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Gutovitz JM, Ben-Simon G, Egozi E, Bar A, Landau Prat D. Transient Postinflammatory Hyperpigmentation Following Eyelid Surgery. Ophthalmic Plast Reconstr Surg 2024; 40:286-290. [PMID: 37972970 DOI: 10.1097/iop.0000000000002565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The authors' aim was to describe a rare mild complication of eyelid surgery presenting as transient hyperpigmentation along the suture lines. METHODS A retrospective case series of 6 patients experiencing transient hyperpigmentation following eyelid surgery. Each patient underwent either blepharoplasty alone or blepharoplasty with ptosis repair utilizing Müller muscle conjunctival resection. Data including surgery type, hyperpigmentation laterality and location, time to diagnosis, follow-up time, and outcome were assessed. RESULTS All 6 patients with hyperpigmentation were females. All patients underwent blepharoplasty, including 1 upper eyelid blepharoplasty and 4 with both upper and lower eyelid blepharoplasty. One patient underwent bilateral upper blepharoplasty with concurrent posterior approach ptosis surgery repair of the left upper eyelid. Hyperpigmentation was bilateral in all 5 blepharoplasty cases and unilateral in the ptosis repair case. Hyperpigmentation included the medial portion of the operated upper eyelid in all cases. Time to diagnosis ranged from 1 to 4 weeks postoperatively, and follow-up time ranged from 3 to 5 months. Management was conservative in all cases. Five patients experienced complete resolution, and 1 patient experienced near-complete resolution on a 3-month follow-up. CONCLUSIONS Transient hyperpigmentation is a rare posteyelid surgery complication, generally with an excellent outcome not requiring additional intervention.
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Affiliation(s)
- Joel M Gutovitz
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
- Faculty of Medicine, Tel aviv University, Ramat Aviv, Israel
| | - Guy Ben-Simon
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
- Faculty of Medicine, Tel aviv University, Ramat Aviv, Israel
| | - Ella Egozi
- Dermatology and Aestetics, Dr. Ella Egozi Medical Center, Faculty of Medicine, Tel aviv University, Ramat Aviv, Israel
| | - Ariel Bar
- Faculty of Medicine, Tel aviv University, Ramat Aviv, Israel
| | - Daphna Landau Prat
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
- Faculty of Medicine, Tel aviv University, Ramat Aviv, Israel
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2
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Lee TC, Fung SE, Hu JQ, Villatoro GA, Park KS, Fung BM, Groessl EJ, Korn BS, Kikkawa DO, Liu CY. Is Blepharoplasty Cost-effective? Utility Analysis of Dermatochalasis and Cost-effectiveness Analysis of Upper Eyelid Blepharoplasty. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00366. [PMID: 38534072 DOI: 10.1097/iop.0000000000002649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE This cross-sectional prospective study measured utility values of upper eyelid dermatochalasis to quantify its impact on quality of life and assess cost-effectiveness of upper blepharoplasty. METHODS Utility of dermatochalasis was assessed using the standard reference gamble and time trade-off methods, with dual anchor points of perfect eye function and perfect health. The utility value obtained was used to create a Markov model and run a cost-effectiveness analysis of blepharoplasty as a treatment for dermatochalasis while utilizing the societal perspective. RESULTS One hundred three patients with dermatochalasis recruited from an urban outpatient ophthalmology clinic completed the utility survey. The authors determined utility values for dermatochalasis ranging from 0.74 to 0.92 depending on the measurement method (standard reference gamble/time trade-off) and anchor points. The cost-effectiveness analysis yielded an incremental cost-effectiveness ratio of $3,146 per quality-adjusted life year, well under the conventional willingness-to-pay threshold of $50,000 per quality-adjusted life year. Probabilistic sensitivity analysis with Monte Carlo simulation demonstrated that blepharoplasty would be cost-effective in 88.1% of cases at this willingness-to-pay threshold. CONCLUSIONS Dermatochalasis has an impact on quality of life that is significantly associated with level of perceived functional impairment. Rising health care costs have underscored the importance of providing value-based treatment to patients, and the results of this study suggest that blepharoplasty is a cost-effective treatment option for symptomatic bilateral upper eyelid dermatochalasis.
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Affiliation(s)
- Tonya C Lee
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California, U.S.A
| | - Sammie E Fung
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California, U.S.A
| | - Jenny Q Hu
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, California, U.S.A
| | - George A Villatoro
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, California, U.S.A
| | - Kathryn S Park
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California, U.S.A
| | - Brian M Fung
- Department of Ophthalmology, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, U.S.A
| | - Erik J Groessl
- Department of Family Medicine and Public Health, University of California, San Diego Herbert Wertheim School of Public Health, La Jolla, California, U.S.A
- Department of Behavioral Science, UC San Diego Health Services Research Center, San Diego, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego
- Division of Plastic Surgery, Department of Surgery, UC San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego
- Division of Plastic Surgery, Department of Surgery, UC San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, California, U.S.A
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego
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3
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Mian OT, Lippe CM, Khan A, Bugg VA, Bryant JC, Riaz KM, Dvorak JD, Ding K, Moreau A. Dry eye in the upper blepharoplasty patient: a study comparing orbicularis-sparing versus orbicularis-excising techniques. Graefes Arch Clin Exp Ophthalmol 2023; 261:3625-3634. [PMID: 37354267 DOI: 10.1007/s00417-023-06131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To compare subjective and objective dry eye syndrome (DES) metrics preoperatively and postoperatively in patients undergoing bilateral upper eyelid blepharoplasty (ULB) using orbicularis-sparing versus orbicularis-excising techniques. METHODS A double-blind, randomized clinical trial was conducted on patients without prior DES or other severe conditions who presented to our institution between 2017 and 2019 for routine functional ULB. Patients were randomized into two treatment arms: bilateral ULB using the orbicularis-sparing technique or bilateral ULB using the orbicularis-excising technique. One subjective and seven objective DES assessments were performed on all patients preoperatively and 1 month and 1 year after surgery. RESULTS A total of 63 patients were recruited for the study. Standard Patient Evaluation of Eye Dryness (SPEED) scores decreased in both treatment groups at 1 month and 1 year postoperatively. This change did not significantly vary based on surgical technique. Objective DES assessments were not significantly changed at both postoperative time points for either group. There was a correlation between the severity of preoperative DES symptoms and the subjective improvement of DES symptoms postoperatively in both groups. CONCLUSIONS ULB with an orbicularis-sparing or orbicularis-excising technique does not worsen subjective or objective DES metrics and so, surgeons may confidently use either surgical technique. These findings may impact postoperative expectations for surgeons and patients alike.
