Brow ptosis: are we measuring the right thing? The impact of surgery and the correlation of objective and subjective measures with postoperative improvement in quality-of-life

Topography of the frontal branch of the facial nerve and its clinical implication for temporal direct browplasty

Due to anatomic proximity to the surgical site, iatrogenic trauma to the frontal branch of the facial nerve (FbFN) with resultant brow paralysis is a recognized major complication of temporal direct browplasty. This study was aimed to elucidate the course of the FbFN in the area superolateral to the brow in order to facilitate safer temporal direct browplasty by preventing facial nerve injury. Forty-five hemifaces from 32 embalmed Korean cadavers were dissected. A horizontal line connecting the tragion to lateral canthus was established. Then, an oblique line passing through the lateral canthus and 45° to the horizontal line was used as reference line. The mean distance from the lateral canthus to the points where the FbFN cross the reference line was measured. The angle between the FbFN and reference line at the crossing points were also recorded. After crossing the zygomatic arch, FbFN continues in an anteriorly inclining curve across the temporal region, passing near the lateral end of the brow as it heads toward frontalis muscles. During the course, the FbFN laying in the innominate fascial layer was divided into 3 branches. The anterior and posterior branch of FbFN crossed the reference line superiorly and laterally at 3 and 4 cm from the lateral canthus, respectively. In conclusion, the oculofacial surgeon must bring the dissection plane of the forehead tissue more superficially around the 3 cm superolaterally to the lateral canthus in the direction of 45° from the horizontal line in order to avoid nerve injury.

Hyaluronic Acid Fillers Enriched with Glycine and Proline in Eyebrow Augmentation Procedure

Background

The eyebrow area is a clinically critical district due to the anatomical complexity and the propensity to aging-related atrophy. Hyaluronic acid fillers have been proposed to recover the dermal volume of the facial and lips regions.

Aim

The aim of the present investigation was to evaluate hyaluronic acid fillers enriched with glycine and proline for the treatment of eyebrow augmentation.

Methods

A total of 15 healthy patients were treated with eyebrow augmentation procedure. The distance between mid-bipupil to lateral eyebrow and mid-eyebrow to the medial eyebrow was measured before, immediately after treatment and at follow-up of 6 months.

Results

The healing period was uneventful, and no evidence of inflammation or swelling associated with the treatment was reported. No macroscopical alteration was reported in the surrounding tissues with no evidences of visible wheals or lumps in the treated sites at the follow-up. Before treatment, the angle was equal to 9.32 ± 0.2°, while after treatment it was 11.21 ± 0.4° (p < 0.01); after three and 6 weeks, it was, respectively, 10.66 ± 0.2° (p<0.05) and 10.02 ± 0.3°(p > 0.05).

Conclusions

The study results suggest that the hyaluronic acid fillers enriched with glycine and proline treatment resulted as being a useful procedure for augmentation, contour and volume definition and elevation of the eyebrow region with a high-level aesthetic result.

Level of Evidence IV

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Patient reported psychosocial functioning following successful ptosis surgery

Background

Ptosis may result in increased anxiety, appearance-related distress and social avoidance, and impacts visual function. Previous work demonstrates the benefits of ptosis surgery for health-related quality of life, but there is a paucity of research comparing such outcomes before and after surgery. The aim of this study was to determine potential patient benefits in health-related quality of life, social dysfunction and anxiety following successful ptosis surgery using validated measures.

Methods

Adult ptosis correction surgery patients completed validated measures of appearance-related social anxiety and avoidance, anxiety and depression, and fear of negative evaluation pre-surgery. Following successful surgery, these measures were repeated post-discharge in addition to another health-related quality of life measure.

