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Ju X, Rokohl AC, Fan W, Simon M, Li X, Hou X, Ukehajdaraj N, Wawer Matos PA, Guo Y, Heindl LM. Periocular Asymmetry Index in Caucasian Populations Using Three-dimensional Photogrammetry Assessment. Aesthetic Plast Surg 2024:10.1007/s00266-024-04125-8. [PMID: 38806825 DOI: 10.1007/s00266-024-04125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To quantitatively assess the periocular asymmetry and investigate its sex and age-related differences in a Caucasian population using three-dimensional (3D) stereophotogrammetry. METHOD Standardized 3D photos of the periocular region of 301 Caucasians were taken using the VECTRA M3 3D Imaging System. Standardized landmarks were positioned, and data measurements in the periocular region were obtained from these images using VAM software and assessed using intraclass correlation coefficients (ICC) for reliability. Absolute differences and asymmetry index between the right and the left periocular region were calculated with a focus on gender and age-related differences. RESULT Fissure height asymmetry was positively correlated with age (p < 0.01). Furthermore, reflex distance asymmetry was positively correlated with age in the elderly group (p < 0.05). Absolute differences of upper eyelid crease were 0.65 ± 0.79 mm for females and 0.90 ± 0.94 mm for males (p < 0.05). In the elderly group, the absolute differences of reflex distance were 0.664 ± 0.471 mm for males and 0.470 ± 0.408 mm for females (p < 0.05), while the absolute differences of fissure height were 0.619 ± 0.469 mm and 0.436 ± 0.372 mm, respectively (p < 0.05). All measurements had an inter-rater ICC and intra-rater ICC between 0.761 and 0.957. CONCLUSION Periocular asymmetry is more prominent in older and male people. 3D photogrammetry is a reliable tool to detect periocular asymmetry and might provide an accurate and effective reference for periocular cosmetic, plastic, and reconstructive surgery in the clinical routine. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .
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Affiliation(s)
- Xiaojun Ju
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander C Rokohl
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Wanlin Fan
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Michael Simon
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Xueting Li
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Xincen Hou
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nexhat Ukehajdaraj
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Philomena A Wawer Matos
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Yongwei Guo
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, 88 Jiefang Road, 310009, Hangzhou, China.
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany.
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Li X, Rokohl AC, Fan W, Simon M, Ju X, Rosenkranz T, Matos PAW, Guo Y, Heindl LM. Quantifying Dermatochalasis Using 3-Dimensional Photogrammetry. Aesthetic Plast Surg 2024; 48:1288-1297. [PMID: 37945760 DOI: 10.1007/s00266-023-03738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Creating an appropriate treatment plan for patients with dermatochalasis requires careful investigation of the periocular region. Utilizing photographic documentation can assist physicians in conducting preoperative analysis and managing expectations regarding surgical outcomes. OBJECTIVES This study aimed to quantify the periocular characteristics of dermatochalasis patients using standardized 3D imaging and to compare age and sex-related changes in periocular features. METHODS In this cross-sectional study, we recruited 145 Caucasian patients with periocular dermatochalasis, comprising 48 men and 97 women, aged between 35 and 91 years. Standardized three-dimensional facial photographs were taken using the 3D Imaging system VECTRA M3. Linear dimensions, curve length, angle, indices, and sizes were measured and analyzed, including palpebral fissure height (PFH), palpebral fissure width (PFW), upper lid fold-palpebral margin distance (FPD), upper palpebral margin length (UPML), lower palpebral margin length (LPML), canthal tilt (CT), palpebral fissure index (PFI), upper eyelid area, and ocular surface area. RESULTS In the female group, the left-side PFH was slightly larger than the right-side PFH (P = 0.023), but the difference was less than 1mm. The corresponding PFI also showed a difference in the female group (P = 0.009). Statistically significant differences were shown in genders for specific parameters, except PFI (P = 0.251) and CT (P = 0.098). Among males, PFW (R = -0.523, p < 0.001) and LPML (R = -0.514, P = 0.264) decreased moderately with age. The correlation between UPML and age was weak (R = -0.367, P = 0.010). Similarly, among females, moderate correlations were found between age and PFW (R = -0.566, P < 0.001) and LPML (R = -0.537, P < 0.001). Additionally, PFH (R = -0.315, P = 0.002), UPML (R = -0.381, P < 0.001), and ocular surface area (R = -0.457, P < 0.001) showed weak correlations with age. CONCLUSIONS The study found that dermatochalasis usually affects both eyes simultaneously, and age is a significant factor in the morphological changes of certain periocular features regardless of sex. The PFI is not influenced by age or sex. These findings may provide useful information for surgical planning and understanding age-related changes in the periocular area. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Xueting Li
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Wanlin Fan
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Michael Simon
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Xiaojun Ju
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Till Rosenkranz
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Philomena A Wawer Matos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Yongwei Guo
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China.