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Affiliation(s)
- Osamah T Mian
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- College of Medicine, University of Oklahoma, Norman, OK, USA
| | - Christina M Lippe
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- Eye Consultants of Pennsylvania, Wyomissing, PA, USA
- Department of Ophthalmology, Drexel University, Philadelphia, PA, USA
| | - Asher Khan
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- College of Medicine, University of Oklahoma, Norman, OK, USA
| | - Victoria A Bugg
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA.
| | - Juliana C Bryant
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
| | - Justin D Dvorak
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kai Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Annie Moreau
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- College of Medicine, University of Oklahoma, Norman, OK, USA
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Facial Cosmetic Surgery. J Oral Maxillofac Surg 2023; 81:E300-E324. [PMID: 37833027 DOI: 10.1016/j.joms.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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5
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Luong KP, Vissers LCM, Domela Nieuwenhuis I, Hazenkamp LS, Hummelink S, Slijper HP, Ulrich DJO. Factors Associated with Treatment Outcome Satisfaction Six Months after Upper Blepharoplasty: A Large Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5260. [PMID: 37718993 PMCID: PMC10501473 DOI: 10.1097/gox.0000000000005260] [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: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023]
Abstract
Background Upper blepharoplasty is the most popular facial cosmetic surgery. Although there are a variety of reasons to undergo this procedure, all patients expect an optimal cosmetic result. However, little is known about the factors that influence satisfaction with treatment outcome. Objectives We assessed to what extent patient characteristics, clinician-rated and postsurgical outcome measures, and patient-reported satisfaction with facial appearance and quality-of-life are associated with patient-reported satisfaction with treatment outcome after a primary upper blepharoplasty. Methods This study was performed in 583 patients with an upper blepharoplasty between 2016 and 2021. The primary outcome was satisfaction with treatment outcome 6 months postoperatively using the FACE-Q. Determinants were baseline patient characteristics (demographics), preoperative and postoperative clinician-rated and surgical outcome measures, and preoperative and postoperative FACE-Q appearance and quality-of-life scales. Hierarchical linear regression analysis was used to determine how much of the variance in satisfaction with outcome could be explained by these groups of determinants. Results A total of 63% of the variance could be explained by the five groups of determinants of which 8% was explained by the baseline patient characteristics and clinician-rated and patient-reported outcomes together, another 8% by the postoperative clinician-rated outcomes, and the remaining 47% by the postoperative patient-reported outcomes. Conclusions Patient characteristics, clinician-rated outcome measures, and baseline FACE-Q appearance and quality-of-life scores were of limited value in explaining satisfaction with treatment outcome. However, the postoperative FACE-Q appearance scale and the decision to undergo a blepharoplasty were strongly associated with satisfaction with treatment outcome.
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Affiliation(s)
- Kim Phi Luong
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
| | - Lieke C. M. Vissers
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
| | - Ileen Domela Nieuwenhuis
- Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa S. Hazenkamp
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan Hummelink
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm P. Slijper
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dietmar J. O. Ulrich
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Heidari M, Haydar AA, Rajabi MT, Rafizadeh SM. Corneal biophysical changes after upper eyelid blepharoplasty and ptosis surgery: a review. BMC Ophthalmol 2023; 23:253. [PMID: 37280563 DOI: 10.1186/s12886-023-03010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
Upper eyelid surgeries, such as blepharoplasty and ptosis correction, are commonly performed procedures worldwide. This review examines the effects of these surgeries on ocular properties and visual function. A search of the PubMed and Google Scholar databases was conducted to identify relevant articles published after 2000. The results demonstrate that the ocular and adnexal organs function as a unified visual system, with changes in one component affecting the functions of others. Eyelid surgery can alter ocular properties and functions by modifying retinal lighting and ocular optics. These alterations can affect intraocular pressure estimation, corneal curvature, corneal epithelial thickness, refractive power of the cornea, and intraocular lens calculation. Additionally, eyelid surgery can exacerbate dry eye symptoms and impact contrast sensitivity, which is a significant factor in visual quality. Therefore, understanding these interactions is crucial before performing eyelid surgery and during follow-up. This review summarizes recent literature on the effects of upper eyelid surgery on corneal properties and visual function, emphasizing the importance of considering these factors when planning or undergoing such procedures.
