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    No-stitch blepharoplasty: Revisiting use of tissue adhesive

    Reduced surgical time, infection among advantages but patient selection paramount

     

    Mindset change

    Despite the high success rate with no-stitch blepharoplasty and the seeming simplicity of the procedure, Dr. LiVecchi—who has performed in excess of 25,000 oculoplastic procedures during his career—noted that he no longer uses the tissue adhesive as his first choice for wound closures.

    “I originally thought that use of a tissue adhesive was indeed a progressive and advantageous step for closing blepharoplasty incisions and would eliminate suturing completely,” he said. “I was extremely excited about the prospect of eliminating sutures and the additional inherent benefits.

    “Now, I believe tissue adhesives should be used for patients who are carefully selected for the procedure,” Dr. LiVecchi said. “I currently use the tissue adhesive for stab and small incisions and in patients who are afraid of or allergic to sutures.”

    An important factor in this decision was the eyelids are constantly moving, unlike other areas where tissue adhesives are used, he noted.

    “This fact became a drawback to my idea of eliminating sutures entirely from blepharoplasties,” Dr. LiVecchi said. “To that end, I continue to use tissue adhesives on areas that are static for the most part.

    “I still use tissue adhesives with carefully selected patients undergoing a blepharoplasty when it is indicated for the patients’ benefit,” he said. “For me, while there still is a place for tissue glue in blepharoplasty, it cannot entirely replace sutures.”

     

    John T. LiVecchi, MD, FACS, FSEE

    E: [email protected]

    This article was adapted from Dr. LiVecchi’s presentation at the 2015 meeting of the American Academy of Ophthalmology. Dr. LiVecchi is editor of the Ophthalmology Times “Plastic Pearls” column and a member of its editorial advisory board. He has no proprietary interest in the subject matter.

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