Preoperative asymmetry of upper eyelid thickness in young Chinese women undergoing double eyelid blepharoplasty

Ultrasound-based histological differences in thickness between puffy eyelids and normal eyelids in Asian monolid women

BACKGROUND

Upper eyelid tissue swelling is a common characteristic among Asian monolid individuals and is associated with a high incidence of complications following eyelid surgery. Currently, there is no precise definition for upper eyelid tissue swelling; thus, further research is required to elucidate the specific causes contributing to upper eyelid puffiness.

METHOD

Between June 2023 and February 2024, we recruited 84 Asian monolid women categorized into groups based on the severity of upper eyelid tissue swelling: the puffy eyelid group and normal eyelid group. High-frequency ultrasound was employed to capture images of the upper eyelids and measure the thickness of various tissue layers. This study aimed to conduct a comparative analysis to identify the factors contributing to upper eyelid fullness, focusing on elucidating the underlying causes of this condition.

RESULT

All volunteers underwent bilateral upper eyelid ultrasound imaging. Significant differences were observed in the thickness of subcutaneous fat, pre-tarsal fat, retro-orbicularis oculi fat (ROOF), and composite fat (ROOF and preaponeurotic fat) layer between the puffy and normal eyelid groups. However, no significant differences were found in skin thickness or orbicularis oculi muscle thickness. Additionally, no significant differences were observed in the thickness of various layers of the upper eyelid tissue between the left and right eyes in all participants.

CONCLUSION

Thickening of the upper eyelid fat layer is a primary cause of upper eyelid puffiness. In upper blepharoplasty, targeted removal of preaponeurotic fat, ROOF, and pre-tarsal fat can achieve precise reduction to correct upper eyelid puffiness effectively.

Preoperative Eyelid and Eyebrow Asymmetry: A Potential Pre-Operation Inform Consent Option: A Descriptive Cross-Sectional Study

Background

We aimed to determine the prevalence of pre-existing asymmetry in our patients and investigate the impact of age and sex on upper facial asymmetry.

Methods

We collected images from 155 patients who were undergoing upper eyelid blepharoplasty and MRD1 (marginal reflex distance 1), TPS (tarsal plate show), and BFS (brow fat span) measurements were extracted by ImageJ software. The relationship between asymmetry and age and gender was assessed by comparing the mean differences of these metrics. A generalized linear model (GLM) was used to compare the outcomes of the study. P-value < 0.05 was considered significantly different in all tests.

Results

Pre-operative asymmetry was present in 112 (72%) patients. Among the cases, 61 (39%), 40 (26%), and 24 (15.5%) patients had more than 1mm of asymmetry in BFS, TPS, and MRD1, respectively. Males under 50 years old had the most asymmetry in the preorbital area. Comparing men under 50 years old with the other groups showed that the mean ± SD of absolute differences of TPS was significantly higher in this group (all P< 0.00), but pairwise comparison for MRD1 and BFS indicated no significant correlation between age, gender, and the mean asymmetry of these parameters (overall test P = 0.70 for MDR1 and P = 0.45 for BFS).

Conclusion

Most patients have asymmetry before surgery without being aware of it. Awareness of this asymmetry and the relationship between facial asymmetry and age and gender is essential to prevent dissatisfaction due to the probable post-operative asymmetry and unrealistic expectations.

Correction of Asymmetry of Palpebral Folds by Adopting Interrupted and Continuous Buried Suture Techniques Respectively on Different Eyelid

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.

Upper Eyelid Skin Laxity in Elderly Patients: Correction Surgery With Eyelid Marginal Incision

BACKGROUND

Laxity of the upper eyelid skin in the elderly usually leads to an aged appearance and visual field defect, which affects their quality of life. However, there are very few reports on the evaluation and treatment strategy for upper eyelid skin redundancy in elderly Asians. Hence, this article describes an upper eyelid skin laxity correction surgery using an innovative parallel palpebral margin incision to improve ptosis and enlarge the visual field.

METHODS

From August 2012 to March 2021, 87 patients with severe eyelid laxity and ptosis presented to the Plastic Surgery Department of the Zhongda Hospital Affiliated to Southeast University. Upper eyelid skin laxity correction surgery with eyelid marginal incision was performed to correct the excessive tissue between the eyebrow and the upper eyelid and improve patients' vision field. Thereafter, a postoperative follow-up was conducted to observe the results in terms of skin laxity, eyelid shape changes, visual field improvement, postoperative scars, and patients' satisfaction.

RESULTS

During the follow-up, information was collected between 3 months and 1 year after surgery. No visible scars were seen in patients after the operation, and the sagging skin of the upper eyelid was corrected. In addition, the effect of correcting visual field defect is stable, with no recurrence within 1 year. The operation was effective, and patients were satisfied.

CONCLUSION

This surgical strategy significantly improved severe upper eyelid skin laxity with inconspicuous postoperative scars. After the operation, patients felt satisfied, and their quality of life was notably improved.

Eyelid Crease Height Affects the Evaluation of Age-related Changes in the Eyelids

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.

Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty

AIM

To evaluate surgical outcomes of modified Z-epicanthoplasty with blepharoplasty that we previously reported from the patient's perspective using patient-reported outcome measures (PROMs) and patient satisfaction scores.

METHODS

A total of patients (n=180) who underwent the surgery between January 2013 and June 2016 were randomly selected. Standardized patient satisfaction forms (total score, 40) and validated PROMs questionnaires (total score, 12) were sent to patients for completion. PROMs assesses the severity of scarring, pain and asymmetry, as well as functional and appearance issues.

RESULTS

All patients were female, ranging from 18 to 35 years old (mean=24). The response rate was 73.3% (n=132). The majority of patients reported good or excellent outcomes based on PROM analysis. Patients reported minimum or non-visible scarring at both the double eyelid surgical scar (85.6%) and the inner canthus (80.3%). Issues concerning function and appearance were minimal as 80.3% reported satisfaction with both domains. Notably, the majority of patients reported either a high or very high satisfaction rate to yield a mean score of 104 out of 120 (P<0.05).

CONCLUSION

Integration of our modified Z-epicanthoplasty with blepharoplasty produces good outcomes based on PROM results, which shows a positive linear relationship with patient satisfaction scores.

Cross-specialty developments: a summary of the mutually relevant recent literature from the journal of plastic, reconstructive and aesthetic surgery

Keeping abreast of current developments is increasingly challenging when the volume of specialty articles being published is rising exponentially, and it is most acute when surgical specialties overlap, as in the case of head, neck, and facial reconstructive surgery. Here, the potential for missing key developments presents a compelling case for a summary article that highlights articles likely to be of mutual relevance. We evaluated 129 original studies and 6 reviews published in the Journal of Plastic, Reconstructive, and Aesthetic Surgery between September 2012 and August 2014, and summarised the main papers of interest and merit under the subheadings of head and neck reconstruction, cleft lip and palate, craniomaxillofacial surgery, facial palsy, facial trauma, and aesthetic surgery. Most of the evidence presented (86%) is level 4.