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Affiliation(s)
- Mostafa Heidari
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Ali A Haydar
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Taher Rajabi
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran.
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8
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Mahrhofer M, Schwaiger K, Weitgasser L, Schoeller T, Hitzl W, Wechselberger G. Patient-Reported Outcome Analysis after Resident Performed Upper Blepharoplasty: A Suitable Procedure for Young Surgeons. Facial Plast Surg 2023; 39:98-103. [PMID: 36100243 DOI: 10.1055/s-0042-1749168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Upper blepharoplasty is one of the most frequently performed aesthetic surgeries worldwide. While it is considered a low risk procedure, patients have high expectations regarding the outcome of elective surgery of the face and the majority of residents usually have little exposure to cosmetic surgeries in the early years of their training. All eligible patients who had undergone bilateral upper blepharoplasty at the senior author's institution between January 2016 and August 2019 were invited to participate in an online questionnaire. Our study used a 27-item questionnaire to evaluate postoperative patient satisfaction and compared the patient reported outcome between operations conducted by surgeons with more than 3 years of experience and less than 3 years. In total, 102 patients returned the completed questionnaire and were included in our study after further screening. There was no significant difference in patient reported satisfaction concerning the aesthetic outcome (8.75 vs. 8.29, p=0.49), and complications (6.2 vs. 18.6%, p=0.63), related to the experience of the surgeons. Overall patient satisfaction was very high, while the rate of complications was low. Patient reported aesthetic outcomes after blepharoplasty demonstrated no significant difference comparing the experience of the surgeons.
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Affiliation(s)
- Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria.,Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Karl Schwaiger
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria
| | - Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria
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Savran F, Elibol ES. Evaluating YouTube as a Source of Patient Information for Blefaroplasty. Facial Plast Surg 2023; 39:86-92. [PMID: 36100244 DOI: 10.1055/s-0042-1744537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study aims to evaluate the content and quality of popular videos about blepharoplasty treatment in YouTube. Four keywords "blepharoplasty," "upper blepharoplasty," "lower blepharoplasty," and "blepharoplasty information" were searched in YouTube. After the videos were sorted by the number of views, the last 50 videos were based on general characteristics, primary purpose, information content, relevance, audiovisual quality, as well as viewer interaction index DISCERN score (minimum-maximum: 16-75), Journal of the American Medical Association (JAMA) score (minimum-maximum: 0-4), and Global Quality score (minimum-maximum: 0-5), and view rate formulas were calculated for each video. A total of the best 49 videos were evaluated in our study. The total number of views of these videos was 10,938,976. The total duration of these videos was 409minutes. The average duration of the videos was 8.35±8.38 (standard deviation [SD]). There was no significant (p>0.05) correlation between the measurement of DISCERN scores of the two observers. A significant (p<0.05) difference was observed between the JAMA score measurements of the two observers. There was no significant difference (p>0.05) between the GQS score measurements of the two observers. Currently, YouTube is not a viable resource for patients to learn about blepharoplasty. Physicians should be aware of the limitations and provide up-to-date and peer-reviewed content on the web site, and patients should also be warned about obtaining information.
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Affiliation(s)
- Fatih Savran
- Department of Otolaryngology, University of Health Sciences, Umraniye Research and Education Hospital, Istanbul, Turkey
| | - Emine S Elibol
- Department of Ophthalmologist, University of Health Sciences, Goztepe Research and Education Hospital, Istanbul, Turkey
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10
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Hollander MH, van der Hoeven JH, Verdonschot KH, Delli K, Vissink A, Jansma J, Schepers RH. Effects of Upper Blepharoplasty Techniques on Headaches, Eyebrow Position, and Electromyographic Outcomes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1559. [PMID: 36674313 PMCID: PMC9866996 DOI: 10.3390/ijerph20021559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The aim of this study was to assess changes in headaches, eyebrow height, and electromyographic (EMG) outcomes of the frontalis and orbicularis oculi muscles, after an upper blepharoplasty with or without resecting a strip of orbicularis oculi muscle. In a randomized controlled trial, 54 patients received an upper blepharoplasty involving either only removing skin (group A) or removing skin with an additional strip of orbicularis muscle (group B). Preoperative, and 6 and 12 months postoperative headache complaints were assessed using the HIT-6 scores and eyebrow heights were measured on standardised photographs. Surface EMG measurements, i.e., electrical activity and muscle fatigue, were assessed for the frontalis and orbicularis oculi muscles preoperatively and 2, 6, and 12 months postoperatively. Significantly fewer headaches were reported following a blepharoplasty. The eyebrow height had decreased, but did not differ between groups. Regarding the surface EMG measurements, only group A's frontalis muscle electrical activity had decreased significantly during maximal contraction 12 months after surgery (80 vs. 39 mV, p = 0.026). Fatigue of both the frontalis and the orbicularis oculi muscles did not change significantly postoperatively compared to baseline. EMG differences between groups were minor and clinically insignificant. The eyebrow height decreased and patients reported less headaches after upper blepharoplasty irrespective of the used technique.
