Evaluation Of The Cosmetic Oculoplastic Surgery Patient

    The preoperative evaluation of the candidate for cosmetic oculoplastic surgery is extremely important and cannot be overemphasized. In addition to helping determine the specific procedures required by the patient, evaluation aids in selecting candidates for surgery. Moreover, the initial visit provides a setting in which to prepare patients for surgery and to inform them about its possible complications, thereby ensuring a smoother postoperative course.

    In this chapter are the steps I follow in evaluating patients who desire cosmetic oculoplastic surgery: (1) examination of abnormalities of the forehead, eyebrows, eyelids, cheeks, face, and skin condition; (2) ocular assessment; (3) tear secretion measurements; and (4) photographs. Most important, the preoperative examination provides an opportunity for the surgeon to determine what the patient hopes to gain from this operation and to tell the patient what can be realistically accomplished.
Allen M. Putterman

    Evaluation of the patient who may be interested in cosmetic surgery is very important. The surgeon can decide which patients should or should not have surgery and can choose the appropriate procedures. A thorough evaluation also can help avoid postoperative complications and unhappiness.
One of the most important aspects of evaluation is to establish what patients find objectionable in their appearance and what they expect surgery to accomplish. I usually determine this by handing patients a mirror and asking them to hold it at eye level as they point out their objectionable features (Fig. 3-1). Frequently, patients emphasize their most minor blemishes and dismiss the major defects noted by the surgeon. The surgeon should therefore make sure that the patient has realistic expectations.

History

    In taking a medical history, the surgeon questions the patient about illnesses, medications, allergies, and edema. Emphasis is on ruling out thyroid disease, heart failure, hypertension, bleeding tendencies, and unusual edema. For example, patients with thyroid disease may look as if they need cosmetic surgery, but the treatment needed is frequently medical, not surgical. Also, patients with thyroid disease must be followed up for at least 6 months until their eyelid retraction measurements and amounts of eyelid edema and hermeasurements are repeated temporally and nasally and on the opposite brow.

 
Figure 3-3 Ocular asymmetry measuring device for determining the amount of brow ptosis. In asymmetric brow ptosis, the measuring rod is set at the central superior aspect of the more ptotic brow, and the point of indicator on the ruler is noted. The measuring rod is then elevated to a similar position on the more normal brow, and the millimeters of excursion of the indicator determine the amount of brow ptosis.


The ocular asymmetry measuring device is especially useful in unilateral brow ptosis. In these cases, the crosspiece is raised to the highest position on the arch of the lower eyebrow, and the position of the indicator on the millimeter ruler is noted. The cross-piece is then raised to the corresponding point on the opposite eyebrow, and the position of the indicator is again noted. The excursion of the indicator is a direct measurement of asymmetry, as the indicator is fixed to the crosspiece and they move as one unit. Measuring the amount of brow ptosis aids in determining the amount of skin that must be removed to elevate the brow surgically. (The ocular asymmetry measuring device is also useful in measuring asymmetric canthi and eye positions.)