).Upper eyelid blepharoplasty is a common procedure that should be in the armamentarium of the aesthetic and reconstructive surgeon. This procedure can transform a person's life through improvement in appearance and visual function. Upper eyelid blepharoplasty should not be considered in isolation, but rather in the context of rejuvenation of the upper third of the face. Functional indications for surgery include significant upper eyelid dermatochalasis encroaching on the visual axis and impeding peripheral vision, associated upper eyelid entropion or lash ptosis causing ocular surface irritation, and severe blepharitis and excessive dermatochalasis affecting prosthetic function in the anophthalmic socket. Cosmetic indications include aesthetically displeasing dermatochalasis and upper eyelid fullness.The foundation of successful blepharoplasty begins with a complete preoperative evaluation, a discussion of expectations, the selection of the appropriate surgical technique, and a discussion of potential complications. Preoperative and postoperative photographs are essential for the documentation of functional and cosmetic patients. Preoperative EvaluationThe preoperative evaluation begins with a careful history to elicit patient's concerns, expectations, and motivations for blepharoplasty. Establishing a strong physician-patient relationship will ensure both parties are satisfied during all phases of care. For functional patients, documentation of impaired visual symptoms, visual field testing showing improvement with eyelid lifting, and photographic documentation showing the degree of skin redundancy are required for many third-party payers. Cosmetic patients should show their areas of concern by using a mirror in their discussion with the physician. Photographs in the frontal, three-quarter profile, and side profiles should be obtained.Surgeons should pay particular attention to a history of previous facial surgery, trauma, neuromodulators and soft tissue fillers, medication allergies, anticoagulants, and overthe-counter supplements. Patients with a history of multiple cosmetic surgeries by different surgeons with minimally evident complaints are concerning for body dysmorphic Keywords ► blepharoplasty ► upper eyelid ► cosmetic surgery ► functional surgery ► eyelid ptosis ► dry eye ► complications AbstractUpper eyelid blepharoplasty is one of the most common procedures performed worldwide for both functional and cosmetic indications. There is a high rate of patient satisfaction; however, in this era of social media, patient expectations are higher than ever. Today's digitally savvy patients expect perfect outcomes with no complications and rapid recovery. To achieve optimal results, a careful preoperative evaluation and sound surgical technique is essential for minimizing complications. Here the authors review their approach to the management of the blepharoplasty patient.Issue Theme Oculofacial Plastic and Reconstructive Surgery; Guest Editor: Douglas P. Marx, MD

We report three paediatric cases, and summarise the reported experience in two others, with cardiorespiratory failure requiring extracorporeal life support for which supportive pump flows could not be maintained due to abdominal compartment syndrome. In two of our patients, the mechanism of abdominal compartment syndrome was massive intra-abdominal fluid extravasation secondary to sepsis, while in the third, the mechanism was post-traumatic intra-abdominal haemorrhage. Although all three children eventually died, decompressive laparotomy and arrest of haemorrhage in the trauma patient restored venous return and enabled technically adequate extracorporeal life support. In two previously reported cases of sepsis with massive fluid resuscitation resulting in abdominal compartment syndrome, one patient died without attempted decompression, while the other patient survived after peritoneal catheter placement restored venous return. Once correctable causes of inadequate venous cannula drainage have been excluded, abdominal compartment syndrome should be considered in any patient on extracorporeal life support with a taut abdomen and reduced venous return. If abdominal compartment syndrome can be proven or is strongly suspected, there may be a role for selective decompressive laparotomy.

The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period) were extracted from these patients' charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4 ± 46.1 months (range 6 months to 15 years). Main underlying diagnoses were Stevens-Johnson syndrome (63%), trachoma (19%), chemical injury (8%), and trauma (5%). Forty-three patients (98%) reported improvement of ocular symptoms after the procedure. Complete resolution (restoration of the upper eyelid margin to normal anatomic position with good esthetic appearance) was achieved in 52 eyelids (83%). Recurrence occurred in 7 (11%) eyelids. No postoperative infection, failure of graft survival, or other complications were observed. The use of labial mucous membrane as a posterior lamella graft showed good functional and cosmetic outcomes, long-term stability and low recurrence rates in the treatment of severe cicatricial entropion of the upper eyelid.