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Affiliation(s)
- Maria H.J. Hollander
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Johannes H. van der Hoeven
- Department of Clinical Neurophysiology, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Koen H.M. Verdonschot
- Faculty of Science and Technology, Department of Technical Medicine, University of Twente, 7522 NB Enschede, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Rutger H. Schepers
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
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11
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The Postsurgical Clavien–Dindo Classification in Minor Surgery Can Improve Perception and Communication (Investigation on Blepharoplasty). J Pers Med 2022; 12:jpm12111900. [DOI: 10.3390/jpm12111900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The postsurgical Clavien–Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. This study aims to evaluate a standardized five-step complication grading system (Clavien–Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide. Methods: A retrospective observational exploratory study of patients (N = 344) who received a bilateral upper eyelid blepharoplasty under local anesthesia from the same surgical staff was performed. Data were retrieved from the electronic patient record: the CDC grading and the surgeon-reported complications (N = 128) at the first follow-up on day 7. In addition, a telephone survey with patients (N = 261) after 6 months was performed, which consisted of 7 complication-related yes/no questions. Results: Based on the CDC, 41.6% of patients were classified as having no complications, and 58.4% had one. Furthermore, 1 patient (0.3%) received a revision under general anesthesia (CDC IIIb), 18 patients (5.2%) were re-operated under local anesthesia (CDC IIIa), 23 patients (6.7%) required pharmacological intervention (CDC II), and 159 patients (46.2%) had a complication from the normal postoperative course and received supportive treatment (CDC I). Moreover, 90.5% of the mentioned complications accounted for Grade I and II; 94% of the patients subjectively experienced no complications; 51% of patients were pleased with the surgery even though a complication occurred according to the CDC; 34% of complications escaped the awareness of the surgeon. Conclusions: Grade I and II complications occurred frequently. Complications escaped the perception of the patients and surgeons. The classification identifies a wide variety of postsurgical complications and allows a standardized comparison in minor surgery objectively. Potential: The CDC in minor procedures can improve the (institutional) preoperative communication with patients regarding potential postoperative expectations. Furthermore, the classification can be a useful tool to detect complication-related costs, identify insurance-related requests, and support evidence in medicolegal disputes. The example of blepharoplasty can be translated to various other and even less invasive procedures.
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Jansma J, Schepers RH. Adjunctive Aesthetic Procedures in Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2022; 35:139-152. [DOI: 10.1016/j.coms.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Comparison of two techniques for surgical eyebrow suspension. J Fr Ophtalmol 2022; 45:741-747. [DOI: 10.1016/j.jfo.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
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14
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Hersant B, Meningaud JP. Commentary on: Labiaplasty: The Stigma Persists. Aesthet Surg J 2022; 42:647-648. [PMID: 34695185 DOI: 10.1093/asj/sjab372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Barbara Hersant
- Department of Maxillofacial and Plastic and Reconstructive Surgery, Henri Mondor Hospital, Créteil, France
| | - Jean-Paul Meningaud
- Department of Maxillofacial and Plastic and Reconstructive Surgery, Henri Mondor Hospital, Créteil, France
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Domela Nieuwenhuis I, Luong KP, Vissers LCM, Hummelink S, Slijper HP, Ulrich DJO. Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study. Aesthet Surg J 2022; 42:340-348. [PMID: 34791033 DOI: 10.1093/asj/sjab389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To determine the success of an upper blepharoplasty, a popular cosmetic procedure, it is essential to measure outcomes from the patient perspective because these often outweigh objective outcomes. OBJECTIVES This study aimed to assess patient-reported satisfaction with facial appearance, psychological well-being, and aging appraisal after upper blepharoplasty with validated questionnaires. METHODS This prospective cohort study included upper blepharoplasty patients from 8 outpatient clinics. Patient-reported satisfaction was assessed with the FACE-Q at intake, and 6 and 12 months postoperatively. RESULTS In total, 2134 patients were included. High satisfaction with outcome and decision to undergo treatment were measured 6 months postoperatively. Large improvements in FACE-Q scores (range, 0-100) between intake and 6 months postoperatively were seen for satisfaction with appearance (mean, effect size: eyes +48, 2.6; upper eyelids +48, 3.1; facial appearance overall +26, 1.4), psychological well-being (+11, 0.56), and aging appraisal (+22, 1.0). Patients reported they appeared a mean [standard deviation] 3.3 [5.2] years younger postblepharoplasty. No clinically relevant changes were seen between 6 and 12 months. Additionally, improvements in appearance were not dependent on their intake scores, whereas improvements in psychological well-being and aging appraisal were smaller in patients with higher intake scores. Satisfaction with treatment outcome was strongly correlated with appearance satisfaction but not with aging appraisal. CONCLUSIONS Significant improvements in patient satisfaction regarding appearance, psychological well-being, and aging appraisal can be seen 6 months after blepharoplasty, and outcomes remain stable up to 12 months postoperatively. These data may be used to inform patients and clinicians and improve the overall quality of care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ileen Domela Nieuwenhuis
- Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kim Phi Luong
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lieke C M Vissers
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Dietmar J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Lu TJ, Nguyen AXL, Trinh XV, Wu AY. Sentiment Analysis Surrounding Blepharoplasty in Online Health Forums. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4213. [PMID: 35492229 PMCID: PMC9038503 DOI: 10.1097/gox.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Upper and lower blepharoplasty are among the most common procedures in aesthetic surgery and are often emotionally laden due to the subjective nature of outcomes and implications with beauty and self-identity. This article capitalizes on the increasing wealth of patient-provided health information online and is the first to analyze the emotions surrounding blepharoplasty discussions in an open internet health forum, MedHelp. METHODS We used Python to scrape MedHelp for threads that contained "blepharoplasty" and then used IBM Watson Natural Language Understanding to perform sentiment analyses, calculating a general sentiment score (-1 to +1) as well as emotion scores for anger, sadness, joy, fear, and disgust (0 to 1) for posts and keywords contained within the posts. Keywords were then manually grouped into five distinct clinical categories: symptoms, doctor, treatment, medication, and body. RESULTS We collected 52 threads containing "blepharoplasty," yielding 154 posts and 1365 keywords. The average sentiment score was negative among all posts (-0.15) and keywords (-0.30). Among all posts and keywords, sadness had the highest score and disgust had the lowest score. CONCLUSIONS Fear and sadness are the predominant emotions for blepharoplasty patients online, and the most negative symptoms cited are not ones that surgeons typically expect.