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany.
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Zhang Z, Di W, Wang Y. Correction of Asymmetry of Palpebral Folds by Adopting Interrupted and Continuous Buried Suture Techniques Respectively on Different Eyelid. J Craniofac Surg 2023; 34:2492-2496. [PMID: 37602459 DOI: 10.1097/scs.0000000000009621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/14/2023] [Indexed: 08/22/2023] Open
Abstract
People with an obvious palpebral fold on 1 eye and a narrow or no palpebral fold on the other eye are usually more satisfied with the shape of the obvious palpebral fold and want to acquire symmetry by minimally invasive surgical methods that preserve the shape of the original folds they are more satisfied with. This study introduced a minimally invasive approach using 2 different buried suture techniques on different eyelids to acquire symmetry. The continuous suture method aimed to build palpebral folds, whereas the 3-point interrupted suture method aimed to enhance naturally formed palpebral folds. The 3-point interrupted buried suture method was used on the eye with an obvious palpebral fold, and the continuous buried suture method was performed on the eye with a narrow or no palpebral fold. Twenty patients underwent this procedure to correct the asymmetry between June 2010 and July 2022. The mean follow-up period was 18.12 months. The average swelling period was 7 days on the side using the interrupted buried suture technique and 10 days on the side using the continuous suture method. It took ~3 weeks to recover a relatively natural appearance. According to postoperative follow-up data, all patients were satisfied with the results. Our surgical approach of adopting 2 different buried suture techniques on different eyelids allowed the building of the palpebral fold on one eyelid while enhancing the original fold on the other eyelid, leading to satisfactory results of palpebral fold symmetry.
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Affiliation(s)
- Zhilu Zhang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, China
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Kitazawa T, Yuzuriha S. Impact of Single Eyelid on Superior Visual Field. Ann Plast Surg 2022; 88:375-380. [PMID: 35312647 PMCID: PMC8929297 DOI: 10.1097/sap.0000000000003201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
ABSTRACT A puffy eyelid without a crease, also known as single eyelid, is a common characteristic in East Asians. Existence of a lid crease is generally considered an aesthetic concern for both patients and surgeons, and postoperative evaluations have mainly focused on the appearance of the eye. The aim of this study was to clarify the functionality of the superior visual field (SVF) with single eyelid.This prospective cohort study compared edge of the upper eyelid to central corneal light reflex distance (edge reflex distance [ERD]) preoperatively and postoperatively and examined the SVF, as measured by Goldmann perimetry, in single-eyelid patients who underwent blepharoplasty.Twenty patients (40 eyelids) with a median age of 21 years were examined. The median preoperative and postoperative ERDs were 1.45 and 3.4 mm, respectively. The median areas of the SVF preoperatively and postoperatively were 34,443 and 50,796 degrees2, respectively. Although a positive correlation existed between preoperative ERD and SVF, no correlation was observed between postoperative ERD and SVF.The SVF of the single eyelid is narrower than that of the double eyelid, even under circumstances of equivalent palpebral fissure height. The single eyelid commonly found in East Asian populations is associated with both cosmetic and functional issues.
