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C. Rosenberg, G. J. Lelli, Jr., R. D. Lisman; Early Post-Operative Adjustability of the Fasanella-Servat Procedure: Consecutive Review of 102 Cases. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2295.
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The Fasanella-Servat operation generally has excellent outcomes in correcting minimal ptosis. However, a percentage of patients undergoing any type of ptosis correction may demonstrate contour or symmetry abnormalities post-operatively. We describe a new technique in which the Fasanella-Servat operation can be adjusted in the first post-operative week and evaluate the frequency, safety and efficacy of the adjustment.
A consecutive series of 102 eyelids undergoing the Fasanella-Servat procedure between July 1, 2006 and July 1, 2007 by a single surgeon (RDL) was retrospectively reviewed to determine the frequency, timing, safety and efficacy of post-operative adjustment. Of those undergoing adjustment, post-adjustment photographs were reviewed by a blinded ophthalmic plastic surgeon for eyelid contour, height, symmetry, overall cosmesis and picture quality as excellent, satisfactory or poor.
The Fasanella-Servat procedure was performed on a total of 102 eyelids over the 12-month interval. Eight-one (79%) eyelids did not require adjustment. In 21 (21%) eyelids, post-operative adjustments were performed to improve mild lid asymmetries. The median time to adjustment was 7 days (range 6-27 days). No patients required formal re-operation with a median follow-up of 40 days. Post-adjustment photographs were available for 11 patients demonstrating excellent eyelid contour (36%), height (82%), symmetry (73%), and cosmesis (45%) after adjustment. Satisfactory results were obtained in all remaining photographed eyelids. There were no adverse events noted in any adjustments.
The Fasanella-Servat operation should be viewed as an adjustable ptosis correction with the adjustment as a standard component of the post-operative suture removal on days 5-7. At this time, the majority of edema has resolved and the tarsus has not yet densely adhered. This manipulation takes only a few moments with minimal to no patient discomfort. It allows for improvements in peaking, asymmetries, and the potential height differential due to Hering’s Law. This series demonstrates a novel procedure that is simple, highly successful and safe; further prospective evaluation with additional patients may better define the expected results.
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