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Affiliation(s)
- Tracy J. Lu
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, Calif
| | | | - Xuan-Vi Trinh
- Department of Computer Science, McGill University, Montreal, QC, Canada
| | - Albert Y. Wu
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, Calif
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17
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Tseng CC, Patel R, Desai AD, Shah VP, Talmor G, Paskhover B. Assessing Patient Satisfaction Following Blepharoplasty Using Social Media Reviews. Aesthet Surg J 2022; 42:NP179-NP185. [PMID: 34537846 DOI: 10.1093/asj/sjab345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Because patient satisfaction is a significant qualitative consideration in measuring aesthetic surgery outcome, it is important to characterize the individual factors that shape the patient perspective about blepharoplasty. OBJECTIVES This study analyzed reviews by blepharoplasty patients on the aesthetic surgery social media platform RealSelf.com to determine which aspects of the surgical process have the most significant impact on patient satisfaction. METHODS Blepharoplasty reviews were gathered from RealSelf.com with an automated web crawler. These reviews were characterized as positive or negative, then given a specific category that more specifically defined the theme of the review. Additional variables, including the specialty of the reviewed physician and any patient self-reported ratings, were documented. RESULTS A total of 1991 reviews pertaining to blepharoplasty were collected. Among reviews with self-reported "worth it" ratings, 93.5% were positive. Following categorization of all reviews, 1865 (93.7%) were positive and 126 (6.3%) were negative. Of the positive reviews, the most common overall themes were bedside manner (n = 899, 48.2%), aesthetic result (n = 859, 46.1%), and overall comfort (n = 58, 3.1%). Among negative reviews, most pertained to aesthetic result (n = 100, 79.4%), and bedside manner (n = 14, 11.1%). The most frequently encountered physician specialties performing blepharoplasty were plastic surgery (n = 1101, 55.3%), ophthalmology (n = 634, 31.8%), and otolaryngology (n = 69, 3.5%). CONCLUSIONS The majority of reviews were positive. The most prominent factor driving positive reviews was bedside manner, followed by aesthetic results. Negative reviews were most frequently attributed to suboptimal aesthetic results. Most blepharoplasties in our study cohort were performed by plastic and oculoplastic surgeons.
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Affiliation(s)
- Christopher C Tseng
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rushi Patel
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amar D Desai
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Vraj P Shah
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Guy Talmor
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Muscle-Sparing Six-Point Upper Blepharoplasty for Asian Male Patients. J Craniofac Surg 2022; 33:2212-2215. [DOI: 10.1097/scs.0000000000008514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022] Open
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Hollander M, Delli K, Vissink A, Schepers R, Jansma J. Patient-reported aesthetic outcomes of upper blepharoplasty: a randomized controlled trial comparing two surgical techniques. Int J Oral Maxillofac Surg 2022; 51:1161-1169. [DOI: 10.1016/j.ijom.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/20/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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20
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Schaal LF, de Souza Meneghim RL, Padovani CR, Schellini SA. Upper eyelid blepharoplasty and associated ancillary procedures to improve cosmesis. J Fr Ophtalmol 2021; 45:53-56. [PMID: 34844777 DOI: 10.1016/j.jfo.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To present combined procedures performed for cosmesis in patients with dermatochalasis who underwent upper lid blepharoplasty (ULB). METHOD This retrospective cross-sectional study evaluated patients who underwent ULB with associated surgical procedures from 2012 to 2016. Data were collected on patient demographics and types of procedures. The primary outcome measure was ancillary procedures combined with ULB. Data were analyzed for correlation. Statistical significance was defined as P<0.05. RESULTS A total of 1,068 ULBs were performed in 825 (86.3%) females and 131 (13.7%) males. The median age was statistically higher in males (P<0.001). Isolated ULB was performed in 296 (31%) patients, and correction of brow ptosis was the most common associated procedure (206/21.5%), followed by repair of eyelid ptosis (183/19.1%). CONCLUSION The majority of patients required combined surgical procedures to correct periorbital involutional changes. A detailed preoperative evaluation is fundamental for choosing the appropriate surgical technique for each case, which can determine the final aesthetic result.