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Affiliation(s)
- Takeshi Kitazawa
- From the Department of Plastic and Reconstructive Surgery, Matsunami General Hospital, Kasamatsu
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine and Graduate School of Medicine, Matsumoto, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine and Graduate School of Medicine, Matsumoto, Japan
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Tran C, Choi D, Wang K, Carter KD, Ko AC, Shriver EM. Trends in horizontal periocular asymmetry. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 58:229-234. [PMID: 34921767 DOI: 10.1016/j.jcjo.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether there is laterality predominance in the horizontal dimensions of the periocular region. DESIGN Retrospective study. PARTICIPANTS Patients >18 years of age who presented to a single academic ophthalmology department. Exclusion criteria included history of facial trauma or surgery, aesthetic injections, or other periocular-altering processes. METHODS Standardized digital photographs were obtained, and periocular structures were measured with Image J software. The midline was defined as the midpoint between the medial canthi, and the distances measured include midline to medial canthus, pupil centre, lateral canthus, and lateral zygoma. The palpebral fissure width was calculated as the distance between the lateral canthus and medial canthus. Data analysis was done for the full cohort and subsequently according to patient-identified gender. RESULTS Periocular structures were measured in 83 patients (50 female and 33 male) with a mean age of 57.0 ± 16.2 years (range, 22-84 years). Right-sided predominance was found to be increasingly significant for the following variables: midline to pupil centre (31.34 mm vs 31.08 mm, p < 0.01), midline to lateral canthus (42.57 mm vs 42.23 mm, p < 0.005), and midline to lateral zygoma (65.70 mm vs 64.01 mm, p < 0.001). CONCLUSIONS Photographic analysis of adults with no periocular-altering history demonstrates that there is a right-sided predominance in the horizontal dimension of the midline to the pupil, lateral canthus, and zygoma with increasing significance. Asymmetry of horizontal periocular measurements was more prevalent in males.
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Affiliation(s)
| | - Dabin Choi
- Carver College of Medicine, Iowa City, Iowa
| | - Kai Wang
- Department of Biostatistics, College of Public Health, Iowa City, Iowa
| | - Keith D Carter
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Audrey C Ko
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa; Wolfe Eye Clinic, West Des Moines, Iowa
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.
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Eyelid Crease Height Affects the Evaluation of Age-related Changes in the Eyelids. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3909. [PMID: 34745800 PMCID: PMC8568474 DOI: 10.1097/gox.0000000000003909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
Although the functional and anatomical differences between the left and right eyelids are important in the evaluation of age-related changes in the eyelids, they have not been described clearly as indications for surgical treatments. This study aimed to investigate how laterality of the eyelids affects evaluation of age-related changes.
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Mini-Incision Eyelidplasty in Single Eye to Correct Congenital Upper Eyelid Crease Asymmetry. J Craniofac Surg 2021; 32:2528-2531. [PMID: 34183636 DOI: 10.1097/scs.0000000000007734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the clinical effect of mini-incision double eyelidplasty in single eye for correcting congenital upper eyelid crease asymmetry. METHODS Mini-incision double eyelidplasty was performed on 24 patients in single eye to treat congenital upper eyelid crease asymmetry between May 2016 and September 2018. The postoperative surgical results were classified as "excellent," "fair," and "poor." The subjective satisfaction and incidence of complications were documented. RESULTS The mean patient age at the time of surgery was 24.6 ± 3.1 years (21-28 years), and the mean follow-up time was 15.4 ± 8.7 (12-34 months). All patients showed "excellent" surgical outcomes according to symmetry of upper eyelid creases. All patients are "very satisfied" with the cosmetic outcomes. There were no cases of recurrence or other complications. CONCLUSIONS Mini-incision double eyelidplasty method in single eye was effective and endurable in the treatment of congenital upper eyelid crease asymmetry. The recovery rate was fast, and no cases of upper eyelid crease disappearance were observed in this study.
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Lee JY, Choung HW, Choung PH. Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction. J Korean Assoc Oral Maxillofac Surg 2020; 46:379-384. [PMID: 33377462 PMCID: PMC7783177 DOI: 10.5125/jkaoms.2020.46.6.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/07/2022] Open
Abstract
Objectives We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans. Patients and Methods In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III. Results Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side. Conclusion The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient's skeletal and soft-tissue discrepancies.
