Simultaneous Aesthetic Eyelid Surgery and Orbital Decompression for Rehabilitation of Thyroid Eye Disease: The One-Stage Approach

Background: Aesthetic rehabilitation of thyroid orbitopathy includes orbital decompression, correction of eyelid retraction, and aesthetic blepharoplasty, performed traditionally in separate stages. Objectives: To report the results of orbital decompression surgery associated with aesthetic eyelid surgery in one stage for aesthetic rehabilitation of patients affected by thyroid eye disease. Methods: Retrospective, multicentric study including 40 consecutive patients, who underwent orbital decompression surgery associated with aesthetic eyelid surgery in two centers: Genova (group 1) + Buenos Aires (group 2). Surgical techniques are described in detail. Results: Mean patient age in the study group was 41.2, 85% of the patients were female, and minimum follow-up time was 12 months, with average follow up of 27 months. All patients underwent orbital decompression; at the same time, 26 patients (65%) underwent bilateral upper blepharoplasty and 32 patients (80%) underwent transconjunctival lower blepharoplasty. Associated upper eyelid procedures included 23 patients (58%) undergoing upper eyelid retraction repair, 9 patients (23%) undergoing associated inferior retractor recession, and 12 patients (30%) closed transcanthal lateral canthopexy. Seven patients (17%) needed strabismus surgery for the treatment of new-onset diplopia and none required further revision eyelid surgery. Conclusions: Shorr and Seiff suggested 4 stages of surgical rehabilitation: (1) orbital decompression; (2) eye muscle surgery; (3) correction of eyelid retraction; and (4) removal of excess fat and skin. This is the first study to suggest single-stage aesthetic rehabilitation consisting of combined orbital decompression and aesthetic eyelid surgery. This approach has high patient satisfaction and significant reduction in direct and indirect healthcare cost.