Tips for successful eyelid grafts

Careful preoperative photography, a 10-minute anesthetic rule and old-fashioned magnifying loupes are crucial to successful eyelid grafts, according to an expert who spoke Friday at the 2014 Annual Meeting of the American Society for Dermatologic Surgery.

READ: More coverage of the 2014 ASDS Annual Meeting

Michael Swann, M.D., who is in private practice in Springfield, Mo., at Swann Dermatology & Esthetics, isn’t a fan of grafts, which can be “very frustrating, even with meticulous technique.” But he has developed pearls of wisdom regarding their use in treatment of tumors.

It’s important to photograph patients when they are upright and before anesthesia. “Really look at the patient and take good photos,” he says. “I’ll often go back to my preoperative photographs because things look so much more dramatically swollen and different after the first stage. Once the anesthesia is in the lines, it’s hard to make an assessment.”

Dr. Swann prefers to not immediately launch into a procedure after an anesthetic is administered. “The eye swells like crazy when we inject them with lidocaine and epinephrine,” he says. “There’s a huge benefit to letting epinephrine go to work and do its thing. I let 10 minutes pass when the patient is numb to do the procedure.”

As for the graft type, Swann says he usually prefers primary closure or flaps, but full-thickness skin grafts are often useful. “You can get good results with use of aggressive carbon dioxide afterwards,” he says.

Finally, Dr. Swann is a fan of magnifying loupes, which can be ordered to prescription specifications. “They’re life changing,” he says. “If you haven’t done it, I’d encourage you to get a good pair.”