable sutures failed, as they provide greater stability and durability.
Patient Education: Instruct patients on proper eyelid care, including avoiding activities that may stress the eyelids. Emphasise the importance of avoiding rubbing or excessive movement and adhering to post-procedure care guidelines.
Follow-Up Appointments: Schedule regular follow-ups to monitor the eyelid crease and assess its stability. Early detection of issues allows for timely interventions and adjustments.
Prevention:
Suture Selection: When possible, opt for non-resorbable sutures, especially in cases where long-term durability is critical. These sutures remain in place longer and reduce the risk of the crease disappearing.
Secure Suture Placement: Ensure that sutures are placed securely and anchored properly to prevent loosening. Techniques such as deep suturing and precise knotting can enhance suture stability.
2. Nodules or Granulomas
Nodules or granulomas can form due to an inflammatory response to suture materials, particularly if sutures are placed superficially or if the suture material itself is irritating to the tissue. The body forms granulomas as a defence mechanism to isolate and reject foreign materials. These complications can result in visible lumps under the skin, which may be aesthetically displeasing and cause discomfort. Additional treatments or interventions might be required, affecting patient satisfaction.
Management Strategies:
Identification and Removal: Identify the problematic sutures and remove them if they are causing significant issues. Reposition or replace sutures as needed to alleviate discomfort and improve aesthetic outcomes.
Anti-Inflammatory Treatment: Prescribe anti-inflammatory medications, such as corticosteroids, to reduce swelling and inflammation associated with granulomas. These medications can help alleviate symptoms and prevent further complications.
Surgical Intervention: For persistent granulomas that do not respond to medication, surgical excision may be required. This involves carefully removing the granuloma to restore a smooth appearance.
Prevention:
Deep Suture Placement: Place sutures deeper within the tissue to avoid visible knots and reduce the risk of granuloma formation.
Material Selection: Use suture materials with lower inflammatory profiles that are biocompatible. Non-reactive materials are less likely to provoke an inflammatory response, minimising the risk of nodules or granulomas.
3. Corneal Irritation
Corneal irritation may occur if sutures are placed too close to the corneal surface, leading to direct contact or friction. The corneal surface is highly sensitive, and any foreign material or irritation can cause discomfort and visual disturbances. Symptoms such as dryness, redness, and discomfort can significantly affect visual clarity and overall patient comfort, potentially leading to dissatisfaction with the procedure.
Management Strategies:
Lubrication: Use fluorescein staining during a slit-lamp examination to highlight the damaged areas of the cornea. This technique provides a clear view of the abrasion’s extent and location. Provide lubricating eye drops or artificial tears to relieve dryness and discomfort. These products help soothe the corneal surface and improve patient comfort.
Suture Adjustment: If corneal irritation is caused by direct contact with sutures, consider adjusting or removing the offending sutures. This may involve minor modifications to the suture placement to prevent further irritation.
Anti-Inflammatory Medications: Administer anti-inflammatory medications to address inflammation and reduce symptoms of irritation. This can help alleviate discomfort and improve visual clarity.
Prevention:
Careful Suture Placement: Ensure sutures are positioned away from the corneal surface to minimize the risk of irritation. Use precise techniques to avoid inadvertent contact with the cornea.
Regular Monitoring: Conduct frequent follow-ups to detect any early signs of corneal irritation. Early intervention can prevent the progression of symptoms and ensure patient comfort.
4. Ptosis (Drooping of the Eyelid)
Ptosis can occur if the levator aponeurosis or other structures responsible for eyelid elevation are damaged or stressed. Incorrect suture placement or excessive manipulation of the eyelid during the procedure can weaken these structures, leading to drooping. Ptosis can impair the ability to open the eyes fully, affecting both function and aesthetics. This can lead to dissatisfaction with the results and may require further surgical intervention.
Management Strategies:
Surgical Correction: For significant ptosis, surgical options such as levator aponeurotic tuck or resection may be necessary to correct the drooping. These procedures aim to restore normal eyelid function and appearance.
Phenylephrine Testing: For mild cases of ptosis, phenylephrine testing can assess the extent of eyelid function and response to treatment. This can help determine the appropriate course of action.
Patient Education: Educate patients on avoiding activities that might stress the eyelids, such as heavy lifting or rubbing, to prevent exacerbating the condition.
Prevention:
Careful Technique: Use a careful and precise technique to avoid damaging the levator aponeurosis or other structures involved in eyelid elevation. Gentle handling during the procedure is crucial to prevent ptosis.
5. Eyelid Retraction
Eyelid retraction can occur if excessive skin is removed or if sutures create excessive tension. This can result in a tight appearance and may lead to lagophthalmos, where the eye does not close fully. Eyelid retraction can create aesthetic issues and cause discomfort, potentially affecting the patient’s quality of life. It may also lead to complications like dryness or irritation if the eye does not close properly.
Management Strategies:
Surgical Intervention: In severe cases of eyelid retraction, surgical release of adhesions or skin grafting may be necessary. These procedures aim to correct retraction and restore a natural eyelid appearance.
Supportive Care: Employ supportive care measures such as cold compresses and anti-inflammatory medications to relieve symptoms and reduce discomfort associated with retraction.
Prevention:
Precise Planning: Avoid over-excision of skin and use precise techniques to ensure appropriate suture tension. Careful measurement during the procedure helps prevent eyelid retraction.
Early Monitoring: Monitor patients closely during the post-operative period to address any signs of retraction early. Prompt intervention can prevent the progression of the condition.
Conclusion
Non-surgical blepharoplasty provides an effective alternative to traditional eyelid surgery, offering minimal invasiveness and reduced recovery time. However, complications can arise, impacting both the aesthetic results and patient satisfaction. By employing appropriate management strategies and taking preventive measures, practitioners can enhance outcomes and ensure that patients achieve their desired results safely and effectively.
Reference:
Young SM, Kim YD. Complications of Asian Double Eyelid Surgery: Prevention and Management. Facial Plast Surg. 2020 Oct;36(5):592-601. doi: 10.1055/s-0040-1717147. Epub 2020 Dec 24. PMID: 33368082.
Wang Y, Zhang Y, Tian N. Cause and Management of Suture-related Ocular Complications after Buried-suture Double-eyelid Blepharoplasty. J Plast Reconstr Aesthet Surg. 2021 Dec;74(12):3431-3436. doi: 10.1016/j.bjps.2021.05.042. Epub 2021 Jun 7. PMID: 34226132.
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