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Affiliation(s)
- Ju-Young Lee
- Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Han-Wool Choung
- Department of Oral and Maxillofacial Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Pill-Hoon Choung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Consejo A, Wu R, Abass A. Anterior Scleral Regional Variation between Asian and Caucasian Populations. J Clin Med 2020; 9:jcm9113419. [PMID: 33113864 PMCID: PMC7692638 DOI: 10.3390/jcm9113419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate the anterior scleral shape regional differences between Asian and Caucasian populations. Methods: The study included 250 Asian eyes and 235 Caucasian eyes from participants aged 22 to 67 years (38.5 ± 7.6). Three-dimensional (3D) corneo-scleral maps were acquired using a corneo-scleral topographer (Eye Surface Profiler, Eaglet Eye BV) and used to calculate sagittal height. For each 3D map, the sclera (maximum diameter of 18 mm) and cornea were separated at the limbus using an automated technique. Advanced data processing steps were applied to ensure levelled artefact-free datasets to build an average scleral shape map for each population. Results: Statistically, Asian and Caucasian sclerae are significantly different from each other in sagittal height (overall sclera, p = 0.001). The largest difference in sagittal height between groups was found in the inferior-temporal region (271 ± 203 µm, p = 0.03), whereas the smallest difference was found in the superior-temporal region (84 ± 105 µm, p = 0.17). The difference in sagittal height between Caucasian and Asian sclera increases with the distance from the limbus. Conclusions: Asian anterior sclera was found to be less elevated than Caucasian anterior sclera. However, the nasal area of the sclera is less elevated than the temporal area, independently of race. Gaining knowledge in race-related scleral topography differences could assist contact lens manufacturers in the process of lens design and practitioners during the process of contact lens fitting.
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Affiliation(s)
- Alejandra Consejo
- Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland;
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Richard Wu
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung City 40601, Taiwan;
- College of Optometry, Pacific University, Forest Grove, OR 97116, USA
| | - Ahmed Abass
- School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
- Correspondence:
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Liew S, Wu WTL, Chan HH, Ho WWS, Kim HJ, Goodman GJ, Peng PHL, Rogers JD. Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty. Aesthetic Plast Surg 2020; 44:1186-1194. [PMID: 32844263 DOI: 10.1007/s00266-020-01808-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asians increasingly seek non-surgical facial esthetic treatments, especially at younger ages. Published recommendations and clinical evidence mostly reference Western populations, but Asians differ from them in terms of attitudes to beauty, structural facial anatomy, and signs and rates of aging. A thorough knowledge of the key esthetic concerns and requirements for the Asian face is required to strategize appropriate facial esthetic treatments with botulinum toxin and hyaluronic acid (HA) fillers. METHODS The Asian Facial Aesthetics Expert Consensus Group met to develop consensus statements on concepts of facial beauty, key esthetic concerns, facial anatomy, and aging in Southeastern and Eastern Asians, as a prelude to developing consensus opinions on the cosmetic facial use of botulinum toxin and HA fillers in these populations. RESULTS Beautiful and esthetically attractive people of all races share similarities in appearance while retaining distinct ethnic features. Asians between the third and sixth decades age well compared with age-matched Caucasians. Younger Asians' increasing requests for injectable treatments to improve facial shape and three-dimensionality often reflect a desire to correct underlying facial structural deficiencies or weaknesses that detract from ideals of facial beauty. CONCLUSIONS Facial esthetic treatments in Asians are not aimed at Westernization, but rather the optimization of intrinsic Asian ethnic features, or correction of specific underlying structural features that are perceived as deficiencies. Thus, overall facial attractiveness is enhanced while retaining esthetic characteristics of Asian ethnicity. Because Asian patients age differently than Western patients, different management and treatment planning strategies are utilized. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Woffles T L Wu
- Woffles Wu Aesthetic Surgery and Laser Centre, Camden Medical Centre, 1 Orchard Boulevard, Suite #09-02, Singapore, 249615, Singapore.