Results

Of 61 patients recruited, follow-up measures were sent to 33 and completed by 23. Paired samples t-tests demonstrated positive significant changes in appearance-related social distress pre-op m = 30.94, post-op m = 23.67 (t(17) = 3.46, 95% CI 2.84–11.72, p = 0.003), anxiety pre-op m = 7.6, post-op m = 4.9 (t(19) = 4.27, 95% CI 1.38–4.02, p < 0.001) and fear of negative evaluation pre-op m = 34.79, post-op m = 31.26 (t(18) = 2.47, 95% CI 0.52–6.53, p = 0.024). There was no significant difference in depression scores pre-op m = 3.6; post-op m = 3.2 (t(19) = 0.672, 65% CL −0.85 to 1.65, p = 0.510). In total, 85% of patients reported positive benefit to well-being following surgery.

Conclusion

Increasingly, evidence suggests ptosis surgery may benefit patient’s well-being, appearance-related social anxiety and avoidance, as well as improving visual function. These psychosocial benefits should be considered alongside functional benefits in the provision of ptosis surgery.

Postoperative Quality of Life in Oculoplastic Patients

PURPOSE

To conduct a literature review on postoperative quality of life in oculoplastic patients.

METHODS

The authors conducted a database search to evaluate the evidence available for the change in quality of life after oculoplastic surgery.

RESULTS

There was a wide disparity of evidence available for different oculoplastic conditions. Certain conditions, such as nasolacrimal duct obstruction, were well-researched while other conditions, such as epiblepharon, had little to no research supporting improvement in quality of life after surgery. The scales used to measure quality of life displayed heterogeneity.

CONCLUSION

There is a lack of published evidence concerning postoperative quality of life in patients with certain oculoplastic conditions such as brow ptosis, entropion, ectropion, epiblepharon, and orbital wall fracture. There is a need to standardize the quality of life data collection tools and scoring systems to allow better comparison and scrutiny of the current literature.

Functional Reconstruction of Forehead and Midface Deficits Using the Endoscopic Technique and Bio-Absorbable Implants

Objectives

Functional deficits of the forehead and midface can pose significant problems for patients varying from mild asymmetry to various degrees of functional impairment including total paralysis. Our objectives were to analyse the use of bio-absorbable implants to reconstruct forehead and midface deficits, all of which were for functional (noncosmetic) reasons.

Methods

This study was a retrospective case series between 2008 and 2018. Institutional review board approval was obtained from the Beaumont Health Human Investigation Committee. Surgeries were performed at a tertiary care centre. We evaluated 50 patients who underwent correction of functional deficits of forehead, eyebrow, and midface using the endoscopic technique and bio-absorbable implants. Patient demographics and indicated etiologies and characterization of minor and major complications and their occurrence rates were characterized.

Results

Fifty patients were included in the study from 2008 to 2018, with 68% female and 32% male. Combined blepharoplasty and brow lift was the most commonly performed procedure, followed by midface lift and browplasty. The mean follow-up time was 372 days. No major operative complications including stroke, permanent nerve paralysis, or mortality occurred. There was a 4% rate of temporary nerve paresthesia that resolved, 2% rate of infection, and 6% rate of implant migration requiring revision surgery.

Conclusion

The endoscopic approach and use of bio-absorbable implants to reconstruct functional deficits of the forehead and midface are safe and effective. There were zero major complications and most of the minor complications were temporary. There was a significant association between non-age-related functional impairment and risk of complication.

Eyebrow Height Changes with Aging: A Systematic Review and Meta-analysis

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.

Transposition Upper Blepharoplasty With Orbital Retaining Ligament Release

PURPOSE

Volume restoration is an important component of aesthetic facial rejuvenation, particularly in the brow and upper eyelid regions. In this study, the authors describe transposition of the central, preaponeurotic fat pad in the sub-brow preperiosteal plane with full release of the brow during upper blepharoplasty.

METHODS

A retrospective review including all patients who underwent transposition of the upper eyelid central, preaponeurotic fat pad at the time of upper blepharoplasty. Patients with simultaneous brow lifting surgeries were excluded. The surgical technique involved placement of the preaponeurotic fat pad pedicle in the sub-brow space after full brow release for augmentation of sub-brow volume after performing upper blepharoplasty.

