Coronal Rhytidectomy and eyelid surgery
2 year old, male entire Neapolitan Mastiff
Neo presented to our Ophthalmology department on 7th May due to entropion and sore eyes which he had been rubbing. His vision was poor due to his eyelid conformation and extremely heavy facial folds. He had previously had surgery, with his own vets, for prolapsed Nictitans glands. He had become anxious with handling around his eyes and face and application of eye drops was nearly impossible for the owners.
Ophthalmic examination showed that both corneas were fluorescein negative, but the left cornea had established vascularisation to the centre and fibrosis laterally para-centrally from recent ulcerative keratitis. He had extreme macropalpebral fissure, with a double kink in the left upper eyelid and single in the right.
There was lower eyelid ectropion with medial and lateral entropion. He had extreme laxity of the skin on the head, facial droop and heavy, large jowels, creating further weight and drag on the eyelids.
The periocular skin was erythematous and swollen from chronic epiphora and rubbing. Neo was struggling, so was considered to be an urgent case and was prioritised for surgery during the Covid-19 pandemic.
Ophthalmic and Soft Tissue Surgery
Our soft tissue surgeon, Andy Phillips, together with Ida Gilbert and Dave Johnson, from our Ophthalmology department joined teams to maximise speed and expertise for this extensive operation. For part of the operation we were able to operate on both the eyelids whilst completing the facelift to minimise the time Neo had to be anaesthetised.
A large Coronal rhytidectomy (facelift) was performed caudal to the ears, removing 1050 grams of skin. Cranial margin was over the mid frontal sinus. A large elipse was excised, ending at the level of and ventral to the wing of the atlas. The skin was anchored to the fascia of the temporalis muscle and the periosteum of the occipital crest for the midline suture. Multiple buried PDS sutures to close panniculus muscle to the sphinctercoli muscle, subcutaneous simple continous PDS and intradermal Monocryl.
Additionally he had shortening of all eyelids by 15mm and entropion/ectropion surgery of the upper and lower eyelids. Neo stayed in the hospital overnight for careful monitoring of his recovery and provision of good analgesia. The owners took great care to take turns to stay with him at all times when he got home.
At 3 weeks Neo had healed very nicely and the owners reported that Neo was a much happier dog as a result of the surgery. He was now able to see well and he was fully comfortable in both eyes.
Relieved owner Mark Hutchins, from Chippenham, Wiltshire, said:
“Neo was having a lot of problems with his face and eyes because he had so much saggy skin hanging down and he was in a lot of pain and discomfort.”
“When he was eating food from his bowl, we even had to pull his skin back for him, so he could see his meal and eat it properly.”
“It was obvious something had to be done, although we were very worried that he wouldn’t look the same afterwards.”
“Thankfully, the results have been amazing and made a big difference to Neo, who’s recovered very well, and we owe a big thank-you to the team at Eastcott.”
“They were absolutely brilliant and Neo had been operated on within three days of us contacting them, which was terrific.”
“No-one believes me when I say the vets removed more than a 1kg of skin, they think I’m joking, but it’s absolutely true and Neo’s all the better for it.”