Başarılı Blefaroplasti İçin Bilinmesi Gereken Anatomik Yapılar ve Ameliyat Öncesi Değerlendirme
Özet
Üst Göz Kapağı Blefaroplasti (ÜGKB) operasyonu, göz kapağındaki fazla deri, orbiküler okuli kası ve orbital yağ dokusunun çıkarıldığı cerrahi bir girişimdir. Tarihsel gelişimi 10. yüzyıla kadar uzanan bu işlem, günümüzde en sık uygulanan yüz plastik cerrahi yöntemlerinden biridir. ÜGKB hem estetik görünümü iyileştirmek hem de dermatoşalazisin neden olduğu fonksiyonel sorunları gidermek amacıyla gerçekleştirilir. Cildin en ince olduğu yer olan üst göz kapaklarının anatomik yapısı; tars dokusu, orbital septum, levator kası ve preaponörotik yağ yastıkçıkları gibi kritik bileşenleri içerir. Başarılı bir cerrahi sonuç için kaş pozisyonunun ve ilişkili kas gruplarının doğru değerlendirilmesi büyük önem taşır. Dermatoşalazis hastalarında bu operasyon sonrası kontrast duyarlılığında artış, görme alanında genişleme, astigmatizmada azalma ve daha canlı bir retinal görüntü elde edilmesi gibi önemli fonksiyonel kazanımlar sağlanır. Ameliyat öncesi süreçte ise hastanın beklentilerinin analizi, periorbital fotoğraflama, detaylı öykü alımı ve özellikle kuru göz sendromu riskine karşı schirmer testi dahil oküler muayenelerin yapılması elzemdir. Gerçekçi hedeflerin belirlenmesi ve bilgilendirilmiş onam formunun alınması, cerrahi başarının ve hasta memnuniyetinin temelini oluşturur.
Upper Eyelid Blepharoplasty (UEB) is a surgical procedure involving the excision of excess skin, orbicularis oculi muscle, and orbital fat tissue from the eyelid. With a historical development dating back to the 10th century, this procedure has become one of the most frequently performed facial plastic surgeries today. UEB is executed both to enhance aesthetic appearance and to resolve functional problems caused by dermatochalasis. The anatomical structure of the upper eyelids, where the skin is at its thinnest, includes critical components such as the tarsal tissue, orbital septum, levator muscle, and preaponeurotic fat pads. Correct evaluation of the eyebrow position and associated muscle groups is of paramount importance for a successful surgical outcome. Following this operation, dermatochalasis patients achieve significant functional gains, such as an increase in contrast sensitivity, expansion of the visual field, reduction in astigmatism, and a more vivid retinal image. In the preoperative phase, analyzing patient expectations, performing periorbital photography, taking a detailed history, and conducting ocular examinations—including the Schirmer test against the risk of dry eye syndrome—are essential. Setting realistic goals and obtaining an informed consent form constitute the foundation of surgical success and patient satisfaction.
Referanslar
McCord CD. Upper blepharoplasty and eyebrow surgery. Chen WP (ed.) Oculoplastic Surgery. New York: Thieme; 2001. p. 125 45.
Rees TD. Blepharoplasty. Wood Smith D (ed.) Cosmetic Facial Surgery. Philadelphia, PA: Saunders; 1973. p. 44 133.
Von Graefe CF. De Rhinoplastice. Berlin: Dietrich Reimer; 1818. p. 13
Codner MA, Hanna MK. Applied anatomy of the eyelids and orbit. Nahai F (ed.) The art of aesthetic surgery-principles and techniques. St Louis (MO): QMP; 2005. p. 626-49.
Larrabee WF, Makielski KH. Surgical anatomy of the face. New York: Ravan Press; 1993. p. 129-53.
Liu D. Oriental eyelids: Anatomic difference and surgical consideration. Hornblass A (ed.) Oculoplastic, Orbital, and Reconstructive Surgery. Baltimore: Williams and Wilkins; 1988. p. 513 24
Park DD. Aging Asian upper blepharoplasty and brow. Semin Plast Surg 2015;29(3):188–200. doi: 10.1055/s-0035-1556853.
Codner MA, Hanna MK. Applied anatomy of the eyelids and orbit. Nahai F (ed.) The art of aesthetic surgery-principles and techniques. St Louis (MO): QMP; 2005. p.578-89
Siegel RJ. Essential anatomy for contemporary upper lid blepharoplasty. Clin Plast Surg 1993;20:209 12.
Nahai F. Clinical decision-making in aesthetic eyelid surgery. Nahai F (ed.) The art of aesthetic surgery principles and techniques. St Louis (MO): QMP; 2005. p. 652-78.
Kakizaki H, Malhotra R, Selva D. Upper eyelid anatomy: an update. Ann Plast Surg. 2009 Sep;63(3):336-43. doi: 10.1097/0b013e31818b42f
Leather BB, (ed.) Blepharoplasty. Oculoplastic Surgery. London, UK: Informa Healthcare; 2011. p. 310 45.
Pepper JP, Moyer JS. Upper blepharoplasty: The aesthetic ideal. Clin Plast Surg 2013;40:133 8. doi: 10.1016/j.cps.2012.07.001.
Codner MA, Kikkawa DO, Korn BS, Pacella SJ. Blepharoplasty and brow lift. Plast Reconstr Surg 2010;126(01):1-17.doi: 10.1097/PRS.0b013e3181dbc4a2
Paul MD. The evolution of the brow lift in aesthetic plastic surgery. Plast Reconstr Surg 2001;108(05):1409–1424
Jacobs LC, Liu F, Bleyen I, Gunn DA, Hofman A, Klaver CC, et al. Intrinsic and extrinsic risk factors for sagging eyelids. JAMA Dermatol 2014;150:836 43. doi: 10.1001/jamadermatol.2014.27.