RESULTS

Nineteen patients (n = 36 eyelids) were identified who underwent this transposition upper blepharoplasty technique. No complications or adverse events related to this procedure were observed. All patients were satisfied with their outcome.

CONCLUSIONS

Transposition upper blepharoplasty with complete brow release is a safe, effective adjunct to blepharoplasty for upper eyelid and periorbital rejuvenation.

The Effect of Blepharoplasty on Our Patient's Quality of Life, Emotional Stability, and Self-Esteem

BACKGROUND

Several studies have been conducted evaluating psychological effects following aesthetic surgery, however few of them following blepharoplasty!

PURPOSE

To determine whether blepharoplasty affects quality of life and satisfaction as well as, emotional stability and self-esteem in patients who underwent only blepharoplasty.

DESIGN

A retrospective study including transdermal blepharoplasty operations between the years 1995 and 2008.

METHODS

A self-developed and indication-specific questionnaire especially for blepharoplasty, as well as the standardized testing instruments FLZM, FPI-R, and RSES, concerning quality of life, body image, personality, and self-esteem was utilized.

PARTICIPANTS

A total of 123 patients were included in the study. Forty-six patients participated in the study.

MAIN OUTCOMES AND MEASURES

Results were compared with the existing representative norm data from the German speaking countries.

RESULTS

In the indication-specific questionnaire, 44 patients reported a positive influence on their personal wellbeing, and 33 were more satisfied with their appearance (follow-up 3-95 months; average 48.5 months); 20 felt more self-confident, and 25 felt more attractive.Statistically significant increased values in quality of life (FLZM) were found in the aspects work (P = 0.02), mobility (P < 0.001) and independence from assistance or help (P < 0.001).Higher scores concerning personality and self-esteem compared with the respective random sample were found in the questionnaires FPI-R (P = 0.02) and RSES (P < 0.001).

CONCLUSION AND RELEVANCE

Among plastic surgical interventions, blepharoplasty is a minimal invasive operation, which is very well tolerated by patients. Patients take advantage in personal wellbeing, self-esteem, and different aspects of their daily life.

Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis

AIM

To assess the effects of upper lid blepharoplasty on visual quality.

METHODS

Seventy-three eyelids of 39 patients were subjected to upper lid blepharoplasty. Pre- and post-operative contrast sensitivity, visual acuity, vertical palpebral aperture and the degree of lash ptosis were measured.

RESULTS

The mean log contrast sensitivities under photopic (P=0.017) and scotopic conditions (P=0.009) were improved after surgery, and these differences were significant. The degree of lash ptosis was also decreased after blepharoplasty (P<0.001).

CONCLUSION

In our study, a significant increase in contrast sensitivity was found after surgery. These results suggest that upper lid blepharoplasty can be helpful for improving visual quality.

Evaluation of surgical outcomes for ptosis surgery by face recognition software

PURPOSE

This study was aimed to use the age estimation segment of face recognition software to determine whether patients appeared younger after surgery for aponeurotic ptosis and dermatochalasis.

DESIGN

This is a prospective interventional case series.

METHODS

Face recognition software was used to estimate the age of 12 Japanese patients who had surgery to repair aponeurotic ptosis or dermatochalasis. Photographs of the faces before and 1 month after the surgery were taken and uploaded to the face recognition software to estimate the age of the subjects.

RESULTS

The preoperative estimated age significantly correlated with the actual age (r = 0.647, P = 0.023), and the postoperative estimated age also significantly correlated with the actual age (r = 0.727, P = 0.007). The scores of the palpebral fissure width of the right eyes (P = 0.003) and left eyes (P = 0.002) significantly improved postoperatively. However, the postoperative estimated age was not significantly younger than the preoperative estimated age (P = 0.173).

CONCLUSIONS

The face recognition software may not be influenced by the lid plastic surgery. Many factors other than the width of the palpebral fissure influence the estimation of age by the face recognition software.