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Thank You Plastic Surgery

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Hello everyone, I'm a board-certified plastic surgeon, Dr. Kim Hyung-seok

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Hello, also a board-certified plastic surgeon, I am Dr. Hwang Soong-oh


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Today we will talk about

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A rather serious topic

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There are cases of medical complication

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Where people lose their eyesight after a plastic surgery

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They're being reported every few years

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Even a while ago...

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(Heartbreaking news of losing eyesight)
There was a news about losing eyesight on one eye after the eye surgery

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And many of you are curious about this

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So today we'll cover this

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What happened that

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It led to losing one's eyesight?

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Is what we'll be covering today

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Thank You Plastic Surgery

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Dr. Hwang, looking at this photo

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We see the stitches under the eyes

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So we can assume that he had a lower blepharoplasty

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What could be the complication here?

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I say, most probably, retrobulbar hemorrhage

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Leading to pressure on arteries around the retina

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Could've caused the loss of sight

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So the term is retrobulbar hemorrhage

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So what is the mechanism? 

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Please give us more details

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In order to do that

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We need to learn the shape of the eye socket

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It is a space where the eyeball is placed

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The compartment syndrome* inside the eye socket
(*dicreased capillaries perfusion due to increase in tissue pressure within a closed compartment)

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Is the mechanism behind the retrobulbar hemorrhage

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Let me break it down a little more

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The eye socket is like a room for the eyes

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There are blood vessels, nerves, muscles around the eye

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And other important tissues

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When the blood fills in the back of the eye, it increases pressure

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Which presses on blood vessels or nerves

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Which it may lead to blindness

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What plastic surgery can lead to this retrobulbar hemorrhage?

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Please, Dr. Hwang.

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(For reconstruction)
It is generally known that

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It could happen during an orbital fracture repair

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For plastic surgery; lower blepharoplasty

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Or under eye fat repositioning

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Could induce such conditions

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So compared to double eyelid surgery, ptosis correction or infrabrow excision blepharoplasty

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Which treat the upper eyelid

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The under eyelid surgery, espeially lower blepharoplasty

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Which treat a bigger area under the eyes

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Could have a higher chance of

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An accident happening

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After lower blepharoplasty

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Or lower eyelid fat repositioning

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Q. From what kind of symptoms should we suspect retrobulbar hemorrhage?

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Please explain the symptoms

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The first symptom is pain

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Which occurs from raised blood pressure behind the eye

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Also with the pain and the pressure

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The eyes might bulge out a little

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Other than that, bruises could be found on the eyelid

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Or chemosis (eye swelling) might occur

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And negative effects to the vision might happen

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For example, the field of vision could narrow

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or the perception of light and objects could degenerate

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If if gets worse, loss of vision

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can occur as well

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[Symptoms of retrobulbar hemorrhage]
Severe pain, eye bulging, eye surface swelling

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bruises on the eyelid, and probems with vision

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If these symptoms appear

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it's crucial to talk to your doctor ASAP

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or visit the emergency room 


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and get your eyes checked and treated

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Q. How common does the retrobulbar hemorrhage occur and how high is the risk of losing vision?

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This question must be the one

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which all patients who have surgery would want to know about

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We’ve searched through some reports

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The first report we will share analyzed

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 the frequency which loss of vision occured, not in plastic surgeries 

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but in orbital fracture surgeries

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It says that 2 out of 1180 had the problem

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The report here for orbital fracture  

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researched in more of a serious external damage

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or circumstances that could 

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cause a lot of bleeding

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So in other words, 1 out of 500 experiences 

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retrobulbar hemorrhage after 

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a big surgery like an orbital fracture

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compared to minor plastic surgeries

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Another research says

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5 out of 400 patients experienced retrobulbar hemorrhage, right?

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Yes. That research was published by ophthalmology specialists

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It says 5 out of 426, that is about 1.2%

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but it says those 5 had undergone emergency surgery

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and recovered well without loss of vision

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That’s right. After orbital fracture surgery,

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patients are taken care at the hospital

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and treated fast

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which significantly lowers the risk of going blind

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So, while it is best to avoid retrobulbar hemorrhage all together

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but even if one experience it, if treated well and fast

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(if treated fast) 
The risk of losing vision is very low

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Q. What should be done when one suspects retrobulbar hemorrhage?

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If symptoms show

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lowering the eye pressure is the first thing to do

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If symptoms show after lower blepharoplasty 

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or lower eyelid’s fat repositioning, we would cut open the surgery area again

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and remove the blood, and find the damaged blood vessel 

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to try to stop the bleeding is one of the most important steps

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That’s right. When bleeding occurs and coagulates

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it causes increase in the pressure

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So if there’s a hematoma, it needs to be removed

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Or if there is a bleeding spot

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stopping the bleeding is important

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The best way is preventing retrobulbar hemorrhage in the first place

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or finding it

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as fast as possible

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Q. How can we prevent from getting retrobulbar hemorrhage?

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It's quite obvious

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but it’s crucial to control bleeding during the surgery

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and check well during the surgery 

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to see if there’s bleeding

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But, even if there’s no sign of bleeding during surgery

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bleeding might occur later

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due to various reasons

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So, patients should also avoid certain things to prevent future bleeding

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For example,

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[How to prevent bleeding]
Apply an ice pack, do not raise pressure in the head, do not lie down flat

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but instead keep the upper body slightly inclined

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Even if doctors control bleeding well

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if patients take certain types of medicine that could cause bleeding

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or coughs hard, or suddenly lower the head

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or move in a way that raises pressure in the face area

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the risk could increase

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Therefore, it’s very important for patients themselves 

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to prevent bleeding

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after the surgery

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It is true that plastic surgeries

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are performed with a good reason

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and to achieve 

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good results

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But please remember

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any kind of surgery can have side effects or complications

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So when you make your decision

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please be aware of these risks

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and make a thoughtful decision

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Since plastic surgery is very common these days

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people tend to take it too lightly

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While you shouldn’t be too scared

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but also shouldn’t take it too lightly

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So, today we learned a bit about retrobulbar hemorrhage

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And in the next video, we will continue to talk about

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the loss of vision that could occur

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after fillers or fat repositioning

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This was Dr. Kim Hyung-seok

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and Dr. Hwang Soong-oh


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Thank you very much

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Thank You Plastic Surgery
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