Diffuse nodular eyelid lipogranuloma following sutureless transconjunctival blepharoplasty dressed with topical ointment

Purpose: Transconjunctival blepharoplasty is becoming the approach of choic e for many cosmetic surgeons. The authors describe a case of a diffuse, mul tinodular eyelid lipogranuloma following transconjunctival blepharoplasty, after which the unsutured wound was dressed with a topical ointment. Methods: Report of clinical course and histopathologic findings. Results: A patient developed multiple firm, nontender masses of the left lo wer eyelid that enlarged despite topical and systemic medical therapy. Prio r to referral, the progressive lesions had recurred despite three successiv e attempts at surgical eradication. Histopathologic examination of excised tissue demonstrated a multifocal lipogranulomatous inflammation consistent with reaction to retained ointment. Conclusions: Sclerosing lipogranulomas are a known complication of intrader mal lipid injection, as well as a late complication of sinus surgery after postoperative nasal packing with ointment-saturated gauze. The application of a topical ointment should be avoided until after transconjunctival lower blepharoplasty unless wound closure is secure or until conjunctival epithe lialization is complete.