| | - Henry H Chan
- Department of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wilson W S Ho
- The Specialists: Lasers, Aesthetic and Plastic Surgery Central, Pok Fu Lam, Hong Kong
| | - Hee-Jin Kim
- Division of Anatomy & Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Greg J Goodman
- Monash University, Clayton, Victoria, and Skin & Cancer Foundation, Carlton, VIC, Australia
| | | | - John D Rogers
- Regional Medical Affairs, Allergan Asia Pacific, Singapore, Singapore
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Ma J, Lin H, Pan B, Xue H. Vertical enlargement of the palpebral aperture by surgical modification of the lower eyelid: A new cosmetic option for Chinese patients. J Plast Reconstr Aesthet Surg 2020; 73:1151-1158. [PMID: 32122765 DOI: 10.1016/j.bjps.2020.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/26/2019] [Accepted: 01/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The distinctive features of Oriental eyes are narrow palpebral aperture and upslanting lower eyelid margin, which are not in accordance with modern appreciation of beauty. Although many ophthalmic plastic procedures have been designed to change the characteristic appearance, the methods to enlarge the palpebral aperture by lowering the lower eyelid are limited. METHODS A total of 63 Chinese patients received the lowering the lower eyelid procedure from April 2014 to August 2018. The main criteria are patients who have vertically narrow palpebral aperture with or without upslanting lower eyelid shape. But patients who have proptosis or unhealthy lower eyelid elasticity are not suitable for this procedure. The operation is performed by suturing the lower tarsal plate and the infraorbital periosteum together, adjusting the tension of knots to reach the patient's desire for the shape of lower eyelid margin, and finally tightening all the knots. RESULTS The lateral lower eyelid margin was lowered and the lateral part of the palpebral aperture was enlarged in all cases (P < 0.01). Only five patients (7.9%) were not fully satisfied because of the partial retraction of the lateral eyelid margin. Minor complications were observed, of which conjunctival chemosis in three patients (4.8%) and conjunctival hemorrhage in two patients (3.2%). CONCLUSION Lowering the lower eyelid procedure is an effective and safe approach for patients who desire to smooth the upslanting shape and enlarge the eyes. The strict criteria and careful preoperative evaluations are critical to avoid complications and achieve good outcomes for Chinese patients.
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Affiliation(s)
- Jianxun Ma
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - Hengju Lin
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - Bailin Pan
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China.
| | - Hongyu Xue
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China.
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Zhang Y, Zhou Q, Niu G, Huang X, Zhang J, Bi Y. Individualized small-incision orbicularis-levator fixation blepharoplasty for unilateral single-eyelid Asians. J Plast Reconstr Aesthet Surg 2019; 72:317-321. [DOI: 10.1016/j.bjps.2018.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
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The Prevalence of Double Eyelid and the 3D Measurement of Orbital Soft Tissue in Malays and Chinese. Sci Rep 2017; 7:14819. [PMID: 29093554 PMCID: PMC5665901 DOI: 10.1038/s41598-017-14829-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 10/18/2017] [Indexed: 12/23/2022] Open
Abstract
This study aimed to determine the prevalence of double eyelid among two main Mongoloid ethnicities, the Malays and Chinese who reside in Malaysia. We also measured their periorbital tissue parameters for application in anthropology, optometry, ophthalmology, oculoplastic surgery and maxillofacial trauma surgery. The images of the 103 Malay and 97 Chinese volunteers were captured using indirect 3D photogrammetry, and quantitative measurement was obtained using the software provided by the manufacturer. All Malays and 70.1% of Chinese in this cross section population had double eyelid on both eyes. The mean pretarsal skin height was 3.99 mm for the Malays and 2.29 mm for the Chinese. The Malays appeared to have shorter eyebrow height (11.10 mm) compared to the Chinese (11.79 mm). An opposite pattern could be seen in the measurement of upper eyelid crease height between the Malays (8.33 mm) and the Chinese (4.91 mm). Of note, the intercanthal distance of the Chinese (IDC = 35.85 mm) was wider and their interpupillary distance was narrower (IPD = 62.85 mm) compared to the Malays' (ICD = 34.21 mm; IPD = 64.04 mm). In conclusion, there were significant differences in the prevalence of double eyelid and periorbital tissue measurements between the Malays and Chinese.
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Doganay F, Dadaci Z, Topcu-Yilmaz P, Doganay Aydin H. The association between ocular dominance and physiological palpebral fissure asymmetry. Laterality 2016; 22:412-418. [DOI: 10.1080/1357650x.2016.1209212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Liew S, Wu WTL, Chan HH, Ho WWS, Kim HJ, Goodman GJ, Peng PHL, Rogers JD. Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty. Aesthetic Plast Surg 2016; 40:193-201. [PMID: 26408389 PMCID: PMC4819477 DOI: 10.1007/s00266-015-0562-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asians increasingly seek non-surgical facial esthetic treatments, especially at younger ages. Published recommendations and clinical evidence mostly reference Western populations, but Asians differ from them in terms of attitudes to beauty, structural facial anatomy, and signs and rates of aging. A thorough knowledge of the key esthetic concerns and requirements for the Asian face is required to strategize appropriate facial esthetic treatments with botulinum toxin and hyaluronic acid (HA) fillers. METHODS The Asian Facial Aesthetics Expert Consensus Group met to develop consensus statements on concepts of facial beauty, key esthetic concerns, facial anatomy, and aging in Southeastern and Eastern Asians, as a prelude to developing consensus opinions on the cosmetic facial use of botulinum toxin and HA fillers in these populations. RESULTS Beautiful and esthetically attractive people of all races share similarities in appearance while retaining distinct ethnic features. Asians between the third and sixth decades age well compared with age-matched Caucasians. Younger Asians' increasing requests for injectable treatments to improve facial shape and three-dimensionality often reflect a desire to correct underlying facial structural deficiencies or weaknesses that detract from ideals of facial beauty. CONCLUSIONS Facial esthetic treatments in Asians are not aimed at Westernization, but rather the optimization of intrinsic Asian ethnic features, or correction of specific underlying structural features that are perceived as deficiencies. Thus, overall facial attractiveness is enhanced while retaining esthetic characteristics of Asian ethnicity. Because Asian patients age differently than Western patients, different management and treatment planning strategies are utilized. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
| | - Woffles T L Wu
- Woffles Wu Aesthetic Surgery and Laser Centre, Camden Medical Centre, 1 Orchard Boulevard, Suite #09-02, Singapore, 249615, Singapore.
