Oriental upper blepharoplasty

Defining the Ideal Reduction Mammaplasty: A Crowdsourcing Study

BACKGROUND

Reduction mammaplasty relieves macromastia symptoms while improving breast aesthetics, although the ideal breast aesthetically has been shown to differ culturally in previous crowdsourcing studies. Better understanding these differences can aid in setting postoperative expectations.

OBJECTIVES

The aim of this study was to characterize the ideal reduction mammaplasty according to demographics such as gender, ethnicity, socioeconomic status, and education.

METHODS

A crowdsourcing platform was utilized to collect 10,169 deidentified responses. Users completed 1 of 3 surveys, either a preoperative, postoperative, or preoperative and postoperative paired survey. The preoperative and postoperative surveys addressed 10 breast measurements, including upper breast slope, projection proportion, nipple position, breast width, and breast fullness. The paired preoperative and postoperative survey assessed the nipple-areola complex (NAC), chest fit, symmetry improvement, and scarring.

RESULTS

Preoperative images were rated more aesthetic than postoperative images. This was consistent across all demographics evaluated. Females, African Americans, Asians, participants ages 55+, and participants with no high school degree or a graduate degree found the most improvement in breast symmetry (P = .001, P = .002, P = .027, P < .001, P = .01). Male and Hispanic participants were most likely to see no change in symmetry (P = .008, P = .04), and South Asian participants found breasts less symmetric postoperatively (P < .001). There were significant demographic differences in aesthetic ratings of the NAC, scarring, and breast fit.

CONCLUSIONS

Perceived breast aesthetics after reduction mammaplasty vary significantly across demographics, including gender, ethnicity, age, socioeconomic status, and educational achievement. Surgeons should consider demographics when planning each patient's reduction mammaplasty.

LEVEL OF EVIDENCE: 5

Managing the Asian Eyelid

The Asian eyelid has distinct anatomic features that distinguish it from the Caucasian eyelid. These anatomic features are responsible for the ethnic identity of the Asian eyelid and guide operative technique and intervention. In the younger patient, the goal of Asian blepharoplasty often centers on the enhancement of the ethnic eye features and the creation of the supratarsal fold often referred to as the "double eyelid." In the aging Asian eyelid, considerations should be made to evaluate and address dermatochalasis, blepharoptosis, and brow ptosis. In patients with significant lateral brow ptosis and lateral hooding, the infrabrow excision blepharoplasty technique may provide an additional functional and esthetic benefit.

Asian Upper Blepharoplasty in Women: A Comprehensive Approach for a Natural and Aesthetically Pleasing Outcome

BACKGROUND

Asian upper blepharoplasty is the most popular cosmetic procedure for Asian women. However, there is no standardized approach to this procedure and suboptimal results are still common.

OBJECTIVES

The aim of this article was to describe a comprehensive approach to Asian upper blepharoplasty in women and report the clinical outcomes obtained with this approach.

METHODS

The comprehensive approach described here for Asian upper blepharoplasty in women includes: (1) determining the height and length of the upper eyelid skin crease; (2) creating a more optimal anatomy of the upper eyelid by removing excess eyelid skin, a portion of the orbicularis oculi muscle, and septal fat; (3) reconstructing the desired anatomic structures of the upper eyelid skin crease through plication of the levator aponeurosis, if necessary, and closure of the upper eyelid skin incision through the septum and the mobile portion of the levator aponeurosis; (4) adding a medial epicanthoplasty if needed to enhance final cosmetic results.

RESULTS

Over a 5-year period, 332 Asian women underwent upper blepharoplasty for creation of double eyelids, or conversion from less visible to more ideal double eyelids, with the above comprehensive approach. There were no surgical complications postoperatively and 326 patients (98.2%) rated their outcome satisfactory over a 5-year follow-up. Only 6 patients (1.8%) required surgical revision for asymmetry or suboptimal shape of the upper eyelid.

CONCLUSIONS

The comprehensive approach to Asian upper blepharoplasty described here can be used for Asian women and produces a natural and aesthetically pleasing outcome and low revision rates.

