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The subciliary portion of the wound should not be under tension and can be closed using 7-0 chromic gut, silk, or nylon sutures in a running fashion from medially to laterally The lateral wound extent is closed in an interrupted fashion to maximally align the closure and distribute tension Sutures are removed in 5 days, although in laser-assisted incisions, the sutures should remain for 7 to 10 days Patients are instructed to maintain ice compresses as often as possible for the rst 48 hours, to apply antibiotic ointment to the sutures three to four times per day, to keep their head elevated during the day and even at night by sleeping on extra pillows, and to avoid heavy bending, lifting, exercise, or other activities that may require a Valsalva maneuver for at least 1 week Airplane travel should be discouraged to avoid potential exposure to decreased atmospheric pressure, which may allow bleeding to occur Satisfactory postoperative analgesia may usually be achieved with acetaminophen, although some patients may require narcotics Nonsteroidal antiin ammatory agents (including ketolorac [Toradol, Roche Pharmaceuticals, Nutley, NJ]) must be avoided to prevent orbital hemorrhage Sutures are removed 6 to 10 days after surgery (Figure 513)
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Figure 513 (A) Preoperative view of a 45-year-old female (B) 1 month after upper and lower blepharoplasty with fat repositioning and periorbital carbon dioxide laser skin resurfacing
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Wearing contact lens may be resumed 1 to 2 weeks after surgery Patients who wear contact lenses should be carefully advised of this preoperatively as many do not have current glasses prescriptions Makeup may be applied to the upper eyelids 1 to 2 days after the sutures have been removed and concealer may be applied to the lower eyelids to cover ecchymosis several days after surgery Erythromycin ophthalmic ointment is applied until makeup use is resumed Patients are told to expect 80% of the swelling to resolve over 2 weeks, while the remaining 20% (which is not usually aesthetically signi cant) make take months to completely resolve Consumption of salty foods or a systemic state of uid retention may produce increased swelling in the eyelids Low-level exercise
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5: Periorbital Rejuvenation
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may be resumed after 1 week, and more vigorous activities after 2 weeks
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To avoid bleeding induced by positive pressure to the orbital or eyelid vasculature during the rst postoperative week, patients should refrain from heavy lifting or exertion, lowering the head beneath the heart, or other activities that result in a Valsalva maneuver If patients live a signi cant distance from a medical facility, they should arrange to stay nearby for the rst night after surgery Patients should be contacted by telephone on the evening of surgery and the following day If a patient reports persistent bleeding, swelling, signi cant pain, decreased vision, erythema, or discharge from the wound, prompt examination is required If there are no unanticipated concerns, the patients are then seen again 5 to 10 days postoperation for suture removal
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Written postoperative instructions should include information on activity restrictions, wound care, and expected wound appearance It is dif cult to list every speci c restriction or contraindication; therefore, an explanation of why the limitations are recommended will allow the patient to extrapolate and employ good judgment The patient should be informed of signs or symptoms that warrant medical attention and then urged to maintain a low threshold for seeking your medical advise It is important to indicate whom to contact in the event of an ocular emergency
Analgesia
Satisfactory postoperative analgesia is usually achieved with acetaminophen alone, although some patients required narcotics Nonsteroidal anti-in ammatory agents and aspirin must be avoided for at least 3 to 4 days after surgery to diminish bleeding risks Application of ice compresses often provides additional comfort
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