Upper Blepharoplasty in the Asian Eyelid

Jawline reshape technique with suspension threads to improve the effect of blepharoplasty on face rejuvenation

BACKGROUND

Blepharochalasis, induced by the aging process, is an important esthetic blemish which can be solved by blepharoplasty, the most performed cosmetic surgical procedure in the world today to repair droopy eyelids. Nowadays, there is a greater interest to combine blepharoplasty with minimally invasive treatments to harmonize the oval shape of the face. Therefore, blepharoplasty technique could be associated with face thread lifting, a safe and effective technique that optimizes the rejuvenation of the central and lower part of the face.

AIM

The aim of this study was to assess the overall safety and efficacy of blepharoplasty combined with suspension thread lifting. The author also aimed to demonstrate patients' satisfaction after treatment.

METHOD

The study involved 12 patients undergoing blepharoplasty plus threads lifting to improve the mandibular line. Patient's satisfaction was valuated with global esthetic improvement score, visual analog scale score, before and after treatment clinical images.

RESULTS

All patients showed optimized face rejuvenation and high satisfaction. Patients experienced an immediate improvement in face harmony in addition to the eye refinement and expressed their satisfaction. The combination of plastic surgery and minimal invasive technique did not cause adverse events to the patients and they would recommend it.

CONCLUSION

Interest in thread lifting is currently high, and this study highlights the excellent outcome and the visible results of blepharoplasty and threads combination.

Complications of Asian Double Eyelid Surgery: Prevention and Management

Double eyelid surgery remains one of the most popular aesthetic surgeries, especially among East Asian populations. Complications related to double eyelid surgery can be divided into various categories: (1) patient dissatisfaction, (2) problems with the eyelid crease, (3) problems with the eyelid height, (4) suture-related complications, and (5) complications related to eyelid surgery in general. As with all eyelid surgeries, it is important to understand and appreciate the normal and abnormal function and anatomy of the Asian eyelid to reduce the risk of complications. It is also important to recognize the various complications and their underlying causes so that the surgeon can confidently revise the surgery to achieve optimal outcomes.

Tarsal-Fixation With Aponeurotic Flap Linkage in Blepharoplasty: Bridge Technique

BACKGROUND

Double eyelid blepharoplasty is the most popular cosmetic surgery among Asian populations. Although various surgical procedures have been reported, certain complications still arise, including asymmetry or the disappearance of the double eyelid crease, an unnatural double eyelid crease curve, and distinct scars.

OBJECTIVES

The aim of this study was to describe a new blepharoplasty technique intended to reduce the various complications and create dynamic, natural-looking double eyelids.

METHODS

From September 2018 to June 2019, the new technique was performed on 92 Chinese patients. The core of our technique was to construct a reliable motion transmitter, the orbital septum-levator aponeurosis flap, which was sutured to the tarsus. The outcomes were assessed 6 months after the surgery by reviewing medical records and photographs to assess the aesthetic outcomes, the relapse rate, and the incidence of complications.

RESULTS

In the aesthetic outcome assessment, 86 patients were graded as good and 4 were graded as fair; of the latter, 2 had uneven scars and 2 showed showed a slight asymmetry of the double eyelid curve in length or width. Two patients were graded as poor because of the disappearance of the double eyelid crease. The relapse rate was 2.2%. Two patients had temporary hematoma. Six patients had lagophthalmos that subsided within 30 days. No cases of infection or ptosis were observed.

CONCLUSIONS

The bridge technique is an effective method for creating dynamic, natural-looking double eyelids. However, the long-term outcome of this new surgical approach requires further study.

LEVEL OF EVIDENCE: 4

Obesity as a Potential Risk Factor for Blepharoptosis: The Korea National Health and Nutrition Examination Survey 2008-2010

Purpose

To examine obesity parameters as potential risk factors associated with blepharoptosis in a representative Korean population.

Methods

We analyzed the Korea National Health and Nutrition Examination Survey (KNHANES), conducted between 2008 and 2010. 10,285 Korean adults (4,441 men and 5,844 women) aged 40 years or older was enrolled. We compared body mass index (BMI), waist circumference (WC) and percentage body fat (BF), according to the severity of blepharoptosis. Multiple logistic regression analysis was conducted to examine the associations of each obesity parameter with blepharoptosis.

Results

The overall prevalence of age-related blepharoptosis was 14.8 % in South Korea. There were significant and graded associations between increasing blepharoptosis severity and the mean value of obesity parameters (P for trend < 0.05). As marginal reflex distance 1 (MRD1) decreased, the prevalence of general obesity and overweight status increased (P for trend=0.121 in men and < 0.001 in women); the prevalence of abdominal obesity increased (P for trend < 0.001 for both genders); the prevalence of highest quartile of percentage BF increased (P for trend ≤0.001 for both genders). Blepharoptosis was significantly associated with general obesity in women (adjusted odds ratio (aOR), 2.14; 95% confidence intervals (CI), 1.32-3.47); and with the highest quartile of percentage BF in men (aOR, 2.01; 95% CI, 1.34-2.97) and in women (aOR, 1.52; 95% CI, 1.06-2.3317, after adjusting for age, smoking exercise, drinking alcohol, total energy intake, fat intake, total cholesterol, and high density lipoprotein cholesterol, diabetes, hypertension, and family history of eye disease.