LEVEL OF EVIDENCE: 4

A Comprehensive Approach to Asian Upper Eyelid Ptosis Correction: The Levator Musculo-Aponeurotic Junction Formula

BACKGROUND

The unique anatomy of the Asian upper eyelid requires specific adaptation to the levator advancement technique for ptosis correction to achieve predictable and reproducible outcomes.

OBJECTIVES

The levator musculo-aponeurotic junction was employed as they key landmark. With a formula developed by the authors, the location of fixation relative to this landmark can be predicted preoperatively. The authors' clinical experience and outcomes with this technique are presented.

METHODS

Inclusion criteria were Asian patients with mild to severe ptosis with at least fair levator function. Patients with acquired or congenital ptosis and primary and revisional cases were all included. The location for placement of the advancement sutures was measured from the musculo-aponeurotic junction of the upper eyelid levator. This distance was determined by a formula that considers (1) the amount of elevation of the upper eyelid margin needed, (2) the degree of compensatory brow elevation present, and (3) eye dominance.

RESULTS

A total 156 Asian patients were included in this prospective study. Of these, 148 were bilateral and 8 were unilateral corrections. The technique was predictable with resolution of symptoms of eyelid ptosis post-surgery and good long-term symmetry of the palpebral aperture and crisp upper eyelid creases. The formula for estimating the fixation point on the levator was accurate to within ±1 mm in the majority of patients. The aperture revision rate was 2%.

CONCLUSIONS

This novel technique provides a predictable and reliable approach for upper eyelid ptosis correction in Asian patients.

LEVEL OF EVIDENCE: 4

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.

PAN-ASIAN CONSENSUS-Key Recommendations for Adapting the World Congress of Dermatology Consensus on Combination Treatment with Injectable Fillers, Toxins, and Ultrasound Devices in Asian Patients

BACKGROUND. The demand for minimally invasive aesthetic procedures has driven requests by physicians for guidance on their use in Asian patients, who have unique cultural preferences, social trends, and anatomy. However, few guidelines exist, particularly on combination treatment strategies for different facial shapes or indications such as the modification of face shapes to the "oval ideal."Physicians must, therefore, apply Caucasian patient-optimized guidelines to their Asian patients. METHODS. Eleven specialists developed a consensus on the use of botulinum toxin A (BoNT-A), calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers, and microfocused ultrasound with visualization (MFU-V) devices in Asian patients on upper-, middle-, and lower-face indications, including strategies to modify different facial shapes to the oval shape. Approval from 70 to 90 percent of all participants led to moderate consensus, while 90 percent agreement denoted a strong consensus. RESULTS. For early intervention/enhancement and restoration, most combination strategies are similar between Asian and Caucasian patients. Compared to Caucasian patients, however, beautification is a more common focus in Asian patients. The "ideal" oval facial shape can be created using different interventions depending on the patient's baseline characteristics. CONCLUSIONS. Although treatments and treatment sequences for early intervention/enhancement and restoration for beautification in Asian patients are similar to those in Caucasian patients, different treatment strategies may be required.

Subclinical Ptosis Correction: Incision, Partial Incision, and Nonincision: The Formation of the Double Fold

Surgery to create eyelid folds accounts for the highest percentage of surgeries in Asians and Koreans who receive the surgery on the upper eyelid 2 to 3 times during their lifetimes for functional or cosmetic reasons. Patients are generally satisfied with the results-the eyes becoming brighter and bigger via the improvement of pseudoptosis by fold creation. The recent trend is to seek the "perfect" eye: a vertically and horizontally big palpebral fissure with more than 90% cornea showing. Surgery of the levator aponeurosis-Müller muscle complex is required to expose the cornea, except in those patients who inherently have good levator-Müller function. However, many complications occur during surgeries of the levator aponeurosis-Müller muscle complex, which increase the reoperation rate. Here, the authors briefly summarize recent experiences correcting subclinical ptosis using the nonincision, incision, and partial incision methods.