Learn Connect Succeed. JCAHPO Regional Meetings 2017

Transcription

1 Learn Connect Succeed JCAHPO Regional Meetings 2017

2 Aesthetics & The Ophthalmic Patient David A. Kostick, M.D., F.A.C.S. Outline Skin Types Skin Care Fillers Surgery Healthy skin (firm, smooth, even color) Aging Skin (loose, lines, discoloration) Fitzpatrick Skin Type (ARCH DERMATOL 1988; 124: ) I Very White Always Burns II White Usually Burns III Light Brown Rarely Burns IV Dark Brown Dark Tan V Black Never Burns, Very Dark Tan

3 Skin Care Cleanser Sunscreen (UVA, UVB) Antioxidant (topcial Vitamin C) Exfoliant (alpha-hydoxy acids) Pigment Therapy (hydroquinone) Retinoids (Retina-A, Renova) Don t Smoke! Fillers / Injections Botulinum Toxin (Botox, Xeomin ) Autologous Fat vs. Hyaluronic Acid (HA) botulinum toxin Botox Purified botulinum toxin Edward J. Schantz, PhD ~ 1944 Alan B. Scott, MD late 1960 s strabismus research st volunteer FDA approval, 1989 Inhibits Acetylcholine release XEOMIN Selected Important Safety Information WARNING: DISTANT SPREAD OF TOXIN EFFECT Postmarketing reports indicate that the effects of XEOMIN and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and at lower doses. CONTRAINDICATIONS XEOMIN is contraindicated in patients with a known hypersensitivity to the active substance botulinum toxin type A or to any of the components in the formulation and in the presence of infection at the proposed injection site(s). Please see other Important Safety Information at the end of this presentation. Please see provided full Prescribing Information, including Boxed WARNING, also available at XEOMIN.com. XEOMIN (incobotulinumtoxina) for injection, for intramuscular use Prescribing Information. Greensboro, NC: Merz Pharmaceuticals, LLC; April 2013.

4 Fillers / Injections Botulinum Toxin (Botox, Xeomin ) Autologous Fat vs. Hyaluronic Acid (HA) Fillers / Injections Autologous Fat vs. Hyaluronic Acid (HA) outline Introduction Anatomy Evaluation Eyebrow Upper lid Lower lid Summary Sharks versus Jets West Side Story

5 anatomy Understanding periorbital anatomy is the most important aspect of being an oculoplastic surgeon. Normal anatomy varies widely especially with appearance it s what makes us unique anatomy Upper lid Lower lid Oculoplastic anatomy Upper lid medial canthal defect Intra-op Post-op

6 medial canthal defect Intra-op Post-op pre-op evaluation Medical History Prior surgery Bleeding Scarring Motivation Occupational Emotional Marital trouble Depression Ocular History Vision Contact Lens wear Prior ocular surgery Lid Refractive Trauma Dry Eyes Glaucoma pre-op evaluation Prior Eye History Check Vision Know what you re getting into!!

7 B A D DO A COMPLETE EYE EXAM 3 causes of eyelid droop, heaviness Brow Position Dermatochalasis KNOW WHAT YOU RE GETTING INTO Lid droop (true blepharoptosis) Weakness of levator / aponeurosis

8 Brow Ptosis I D E A L B R O W

9 Brow Ptosis Surgical Options Botulinum Injection Direct brow Mid-forehead Bicoronal Temporal hairline Endoscopic (sub-periosteal) DIRECT BROW MID-FOREHEAD LIFT ENDOSCOPIC BROW LIFT

10 PTOSIS REPAIR Ptosis Repair surgical options External Ptosis Repair (levator surgery) Internal Ptosis Repair (conj-muller, Fasanella-Servat) Frontalis suspension (banked, autologous, synthetic) (not really considered cosmetic) Ptosis Repair levator function / surgical options Excursion (mm) Levator function 0 4 Poor / Frontalis suspension PTOSIS REPAIR: External Approach 5 10 Fair / External levator 11 + Good / External or Internal

11 BE AWARE OF UNILATERAL PTOSIS PTOSIS REPAIR: Internal Approach Conjunctival-Muller Resection phenylephrine test Instrument Tray Before Drops After Drops (OS only)

12 Conjunctival-Muller Resection post-operative No Patch Ophthalmic ointment BID & prn Cool Ice compress: (10 minutes q hour while awake) Prn acetaminophen, ibuprofen & diphenhydramine Follow-up visits: (1 day, 1 week, 6 8 weeks) BLEPHAROPLASTY change the shape of the eyelid

13 Pseudoptosis Upper Blepharoplasty Lower Blepharoplasty summary Know anatomy Restore anatomy Everyone is unique Less is more Understand patient expectations Be Aware of Unilateral Ptosis Know what you re getting into

14 Aesthetics & The Ophthalmic Patient David A. Kostick, M.D., F.A.C.S.