World Health Organization. World Health Statistics 2009. Geneva: World Health Organization; 2009.
Damasceno RW, Avgitidou G, Belfort R Jr., Dantas PE, Holbach LM, Heindl LM. Eyelid aging: Pathophysiology and clinical management. Arq Bras Oftalmol 2015;78:328 31. doi: 10.5935/0004-2749.20150087.
Altin Ekin, M., Karadeniz Ugurlu, S. Prospective analysis of visual function changes in patients with dermatochalasis after upper eyelid blepharoplasty. European journal of Ophthalmology, 2020 30(5), 978-984.doi: 10.1177/1120672119857501.
Meyer DR, Stern JH, Jarvis JM, Lininger LL. Evaluating the visual field effects of blepharoptosis using automated static perimetry. Ophthalmology 1993;100:651 8.
Fowler BT, Pegram TA, Cutler Peck C, Kosko M, Tran QT, Fleming JC, et al. Contrast sensitivity testing in functional ptosis and dermatochalasis surgery. Ophthal Plast Reconstr Surg 2015;31:272 4. doi: 10.1097/IOP.0000000000000307.
Song IS, Kim MJ, Yoon SY, Kim JY, Tchah H. Higher order aberrations associated with better near visual acuity in eyes with aspheric monofocal IOLs. J Refract Surg 2014;30:442 6. doi: 10.3928/1081597X-20140530-01
Yoon GY, Williams DR. Visual performance after correcting the monochromatic and chromatic aberrations of the eye. J Opt Soc Am A Opt Image 2002;19:266 75. doi: 10.1364/josaa.19.000266
Kim JW, Lee H, Chang M, Park M, Lee TS, Baek S. What causes increased contrast sensitivity and improved functional visual acuity after upper eyelid blepharoplasty? J Craniofac Surg 2013;24:1582 5. doi: 10.1097/SCS.0b013e318292c5ac.
Hacker HD, Hollsten DA. Investigation of automated perimetry in the evaluation of patients for upper lid blepharoplasty. Ophthal Plast Reconstr Surg 1992;8:250 5. doi: 10.1097/00002341-199212000-00003.
Cahill KV, Bradley EA, Meyer DR, Custer PL, Holck DE, Marcet MM, et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery: A report by the American Academy of Ophthalmology. Ophthalmology 2011;118:2510 7. doi: 10.1016/j.ophtha.2011.09.029
Kosmin AS, Wishart PK, Birch MK. Apparent glaucomatous visual field defects caused by dermatochalasis. Eye 1997;11:682 6. doi: 10.1038/eye.1997.177.
Brown MS, Siegel IM, Lisman RD. Prospective analysis of changes in corneal topography after upper eyelid surgery. Ophthal Plast Reconstr Surg 1999;15:378 83. doi: 10.1097/00002341-199911000-00002.
Callahan, A.B., Lisman, R.D.. Complications of Blepharoplasty. Cohen, A., Burkat, C. (ed.) Oculofacial, Orbital, and Lacrimal Surgery p 215–226
Zloto O, Matani A, Prat D, Leshno A, Ben Simon G. The Effect of a Ptosis Procedure Compared to an Upper Blepharoplasty on Dry Eye Syndrome. AmJOphthalmol.2020;212:1-6.doi: 10.1016/j.ajo.2019.11.021.
Mak FHW, Ting M, Edmunds MR, Harker A, Edirisinghe M, Duggineni S, Murta F, Ezra DG. Videographic Analysis of Blink Dynamics following Upper Eyelid Blepharoplasty and Its Association with Dry Eye. Plast Reconstr Surg Glob Open. 2020 Jul 21;8(7) doi: 10.1097/GOX.0000000000002991.
Cho IC, Kim BJ, You HJ, Tark WH. Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms. Aesthet Surg J. 2021 1;41(1):1-9. doi: 10.1093/asj/sjaa143.
Korn BS, Kikkawa DO, Schanzlin DJ. Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome. Plast Reconstr Surg. 2007 ;119(7):2232-2239. doi: 10.1097/01.prs.0000260750.15059.17.
Afrooz PN, Gorantla VS. Blepharoplasty, laser in situ keratomileusis, and the corneal reflex arc. Plast Reconstr Surg. 2008 ;121(4):1506-1507. doi: 10.1097/01.prs.0000305374.68393.4d.
Lee WB, McCord CD Jr, Somia N, Hirmand H. Optimizing blepharoplasty outcomes in patients with previous laser vision correction. PlastReconstrSurg.2008;122(2):587-94. doi:10.1097/PRS.0b013e31817d61d9.
Griffin RY, Sarici A, Ayyildizbayraktar A, Ozkan S. Upper lid blepharoplasty in patients with LASIK. Orbit. 2006;25(2):103-6. doi: 10.1080/01676830600675145
Sedgh J. The Aesthetics of the Upper Face and Brow: Male and Female Differences. Facial Plast Surg. 2018 ;34(2):114-118. doi: 10.1055/s-0038-1636935.
Karlin JN, Rootman DB. Brow height asymmetry before and after eyelid ptosis surgery. J Plast Reconstr Aesthet Surg. 2020 ;73(2):357-362.doi: 10.1016/j.bjps.2019.07.018.
Warren RJ. Upper Blepharoplasty and Brow Rejuvenation in Men. Clin Plast Surg. 2022 ;49(2):197-212 . doi: 10.1016/j.cps.2021.12.006.