| | - Henry H Chan
- Department of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wilson W S Ho
- The Specialists: Lasers, Aesthetic and Plastic Surgery Central, Pok Fu Lam, Hong Kong
| | - Hee-Jin Kim
- Division of Anatomy & Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Greg J Goodman
- Monash University, Clayton, Victoria, and Skin & Cancer Foundation, Carlton, VIC, Australia
| | | | - John D Rogers
- Regional Medical Affairs, Allergan Asia Pacific, Singapore, Singapore
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Facial changes after early treatment of unilateral coronal synostosis question the necessity of primary nasal osteotomy. J Craniofac Surg 2015; 26:141-6. [PMID: 25534063 DOI: 10.1097/scs.0000000000001400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS. METHODS Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed. RESULTS Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05). CONCLUSIONS Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.
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Abstract
It is well known that facial beauty is dictated by facial type, and harmony between the eyes, nose, and mouth. Furthermore, facial impression is judged according to the overall facial contour and the relationship between the facial structures. The aims of the present study were to determine the optimal criteria for the assessment of gathering or separation of the facial structures and to define standardized ratios for centralization or decentralization of the facial structures.Four different lengths were measured, and 2 indexes were calculated from standardized photographs of 551 volunteers. Centralization and decentralization were assessed using the width index (interpupillary distance / facial width) and height index (eyes-mouth distance / facial height). The mean ranges of the width index and height index were 42.0 to 45.0 and 36.0 to 39.0, respectively. The width index did not differ with sex, but males had more decentralized faces, and females had more centralized faces, vertically. The incidence rate of decentralized faces among the men was 30.3%, and that of centralized faces among the women was 25.2%.The mean ranges in width and height indexes have been determined in a Korean population. Faces with width and height index scores under and over the median ranges are determined to be "centralized" and "decentralized," respectively.
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Gudek MA, Uzun A. Anthropometric measurements of the orbital contour and canthal distance in young Turkish. J ANAT SOC INDIA 2015. [DOI: 10.1016/j.jasi.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pool SM, van der Lei B. Asymmetry in upper blepharoplasty: A retrospective evaluation study of 365 bilateral upper blepharoplasties conducted between January 2004 and December 2013. J Plast Reconstr Aesthet Surg 2015; 68:464-8. [DOI: 10.1016/j.bjps.2014.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/20/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022]
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Macdonald KI, Mendez AI, Hart RD, Taylor SM. Eyelid and brow asymmetry in patients evaluated for upper lid blepharoplasty. J Otolaryngol Head Neck Surg 2014; 43:36. [PMID: 25294556 PMCID: PMC4193127 DOI: 10.1186/s40463-014-0036-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/24/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction In evaluation for blepharoplasty, patients often desire improved cosmesis and/or correction of visual field deficits. However, patients are usually unaware of eyelid or brow asymmetry. Furthermore, the prevalence of eyelid and brow asymmetry is infrequently reported in the medical literature. Purpose To determine the prevalence of brow and eyelid asymmetry in patients evaluated for upper lid blepharoplasty. Methods One hundred consecutive patients evaluated for upper lid blepharoplasty were included in the study. Standard pre-operative photographs were taken of all patients using consistent background and photographic equipment. Two of the authors (KM & AM) independently recorded the margin pupil (MPD), central eyebrow (CED), nasal eyebrow (NED) and temporal eyebrow (TED) distances. To test the inter-observer reliability, the senior author (SMT) recorded the same measurements for 10% of randomly selected patients. We calculated 95% confidence intervals to compare symmetry between the right and left sides. Results One hundred patients (94 female, mean age 57.7) were included in the study. The average MPD, CED, NED and TED distances were 0.55 mm (95% CI 0.45-0.65), 1.77 mm (95% CI 1.47-2.07), 1.34 mm (95% CI 1.14-1.54), and 1.78 mm (95% CI 1.50-2.06), respectively. Ninety-three percent of patients had at least one asymmetric measurement of greater than 1 mm. Seventy-five percent of patients studied had at least one measurement greater than 2 mm while 37 percent had at least one greater than 3 mm. Conclusion Brow and eyelid asymmetry is common in patients being evaluated for upper lid blepharoplasty. The facial plastic surgeon should identify and document facial asymmetry pre-operatively, and discuss it with prospective blepharoplasty patients. This will improve informed consent and patient expectations.
