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Defraia B, Focardi M, Grassi S, Chiavacci G, Faccioli S, Romano GF, Bianchi I, Pinchi V, Innocenti A. Negative Outcomes of Blepharoplasty and Thyroid Disorders: Is Compensation Always Due? A Case Report with a Literature Review. Diseases 2024; 12:75. [PMID: 38667533 PMCID: PMC11049061 DOI: 10.3390/diseases12040075] [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: 02/07/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Plastic surgery is one of the medical specialties with the highest risk of recurrent medical malpractice claims. The frequency of civil lawsuits represents an issue for the micro- and macro-economy of practitioners of these health treatments. This paper aims to discuss the medico-legal aspects and claim path in a case of a cosmetic blepharoplasty complicated by lagophthalmos wrongly related to the procedure but due to missed hyperthyroidism. CASE DESCRIPTION AND LITERATURE REVIEW A 48-year-old woman who underwent cosmetic blepharoplasty with undiagnosed hyperthyroidism claimed that the lagophthalmos that occurred some months after the procedure was due to medical malpractice, due to an over-resection of the exuberant lower eyelid tissue. The review question was, "Are thyroid disfunctions usually considered contraindications to be communicated to patients who undergo blepharoplasty?", and the databases MEDLINE via PubMed, Embase, Scopus, Ovid, ISI Web of Science, Cochrane, and Google Scholar were used. RESULTS AND DISCUSSION There were 21 eligible papers. The case highlights the importance and complexity of causal inference (such as unknown thyroid dysfunctions), related informed consent involving information on possible complications unrelated to malpractice, and guidelines recommending endocrinological consultation for cosmetic/functional blepharoplasty in patients at risk (e.g., female patients with a known history of thyroid disease).
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Affiliation(s)
- Beatrice Defraia
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Focardi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Giulia Chiavacci
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
| | - Simone Faccioli
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
| | - Gianmaria Federico Romano
- Doctor in Medicine Specialized in Plastic Reconstruction and Aesthetic Surgery, Via Francesco Baracca, 1f, 50127 Firenze, Italy;
| | - Ilenia Bianchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Vilma Pinchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandro Innocenti
- Plastic Reconstructive Microsurgery, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
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Wang X, Li R, Qiu CS, Deng Z, Yu W, Jin R, Zhou X, Liu F, Yang J. The Pendulum Movement of Orbital Fat and Retro-Orbicularis Oculi Fat: A New Strategy for Correction of Sunken Eyelid Deformity in Revision Upper Blepharoplasty for Asian Patients. Aesthetic Plast Surg 2024; 48:1104-1110. [PMID: 38315230 DOI: 10.1007/s00266-023-03827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND With an increasing number of East Asians undergoing blepharoplasty, the number of patients with secondary upper eyelid deformities is increasing. The sunken eyelid deformity is a common deformity after upper blepharoplasty in Asians due to over-resection, retraction, or atrophy of the nasal and central orbital fat pads. Herein, we present a novel procedure, the pendulum movement of orbital fat and retro-orbicularis oculi fat ("POR" technique), for correction of sunken eyelid deformity in secondary Asian blepharoplasty. METHODS Patients who underwent secondary upper blepharoplasty with the POR technique by the senior author between January 2020 and October 2021 were identified retrospectively. Those with fewer than 6 months of follow-up were excluded. Patient charts and images were reviewed for demographic data, comorbidities, concomitant eyelid deformities, and postoperative complications. Pre- and postoperative aesthetics, including degree of sunken eyelid deformity, were assessed by two independent raters and by self-reported patient satisfaction. RESULTS Forty-nine consecutive patients were identified, all of whom were female and had grade I or II sunken eyelid deformity. Median follow-up was 8 months. Concomitant deformities included high tarsal crease (N = 31 patients, 63.3%), ptosis (N = 13, 26.5%), and upper eyelid retraction (N = 5, 10.2%). Almost patients had improvement in their eyelid volume, and 95.9% had improvement in their aesthetic rating. Approximately 93.9% of patients were satisfied with the outcome. CONCLUSIONS The POR technique is an effective technique for correction of sunken eyelid deformity and can be utilized in conjunction with other techniques during secondary blepharoplasty. LEVEL OF EVIDENCE III 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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Affiliation(s)
- Xiuxia Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | | | - Cecil S Qiu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Zhizhong Deng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Wenjie Yu
- Shang Shi Aesthetic Medicine, Shanghai, China
| | - Rui Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xianyu Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Fei Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Krajewska-Węglewicz L, Felczak P, Adamek D, Dorobek M. Damage to the orbicularis oculi muscle may impair the development of dermatochalasis. Sci Rep 2024; 14:2417. [PMID: 38287145 PMCID: PMC10825163 DOI: 10.1038/s41598-024-52955-y] [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: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
The purpose of this article is to investigate the changes that occur in the orbicularis oculi muscle (OOM) in patients with dermatochalasis. The OOM specimens from 26 patients were collected during upper eyelid blepharoplasty. Each specimen was divided into three parts, which were then examined using different techniques: formalin embedding for light microscopy, free freezing for histochemical examination, and fixation in 3% glutaraldehyde for electron microscopy. The severity of dermatochalasis was classified according to the anatomical landmarks. 78 specimens from patients with dermatochalasis were evaluated. Under light microscopy, specimens showed an increase in muscle fiber size variation, rounding of muscle fibers, and lobulation of myocytes in a fibrotic background. Under electron microscopy, loss of myofilaments, vacuolar vesicles, and swollen mitochondria were observed, along with osmophilic aggregates resembling nemadine bodies and collagen fibrils. A statistically significant association between the progression of dermatochalasis and the presence of aggregates resembling nemaline bodies was found (p- value < 0.005). Significant changes occur in the OOM in patients with dermatochalasis and the presence of aggregates resembling nemaline bodies is correlated with the degree of eyelid drooping. Thus, OOM may contribute in dermatochalasis progression.
