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Preoperative preparation and patient counseling
Preoperative preparation and patient counseling
It is most accurate to mark the position of cosmetic subunit junctions prior to infiltrating local anesthesia. Distortion from anesthesia may blur these anatomic boundaries and make accurate placement of incision lines more challenging. While drawing these preoperative markings, it is helpful to explain to the patient why lines are being drawn that extend away from the site of the defect. This may also assist with controlling patient anxiety.
As with any closure, setting realistic expectations prior to advancement flap closure may help maintain a healthy patientโphysician relationship in the postsurgical healing period. Beyond the typical counseling for infection, bruising, swelling, and scar formation, several situations may warrant extra counseling. First, advancement flaps on the lower eyelid are occasionally complicated by prolonged postoperative edema that may take months to fully resolve. Second, incision lines that fall along natural grooves or creases camouflage well over time, but they may be noticeable in the early postoperative period, particularly if the wound edges are markedly everted. In general, tincture of time and the occasional use of intralesional steroids correct any residual eversion.