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Affiliation(s)
- Kristian I Macdonald
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, 1081 Carling Ave, Ottawa, ON K1Y 4G2 Canada
| | - Adrian I Mendez
- Division of Otolaryngology - Head & Neck Surgery, University of Alberta, Edmonton, AB Canada
| | - Robert D Hart
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS Canada
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Eze BI, Uche JN, Shiweobi JO, Mba CN. Oculopalpebral dimensions of adult Nigerians: report from the Enugu normative ocular anthropometry study. Med Princ Pract 2013; 22:75-9. [PMID: 22813784 PMCID: PMC5586704 DOI: 10.1159/000339800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 05/31/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the normal oculopalpebral anthropometric measurements of a Nigerian adult population. SUBJECTS AND METHODS A population-based prospective observational random survey was conducted in Enugu, South-Eastern Nigeria between January and April 2010. The participants were healthy adults comprising 248 males and 252 females aged 18-76 years. One thousand eyes were examined. Demographic data, and bilateral direct manual millimetre measurements of the horizontal palpebral fissure (HPF), vertical palpebral fissure (VPF), upper lid crease (ULC), brow height (BH), and margin reflex distance (MRD) were obtained from all participants. Data were categorised by demographic variables and analysed to yield frequencies, percentages and proportions. Between-gender comparisons, using the independent t test, were considered significant at p < 0.05. RESULTS The mean age of the participants was 36.5 ± 14.6 years. There was no significant difference between the genders in mean age (men: 37.3 ± 15.7 vs. women: 35.8 ± 13.3, p = 0.2302). The mean values of the parameters were (male, female) HPF: 32.8 ± 2.0 vs. 32.6 ± 3.0; VPF: 10.6 ± 1.2 vs. 10.6 ± 1.2; ULC: 8.2 ± 2.5 vs. 7.9 ± 2.2; BH: 13.1 ± 2.4 vs. 13.6 ± 2.7; and MRD: 4.1 ± 0.5 vs. 4.2 ± 0.8. Significant between-gender difference was observed only in BH measurements (p = 0.029) and variable trends with age. CONCLUSION Oculopalpebral measurements of normal adult Nigerians in Enugu showed variations by age and gender. This may have implications for clinical evaluation and surgical management of oculopalpebral disorders in adult South-Eastern Nigerians. Future longitudinal studies are needed.
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Affiliation(s)
- Boniface I Eze
- Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria.
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Zhou Q, Zhang L, Wang P, Yang S, Bi Y. Preoperative asymmetry of upper eyelid thickness in young Chinese women undergoing double eyelid blepharoplasty. J Plast Reconstr Aesthet Surg 2012; 65:1175-80. [DOI: 10.1016/j.bjps.2012.03.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 11/30/2022]
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Anterior lamellar repositioning with complete lid split: a modified method for treating upper eyelids trichiasis in Asian patients. J Plast Reconstr Aesthet Surg 2009; 62:1395-402. [PMID: 18945658 DOI: 10.1016/j.bjps.2008.06.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 05/11/2008] [Accepted: 06/05/2008] [Indexed: 11/20/2022]
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16:394-7. [PMID: 18626261 DOI: 10.1097/moo.0b013e32830c1edc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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