Conclusions

The etiology of age-related blepharoptosis may be multifactorial and is unclear. Our results suggest that obesity parameters such as BMI, WC and percentage BF might be potential risk factors for age-related blepharoptosis in a representative Korean population.

Effect of double-fold surgery on spontaneous resolution of Graves' upper eyelid retraction

OBJECTIVE

To investigate the effect of previous incisional double-fold surgery on spontaneous resolution of eyelid retraction caused by Graves orbitopathy (GO) in Asian individuals.

DESIGN

Retrospective review of medical records.

PARTICIPANTS

Patients (N = 30; 39 eyes) with eyelid retraction associated with GO with symptom duration of less than 6 months.

METHODS

Patients who visited the Ophthalmology Department of Severance Hospital, Yonsei University, between January 2010 and December 2011, followed up for more than 6 months and in a euthyroid state with antithyroid drug treatment were included. Patients treated with steroids or who underwent surgery during follow-up were excluded. Upper scleral show was measured as the distance between the central upper lid margin and limbus at initial presentation and after 6 months. Comparative analysis was performed between the 2 groups delineated by history (n = 12; 16 eyes), or lack thereof (n = 18; 23 eyes), of incisional double-fold surgery before onset of GO symptoms and signs.

RESULTS

Patient demographics and initial upper scleral show were not significantly different between groups. In both groups, upper scleral show significantly decreased at 6 months of follow-up (p < 0.001 in both groups); however, improvement of upper scleral show was significantly reduced in patients who had undergone previous double-fold surgery (0.8 ± 0.5 mm) than in nonsurgical patients (1.8 ± 0.5 mm; p < 0.001).

CONCLUSIONS

Graves eyelid retraction resolves spontaneously over time, albeit not completely. Previous double-fold surgery hinders the degree of spontaneous resolution, probably because of the fibrosis and cicatrization between the skin, the subcutaneous layer, and the levator complex.

Application of microautologous fat transplantation in the correction of sunken upper eyelid

Supplemental Digital Content is available in the text.

Background:

Although fat grafting has been clinically applied by surgeons in esthetic and reconstructive surgery, it has widely evolved in processes such as harvesting, processing, and placement of fat, using the fat-grafting procedure, which dates back over 100 years. Surgeons frequently use fat grafting to recontour, augment, or fill soft-tissue defects, facial wrinkles, or skin problems such as depressions or scars. However, fat grafting has not been thoroughly understood and has not been conclusively standardized to ensure superior clinical results.

Methods:

This study was intended to determine the role of microautologous fat transplantation (MAFT) under evidence-based medicine, particularly in accurate delivery of small fat parcels. The research method involved the conceptualization of MAFT and the development of an innovative surgical instrument for fat placement. Clinically, 168 patients with sunken upper eyelids with multiple folds underwent this procedure.

Results:

The major findings suggested that MAFT exhibits promising clinical results and offers a superior guideline for fat placement. Details of the technique and theoretical implications are also discussed.

Conclusions:

The therapeutic effects of MAFT and the long-term clinical results of patients with sunken upper eyelids with multiple folds indicated satisfactory outcomes. Based on the results, MAFT offers an alternative option to surgeons for performing fat grafting and provides a more favorable option for the benefit and welfare of patients by reducing the potential complications.

Simultaneous fat removal with suture upper blepharoplasty

BACKGROUND

Suture blepharoplasty for double eyelids is one of the most common aesthetic plastic surgery procedures in Asia. Because the technique of celebrity arcade suture blepharoplasty is effective and reliable, it has gained in popularity over the past 10 years. During this period, a significant group of patients has requested double-eyelid suture blepharoplasty combined with correction of upper eyelid puffiness. In the past, upper eyelid fat removal was performed primarily by an open excision technique, which could result in a visible scar and a prolonged recovery period. Fat removal performed simultaneously with suture blepharoplasty was a technique not considered. The reported technique is introduced to achieve simultaneous fat removal and suture blepharoplasty for double eyelids.

METHODS

The operative design is almost the same as that of the celebrity arcade suture blepharoplasty technique. The difference is that the lateral incision should be longer (3-4 mm) and placed 5-mm medially to the vertical line of the lateral canthus. From this lateral incision, a bulky fat pad can be removed with cauterization.

RESULTS

From June 2001 to December 2011, 79 of 807 patients who received celebrity arcade suture blepharoplasty also had simultaneous fat removal. No complications of hematoma, granuloma, or transient dry-eye symptoms occurred.

CONCLUSIONS

The results show that fat removal simultaneous with celebrity arcade suture blepharoplasty is a reliable and easily duplicated technique for patients who request correction of puffy eyelids and suture blepharoplasty for double eyelids.

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.

Infraeyebrow blepharoplasty for blepharochalasis of the upper eyelid: its indication and priority

Eyelid bags and blepharochalasis are the result of relaxation of lid structures like the skin, the orbicularis oculi, and mainly the orbital septum. Therefore, this aged appearance cannot be improved sufficiently with only a skin and orbicularis oculi resection. To improve this appearance, we use a very effective method of tucking of the orbital septum with infraeyebrow excision of the skin and the orbicularis oculi. Between January 2005 and April 2011, 103 patients (206 lids) were treated. There were 89 female and 14 male patients whose ages ranged from 43 to 75 years (mean = 65.2 years). After infraeyebrow excision, blepharoplasty with tucking of the orbital septum, the concealed lid crease becomes apparent and a good rejuvenation effect is obtained in all patients.