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Affiliation(s)
- L F Schaal
- Ophthalmology Department, Botucatu Medical School, State University of São Paulo-UNESP, avenida Professor Mário Rubens Montenegro, Botucatu, 18618-970 São Paulo, Brazil.
| | - R L de Souza Meneghim
- Ophthalmology Department, Botucatu Medical School, State University of São Paulo-UNESP, avenida Professor Mário Rubens Montenegro, Botucatu, 18618-970 São Paulo, Brazil
| | - C R Padovani
- Biostatistic Department, Botucatu Bioscience Institute, State University of São Paulo - UNESP, rua Professor Doutor Antonio Celso Wagner Zanin, 18618-689, 250, Botucatu-São Paulo, Brazil
| | - S A Schellini
- Ophthalmology Department, Botucatu Medical School, State University of São Paulo-UNESP, avenida Professor Mário Rubens Montenegro, Botucatu, 18618-970 São Paulo, Brazil
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Evidence-Based Blepharoplasty: An Analysis of Highly Cited Research Papers. Ophthalmic Plast Reconstr Surg 2021; 38:325-329. [PMID: 34798655 DOI: 10.1097/iop.0000000000002087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to appraise the methodological quality of the highest impact blepharoplasty research and to describe prevalent research themes. METHODS The 100 most highly cited research papers relevant to blepharoplasty were obtained from Web of Science, with no journal or date limitations applied. Data extraction included the study design, main research topic and specialty, outcome measures, and citation count. Each paper's level of evidence was independently evaluated by 2 authors according to the Oxford Centre for Evidence-Based Medicine system. RESULTS Overall, the 100 most cited blepharoplasty research papers were cited by 4,194 papers. The mean number of citations for each paper was 73 (range: 42-239). Most of the papers presented level 4 (n = 51) or level 5 (n = 35) evidence, which is consistent with the predominance of case series (n = 47) and expert opinions (n = 18) amongst study designs. No papers achieved level 1 (highest) evidence. Six papers presented level 2 evidence and 8 papers presented level 3. Significant research foci included innovative surgical techniques (n = 65) and anatomical considerations (n = 10), with reconstructive and cosmetic implications. Senior authors were mainly affiliated with centers of plastic (n = 53) or ophthalmic/oculoplastic (n = 34) surgery. Only 3 papers used validated subjective or objective cosmetic outcome measures. CONCLUSIONS Despite a significant impact on current practice, the level of evidence of the highly cited blepharoplasty research was predominantly low. Robust research methodology, through well-designed studies and standardized outcome measures, is necessary to facilitate evidence synthesis and guide clinical practice.
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Hollander MHJ, Pott JWR, Delli K, Vissink A, Schepers RH, Jansma J. Impact of upper blepharoplasty, with or without orbicularis oculi muscle removal, on tear film dynamics and dry eye symptoms: A randomized controlled trial. Acta Ophthalmol 2021; 100:564-571. [PMID: 34612583 DOI: 10.1111/aos.15036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Upper blepharoplasty may be related to dry eye symptoms since the function of the orbicularis oculi muscle may affect the tear film. We aimed to assess the effect of blepharoplasty with or without the removal of a strip of orbicularis oculi muscle on tear film dynamics and dry eye symptoms. METHODS A double-blind, randomized, controlled trial comparing upper blepharoplasty without (group A) or with (group B) orbicularis oculi muscle excision was performed on 54 healthy Caucasian patients. Tear film dynamics and dry eye symptoms were evaluated using multiple dry eye parameters, i.e. tear osmolarity, Schirmer test I, corneal/conjunctival staining, tear break-up time (TBUT), Oxford Scheme, Sicca Ocular Staining Score and Ocular Surface Disease Index questionnaire. All the parameters were assessed preoperatively and 6 and 12 months after upper blepharoplasty. All the groups' outcomes were compared. RESULTS The differences were not significant between the two upper blepharoplasty techniques regarding most of the above-mentioned outcomes. Subjective symptoms of ocular irritation, consistent with dry eye disease and vision-related impairment, were reduced after upper blepharoplasty independent of the type of the technique applied, while the pre and postoperative outcomes of the objective tear dynamics did not differ 12 months after surgery. However, group B demonstrated a significant increase in tear osmolarity and TBUT at the 6-month follow-up visit. CONCLUSION An upper blepharoplasty alleviates subjective dry eye complaints in the long term, while not changing the tear dynamics. The improvement was independent of the blepharoplasty technique used.
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Affiliation(s)
- Maria H. J. Hollander
- Department of Oral and Maxillofacial Surgery University of Groningen and University Medical Center Groningen (UMCG) RB Groningen The Netherlands
| | - Jan Willem R. Pott
- Department of Ophthalmology University of Groningen and University Medical Center Groningen (UMCG) RB Groningen The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery University of Groningen and University Medical Center Groningen (UMCG) RB Groningen The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery University of Groningen and University Medical Center Groningen (UMCG) RB Groningen The Netherlands
| | - Rutger H. Schepers
- Department of Oral and Maxillofacial Surgery University of Groningen and University Medical Center Groningen (UMCG) RB Groningen The Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery University of Groningen and University Medical Center Groningen (UMCG) RB Groningen The Netherlands
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Epiphora before and after upper eyelid functional blepharoplasty: A retrospective cohort study. PLoS One 2021; 16:e0255988. [PMID: 34383823 PMCID: PMC8360589 DOI: 10.1371/journal.pone.0255988] [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: 05/06/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
Epiphora and dermatochalasis are common presentations in the ophthalmology clinic. To evaluate the change of epiphora before and after functional blepharoplasty, this retrospective cohort study reviewed 39 medical records of epiphora patients who underwent upper blepharoplasty. Severity of epiphora using MUNK score was collected and compared between before and at 6 months after blepharoplasty. The analysis model was performed to measure tear breakup time (TBUT) and frequency of artificial tears use. Subgroups of subjects before blepharoplasty to short baseline TBUT (≤ 10 seconds) and long TBUT (≥ 10 seconds) were also evaluated for the MUNK score change. From the analysis of 39 patients, the results showed a statistically significant decrease in post blepharoplasty MUNK score compared to the baseline (all P < 0.001). There was no significant difference between baseline and post-operative TBUT (P > 0.05). Twenty patients were in the short TBUT group and 19 in the long TBUT group. The reduction of MUNK score after blepharoplasty in the short TBUT group was not different to the long TBUT group (P = 0.50, 95% CI -0.84 to 0.41). However, in short TBUT group, frequency of artificial tears use after surgery was less than pre-operation. From the study, upper eyelid blepharoplasty might be one technique reducing the bothersome epiphora in dermatochalasis patients.
