Delay in repair is acceptable while more life threatening injuries are dealt with, but it is important to ensure that the globe is protected from pressure until penetrating injury is excluded, and the cornea is protected from dehydration until the lids can be repaired. One should always check for penetrating injury when the patient is under general anaesthetic before embarking on repair of eyelid lacerations.If the globe is intact, or when it has been repaired, lid lacerations should be repaired. This should be performed before repair of other facial lacerations, because primary closure in circumstances where tissue loss has occurred elsewhere in the face may result in stretching and difficult closure in the periocular region. The upper lid takes priority and should be repaired before the lower lid. Avoid excising tissue from the eyelids, as even
apparently devitalised tissues may regain perfusion when anatomical relationships have been restored. In repairing the lids, it is important that the tarsal plates are accurately aligned to prevent eyelid deformity, and the eyelid margins must be smooth to prevent corneal damage.
These do not gape and can be left if small. Larger, slightly gaping wounds can be closed with a subcuticular technique.Lacerations perpendicular to the orbicularis fibres These have a tendency to gape and healing by primary intention leaves an unsightly scar, producing distortion of the eyelid margin and poor functional results. The obicularis should be closed with interrupted 6/0 catgut sutures. The skin is closed with 6/0 silk or nylon using an everting technique.Lacerations to the levator muscle.The levator can consistently be found under the pre-aponeurotic fat pad and the severed ends brought into apposition using 6/0 catgut or Vicryl. Lacerations of the levator aponeurosis will heal spontaneously if less than half of its width is involved.When the levator muscle is severely damaged it may be easier to perform an accurate primary repair of other lid structures and repair the levator as a secondary procedure under local anaesthesia, using the movement of the muscle in upgaze to help identify the proximal end.
In orbital trauma in children it is important to take steps to prevent amblyopia by measures aimed at reducing swelling rapidly (ice packs, prompt treatment of infection) and occluding the fellow eye if necessary. While it would be acceptable to delay the repair of a traumatic ptosis in an adult, this would carry the risk of amblyopia in a child and a temporary brow suspension should be carried out urgently if necessary. It is preferable to use a non integratible material for the suspension such as a prolene suture or silicone rod so that it can be removed subsequently if the ptosis recovers.
Associates In Plastic Surgery
Many things have changed since entering the 21st Century: Technological advancements, medical breakthroughs and a different philosophy to life have all combined to completely alter public perception. Long-standing taboos have been pushed aside by progressive thinking and cosmetic surgery is not only acceptable now but also celebrated.
Talk The Talk
Thirty years ago if someone dared to get plastic surgery it was done in secret. Celebrities would sneak into hospitals and clinics, claiming health problems if they were discovered.
There was stigma attached to changing your appearance and a hush-hush attitude prevailed throughout society. Everyone was still doing it just no one was talking about it.
The ironic thing about this attitude was that people had been changing their appearance for centuries. Corsets, heavy powder and wigs were all used to alter looks in times gone by. Why this desire for a different look suddenly became taboo in society is unknown. Whatever the reason for this negative perception towards changing our bodies it has certainly been shattered now and replaced with a positive outlook on personal transformation.
Today people are loud and proud about their procedures. People talk about what they've had done, who did it and how much they love it. Even men are spilling about facelifts and hair restoration in a way that never would have happened in the past.
Celebrities are walking out of clinics, bruised and wrapped, and heading over to their favorite restaurants for lunch or dinner with friends. Botox parties have become fashionable and keeping abreast of cosmetic surgical procedures is all the rage.
So What Changed?
Many things coincided to change the old attitude of cosmetic surgery being embarrassing or not something to be considered.
First was the realization of just how many people had done it behind closed doors. Celebrities began to tell the public the truth behind their ever-youthful looks.
Botox came on the scene and revolutionized cosmetic procedures. No longer did you have to go under the knife to see spectacular results and wrinkle reduction.
With more people opting for cosmetic correction the prohibitive prices came down and suddenly it wasn't just the wealthy that could afford to alter the one thing that was causing a bad self-image.
Governments did their part by introducing tighter regulations on plastic surgeons and clinics in order to ensure a higher level of safety for the patient and the media stories following all of these events brought cosmetic surgery, once and for all, out of the darkness and into the light.
Reality TV since then has come out with a number of shows that follow ordinary people going through the process of extraordinary transformations. These shows have a wide viewing audience and detail the emotional journey of someone who starts out unhappy with their appearance and leaves with a greater sense of self-esteem and confidence.
While many people agree that happiness has to come from within, what these programs have examined is the fact that for many, this is not the reality of their life. By altering the outside they are able to finally transform on the inside. It's a rewarding experience for those involved.
This kind of mass exposure to the idea of cosmetic surgery as simply a personal life choice along with the many other choices we make on a day-to-day basis is probably the biggest reason why the taboos are gone.
So, if cosmetic alteration is something you have considered for yourself, you can be secure in the knowledge that you are not alone. The stigma attached was left behind at the turn of the century.
Both Seo Firm & Anthony Williams Sr. are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
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