Dr. Tovilla-Canales said he uses a guideline of 20 millimeters from below the incision to above the incision as a safe amount. When it comes to anesthesia, Dr. Tovilla-Canales advises administering intravenous sedation preoperatively and a small amount of local anesthesia.
The incision, skin and fat removal also are important, and Dr. Tovilla-Canales said his preference is to create incisions using a blade rather than a CO2 laser because of the possibility of wound dehiscence related to the laser. Once the incision is created, Dr. Tovilla-Canales performs electrocautery. When removing the orbicularis, he said he prefers to remove only skin and preserve as much orbicularis as possible.
When removing fat, he extracts the least amount possible to avoid hollowing of the eye. Typically, he removes only the medial fat pad. Dr. Tovilla-Canales also emphasized the importance of identifying lacrimal gland prolapse, which also can mimic the appearance of fat pads; his procedure of choice in such cases is to reposition the lacrimal gland with sutures.
The procedure is not simply one of removing skin and/or fat, but recognition of structural issues such as ptosis. “Surgeons must be very conservative with the amount of skin, fat, and orbicularis muscle that is left postoperatively,” he said.
During wound closure and crease formation, the wounds can be closed with interrupted 6-0 or 7-0 nylon or Prolene sutures. In some cases, a crease may need to be created. Dr. Tovilla-Canales said he takes a small bite of the orbicularis muscles, a bite of the aponeurosis where it joins the tarsus and finally another bite of the orbicularis muscle in the upper incision.
While UEB appears to be a simple procedure, complications can occur. This can include asymmetry, ptosis, lagophthalmos, ocular motility disorders, scarring, hematoma, retrobulbar hemorrhage, and lymphedema.
“UEB is usually a safe and effective procedure,” Dr. Tovilla-Canales concluded. “Complications can be prevented by performing an adequate preoperative assessment, understanding the patient’s expectations, obtaining meticulous measurements for skin markings, and proper surgical technique.”
Jośe Tovilla-Canales, MD
E: [email protected]
Dr. Tovilla-Canales has no financial interest in any aspect of this report.