OPTIMAL BLEPH
Season 1, Episode 8
This article by Dr. Shauly and his mentor Dr. Nahai, examines the impact of blood pressure control on preventing hematoma formation after blepharoplasty, a common cosmetic eyelid surgery. It highlights that hypertension is a primary risk factor for this serious, potentially vision-threatening complication, especially in an aging population often on anti-coagulative medications. The study retrospectively analyzed 32 patients undergoing blepharoplasty with a strict protocol to maintain systolic blood pressure below 120 mmHg, finding no instances of hematoma in this cohort. The findings suggest that vigilant blood pressure management is crucial, particularly for patients with pre-existing hypertension, males, and individuals over 65, offering a safer alternative to discontinuing necessary anticoagulant or antidepressant therapies in these patients.
Comprehensive Study Guide
Short Answer Questions
Instructions: Please answer the following questions in 2-3 sentences each.
What is the primary risk factor for hematoma formation after blepharoplasty, and why is this complication considered serious?
What was the main objective of the study regarding blood pressure control after blepharoplasty?
Describe the methodology used in this study, specifically mentioning the type of review and the patient cohort.
What were the key findings regarding mean systolic blood pressure (SBP) trends across different phases of care?
Which patient demographic groups were identified as having higher average blood pressure immediately postoperatively or in the immediate preoperative period?
How effective was the strict blood pressure protocol (keeping SBP below 120 mmHg) in preventing hematoma in this study?
Why is the increasing prevalence of cardiovascular disease and anticoagulant use relevant to blepharoplasty patients?
Besides hypertension, what other predisposing factors for hematoma formation are mentioned in the introduction?
What alternative methods for decreasing complications after blepharoplasty were discussed, and how did they compare to blood pressure control in terms of patient preference or effectiveness?
What were the main limitations of this study as acknowledged by the authors?
Short Answer Key
Hypertension is the primary risk factor for hematoma formation after blepharoplasty. This complication is considered serious because it can be vision-threatening, potentially leading to tissue fibrosis, lid scarring and retraction, and even permanent visual loss in severe cases like retrobulbar hematoma.
The main objective of this study was to assess perioperative blood pressure trends and the rates of complication, specifically hematoma, in patients undergoing a strict blood pressure protocol designed to maintain perioperative systolic blood pressure (SBP) below 120 mmHg after blepharoplasty. It aimed to determine the effectiveness of this protocol in preventing hematoma.
The study employed a retrospective chart review. It involved 32 patients who underwent a facelift with concomitant upper lid blepharoplasty between January 2015 and July 2018, all of whom were managed with an ultra-strict intra-operative blood pressure control method.
The study found that the mean systolic blood pressure (SBP) for all patients was highest intraoperatively. Patients with known hypertension consistently had higher mean SBPs across all phases of care compared to those without hypertension, with a statistically significant difference in immediate preoperative SBP.
Males were found to have a higher average blood pressure immediately postoperatively. Additionally, a previous diagnosis of hypertension in females and age over 65 were both associated with a higher immediate preoperative SBP.
The strict blood pressure protocol was highly effective in preventing hematoma in this study. No patients experienced hematoma, even those concurrently on anti-coagulative medications, supporting the efficacy of keeping blood pressure below 120 mmHg after surgery.
The increasing prevalence of cardiovascular disease (CVD) means more cosmetic patients are on anti-hypertensive and anti-coagulative therapy. This increases their risk of hematoma, making it crucial to find effective methods of hematoma prevention that do not require discontinuing necessary medications.
Besides hypertension, other predisposing factors for hematoma formation mentioned in the introduction include NSAID and aspirin therapy, lower eyelid blepharoplasty, and extensive resection of the orbicularis muscle. These factors also contribute to the risk of bleeding after the procedure.
Other suggested methods included post-operative eyelid cooling for 24 hours. However, a randomized controlled study found that cooling did not significantly affect post-operative erythema, edema, or hematoma, and the majority of patients preferred not to cool their eyelids.
The main limitations of this study included its retrospective review design, which introduces selection bias, and the absence of control groups or historic controls for comparison. A significant limitation was also the small sample size, and the fact that blepharoplasty was performed in conjunction with rhytidectomy, meaning further research is needed for blepharoplasty alone.
Key Terms
Anticoagulant therapy: Medications that prevent blood clots from forming or growing. Patients on these therapies have an increased risk of bleeding.
Anti-Hypertensive Therapy: Medications used to treat high blood pressure (hypertension).
Blepharoplasty: A cosmetic surgical procedure performed on the eyelids to remove excess skin, muscle, and sometimes fat, often to improve appearance or correct vision problems.
Hematoma: A localized swelling filled with blood, caused by a break in the wall of a blood vessel. After blepharoplasty, it can be a serious, vision-threatening complication.
Hypertension: High blood pressure, identified in the study as the primary risk factor for hematoma formation after cosmetic surgery.
Lagophthalmos: The inability to close the eyelids completely.
Orbicularis Muscle: The muscle that encircles the eye; excessive resection of this muscle can be a predisposing factor for hematoma.
P Value (p<0.05): In statistics, a measure of the probability that an observed difference could have occurred by random chance. A p-value less than 0.05 is typically considered statistically significant, meaning the observed difference is unlikely due to chance.
Retrospective Chart Review: A research method where existing medical records are examined to collect data for a study.
Rhytidectomy: A surgical procedure commonly known as a facelift, performed to reduce sagging skin and wrinkles on the face and neck.
Systolic Blood Pressure (SBP): The top number in a blood pressure reading, representing the pressure in the arteries when the heart beats (contracts). This study focused on keeping SBP below 120 mmHg.
Tarsorrhaphy: A surgical procedure in which the eyelids are partially sewn together to protect the cornea or for other therapeutic purposes.
Two-Sample One-Tail T-Test: A statistical test used to determine if there is a significant difference between the means of two independent groups, with a directional hypothesis (e.g., one group's mean is higher than the other).
Wound Dehiscence: The splitting or bursting open of a wound along the incision line.