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Ramanathan D, Chu S, Prendes M, Carroll BT. Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Eyelid Surgery: A Systematic Review. Dermatol Surg 2021; 47:914-920. [PMID: 33988553 DOI: 10.1097/dss.0000000000003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Determining which postsurgical scar assessment instruments, if any, cover important eyelid outcome measures can either attest to the strength of one or more instruments or reveal the need for a more comprehensive scale. OBJECTIVE To systematically review validated outcome measures after eyelid surgery and postsurgical scar assessment tools to see whether any individual or combination of 2 assessment tools encompass all relevant, validated eyelid outcome measures. METHODS Systematic reviews of validated eyelid outcome measures and postsurgical scar assessment tools were conducted using PubMed/MEDLINE and Ovid. Outcome measure papers that met inclusion criteria were sorted into 8 categories: Patient Subjective, Visual Function, Mechanical Function, Daily Activities, Adverse Effects, Aesthetic Quantitative: Clinical Measurements, Aesthetic Qualitative: Global, and Aesthetic Qualitative: Specific. Outcome measure papers were categorized into tiers of evidence support, and assessment tools were evaluated based on which outcome measures each covered. RESULTS No one or combination of 2 assessment tools covered all selected eyelid outcome measures. Although measures related to the subjective patient experience were included in several of the assessment scales, none covered measures of visual function or eyelid-specific clinical measurements. CONCLUSION There is currently no existing postsurgical scar assessment instrument that covers all important eyelid-specific outcome measures.
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Affiliation(s)
- Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark Prendes
- Department of Ophthalmology and Visual Sciences, University Hospitals, Case Western
- Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Abstract
Of the two common techniques of lower blepharoplasty, the transconjunctival approach is limited to young patients with prominent herniation of lower fat pad without skin excess and the transcutaneous approach to patients requiring skin excision. However, the current trends not only highlight the traditional sculpting of the three orbital fat pads in lower lid blepharoplasty but also additional relocation of the intraorbital fats for correcting the inferior orbital hollowing. The purpose of this review is to analyze the published literature on common types, techniques, indications, and outcomes of the multiple surgical variants of lower lid blepharoplasty often aimed at treating the redundant skin, steatoblepharon, tear trough deformity, lid laxity, and dermatochalasis, thereby to correct the negative vector and inferior orbital hollowing along with effacement of the lid cheek junction. An extensive survey of peer-reviewed literature published in English in electronic databases, as well as bibliographies from cited articles, was conducted. Databases such as MEDLINE PubMed, the Cochrane Library, and Embase were scanned using relevant medical subject heading (MeSH) terms. Clinical studies with a minimum of five study cases were included. Level III evidence, case reports, letters, editorials, and case series with fewer than five eyes were excluded. This article provides a concise overview of available literature and as such no meta-analysis was done due to the narrowed scope of the involved studies and the variety in surgical approaches and techniques of lower lid blepharoplasty.
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Affiliation(s)
- Kasturi Bhattacharjee
- Department of Ophthalmic Plastic and Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Sripurna Ghosh
- Medical Officer, N.R.S Medical College, Kolkata, Former Fellow, Department of Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Shoaib Ugradar
- Faculty, UCLA, Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, Los Angeles, California, USA
| | - Ariel M Azhdam
- Research Associate, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
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Zandi A, Akbari Samani S, Sardarinia M, Faghihi G, Pourazizi M. The effect of upper lid blepharoplasty on forehead and glabellar lines. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1829477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alireza Zandi
- Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somaye Akbari Samani
- Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Sardarinia
- Department of Ophthalmology, Hazrat E Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gita Faghihi
- Department of Dermatology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Cao L, Zhu F. Comparison of tumescent local anesthesia vs normal anesthesia technology in upper blepharoplasty in Asian women. J Cosmet Dermatol 2020; 20:2264-2269. [PMID: 33217779 DOI: 10.1111/jocd.13855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Blepharoplasty is the most common type of plastic surgery, used to improve most of the eyelid skin sag caused by aging. In the past, local infiltration anesthesia was widely used in blepharoplasty. Tumescent local analgesia (TLA) is safe and reliable method for anesthesia, even children can use this method. AIMS This research aimed to systematically compare the differences between conventional local infiltration anesthesia and TLA in blepharoplasty. PATIENTS/METHODS One hundred and seventy-eight bilateral upper blepharoplasty patients participated in this research. Visual analog scale (VAS) was employed to evaluate the postoperative pain in the patients. Periorbital appearances are based on light photography and judged by both medical and nonmedical panel. RESULTS The use of TLA decreased the surgery duration but had no influence on the other surgery characteristics of upper blepharoplasty. Using TLA for anesthesia in bilateral upper blepharoplasty generated less pain than using local infiltration anesthesia. At day 7 after upper blepharoplasty, the rate of generation of both ecchymosis and erythema in normal anesthesia (NA) side were higher than in TLA side. The satisfaction of patients after upper blepharoplasty was not influenced by the use of different anesthesia methods. CONCLUSION Compared with the normal anesthesia technology, the use of TLA in the upper blepharoplasty shortened the surgery duration, alleviated the postoperative pain, and mitigated the generation of ecchymosis and erythema. So, TLA is suitable for the performance of anesthesia in blepharoplasty.
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Affiliation(s)
- Lin Cao
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Plastic Surgery, The Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Yan Y, Zhou Y, Zhang S, Cui C, Song X, Zhu X, Fu Y. Impact of Full-Incision Double-Eyelid Blepharoplasty on Tear Film Dynamics and Dry Eye Symptoms in Young Asian Females. Aesthetic Plast Surg 2020; 44:2109-2116. [PMID: 32696159 DOI: 10.1007/s00266-020-01874-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dry eye symptoms as a complication of double-eyelid blepharoplasty are controversial. This article evaluates tear film dynamics and changes in dry eye symptoms after cosmetic double-eyelid blepharoplasty in young Asian female. METHODS One hundred and twenty patients underwent full-incisional double-eyelid blepharoplasty. Subjective and objective parameters were documented before surgery, at 1 week, 1 month and 3 months post-surgery, which included Ocular Surface Disease Index questionnaire (OSDI), tear meniscus height (TMH), noninvasive breakup time (NIBUT), Schirmer I test, corneal and conjunctival fluorescein staining scores, and palpebral fissure height. Dry eyes were defined based on the DEWS II criteria: OSDI ≥ 13 points and NIBUT < 10 s. Patients were divided into two groups, group A included patients with redundant skin, while group B included patients with absence of redundant skin. RESULTS The incident rate of dry eyes preoperatively, and at 1 week, 1 month and 3 months were 12.5%, 12.5%, 32.5%, and 16.67%. OSDI scores were significantly increased at 1 week (9.71 ± 10.07, P < 0.001) and 1 month (11.35 ± 12.28, P < 0.001) postoperatively. A significant increase in TMH, NIBUT and Schirmer's test I values were observed at 1 week post-surgery (P < 0.001). Patients in group A showed higher OSDI scores compared to group B at 1 week and 1 month (P = 0.051) post-surgery, and the other variables showed no difference between the groups. CONCLUSIONS Cosmetic double-eyelid blepharoplasty may temporarily affect tear film dynamics and aggravate dry eye symptoms in young females. However, these changes generally recover 3 months postoperatively. LEVEL OF EVIDENCE IV 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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Ferreira FC, Sathler CSCDO, Hida IY, Leite SC, Kusabara AA, de Castro ACV, Ribeiro MZML, Nahas TR. Upper eyelid blepharoplasty using plasma exeresis: Evaluation of outcomes, satisfaction, and symptoms after procedure. J Cosmet Dermatol 2020; 20:2758-2764. [PMID: 33252188 DOI: 10.1111/jocd.13868] [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: 07/12/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Facial care treatments have grown a remarkable demand for effective and minimally invasive techniques with fast recovery time. Plasma technology is a nonsurgical alternative technique for skin rejuvenation. AIMS We assessed patient satisfaction and symptoms after upper eyelid blepharoplasty with plasma technology. PATIENTS/METHODS Observational study including 16 patients submitted to upper eyelid blepharoplasty using plasma technology to treat dermatochalasis. Patient satisfaction, symptoms, and quality of life were assessed using 2 questionnaires at follow-up days 7 and 30. Also, the answers were correlated with age, Fitzpatrick skin type, and quantity of eyelid skin treated with plasma. RESULTS All 16 patients were treated and completed the survey. Fourteen (87.5%) were female, and the mean age was 50.5 years. Physical appearance was the most relevant factor impacting on quality of life at first week postoperative. Regarding satisfaction with results, most patients stated higher level of satisfaction at day 7 follow-up analysis (P = .038). Less impact on quality of life and higher satisfaction was associated with eyelid-treated area (P = .044 and P = .036) and Fitzpatrick skin type (P = .043) at 7 and 30 days after procedure, respectively. Eyelid edema and itching were the symptoms most reported at 7 and 30 days, respectively. CONCLUSIONS Upper blepharoplasty with plasma is a minimally invasive treatment with low impact on quality of life. However, overall patient satisfaction is questionable when considering less willing of undergoing procedure again and decreased expectation with results over postoperative period. Symptoms are reported mainly at the first week after procedure.
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Affiliation(s)
- Flávio Calice Ferreira
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Ilana Yamakami Hida
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Suzana Crispin Leite
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Ana Clara Vieira de Castro
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Tatiana Rizkallah Nahas
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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ALTIN EKİN M. Dermatoşalazisli hastalarda üst kapak blefaroplasti cerrahisinin baş ağrısı üzerine etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.628871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Eyebrow Height Changes with Aging: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2433. [PMID: 31942395 PMCID: PMC6908395 DOI: 10.1097/gox.0000000000002433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/12/2019] [Indexed: 11/26/2022]
Abstract
The eyebrows play an important role in emotional facial expressions, nonverbal communication, and facial esthetics. A comprehensive understanding of the mechanisms underlying eyebrow aging is vital in allowing plastic surgeons to appropriately address these age-related changes and to recreate an aesthetically desirable outcome for patients seeking brow rejuvenation. The aim of this study is to summarize the current literature on eyebrow height changes with aging.
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