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Affiliation(s)
- Larysa Krajewska-Węglewicz
- Department of Ophthalmology, National Institute of Medicine of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland.
| | - Paulina Felczak
- Department of Neuropathology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Dariusz Adamek
- Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland
| | - Małgorzata Dorobek
- Department of Neurology, National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
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Demir A, Ünverdi ÖF, Orhan AE. A Novel Approach to Reduce Lid Weight in the Upper Eyelid Blepharoplasty: Split-Thickness Excision of the Palpebral Part of Orbicularis Oculi Muscle. J Craniofac Surg 2023:00001665-990000000-01154. [PMID: 37934946 DOI: 10.1097/scs.0000000000009831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/14/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES With the effect of advancing age and environmental factors, excess skin and muscle start to weigh on the eyelids and cause a tired facial expression. The prevailing opinion is that by partially excising muscle in surgical treatment, this load on the eyelid will be reduced, and more successful results will be obtained. Using a classic strip orbicularis oculi excision, the integrity of the muscle is disrupted, and morbidities such as lagophthalmos and edema increase. In this paper, we share our clinical experiences regarding the split excision of the palpebral part of the orbicularis oculi muscle and the subsequent process. METHODS Twenty-seven patients who applied to our clinic to undergo blepharoplasty were operated on under local anesthesia. The orbicularis oculi muscle was split-excised together with the skin from the marked areas. RESULTS The split excision of the orbicularis oculi muscle did not cause prolonged edema. The general appearance of the eyelid and face of the patients was observed to have significantly improved in the third month after surgery compared with the preoperative period. No complications such as wound healing, hypertrophic scar, asymmetry, or infection were observed during the follow-up period. CONCLUSIONS The split excision of the orbicularis oculi muscle can be considered a new and effective method in cases in which a muscle excision is planned as part of blepharoplasty. Prolonged edema due to the strip muscle excision is not observed clinically. This technique can eliminate the negative effects of excess muscle tissue on the eyelid without disrupting the integrity of the muscle. LEVEL OF EVIDENCE Evidence Based Medicine Level V.
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Affiliation(s)
- Ahmet Demir
- Plastic, Reconstructive and Aesthetic Surgery, Antalya
| | | | - Abdullah Erkan Orhan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Krajewska-Węglewicz L, Dorobek M. The evaluation of the skin-muscle and only-skin upper blepharoplasty featuring surface electromyography: a single-masked, randomized split-face prospective study. Int Ophthalmol 2023; 43:3979-3987. [PMID: 37420125 DOI: 10.1007/s10792-023-02801-3] [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: 12/15/2022] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Even though upper blepharoplasty is one of the most commonly performed procedures in esthetic surgery, there is still no consensus regarding the management of the orbicularis oculi muscle (OOM). AIM To compare outcomes of upper eyelid blepharoplasty with or without OOM excision using surface electromyography in a 12 month follow-up. METHODS A prospective, randomized, single-blinded comparative split-face study was conducted on 26 patients with dermatochalasis. Skin-only upper blepharoplasty was performed on a randomly selected side, and on the contralateral side, a strip of OOM was resected as well. The functional outcomes were assessed using sEMG, and the esthetics were evaluated independently by the operating surgeon, blinded patients, and three blinded ophthalmic surgeons. RESULTS The RMS values of maximal contraction of the OOM were statistically significantly lower two weeks after blepharoplasty than the values before surgery in both groups (p < 0,001) and reached the preoperative values after six months. Lagophthalmos occurred in 2 cases in the skin-muscle group (7.69%), and no incidence of lagophthalmos was observed in the skin group. There were comparable esthetic outcomes on both operated sides. CONCLUSIONS This study is an objective and quantitative report using surface electromyography on upper blepharoplasty with or without a strip of OOM excision. Our results showed that OOM fully recovers after the stripping procedure. The resection of the skin-OOM flap showed no difference in long-term cosmetic results. Therefore, we recommend OOM preservation during upper blepharoplasty unless muscle excision is well-grounded.
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Affiliation(s)
- Larysa Krajewska-Węglewicz
- Department of Ophthalmology, National Medical Institute of the Ministry of Interior and Administration in Warsaw, Woloska 137 Str, 02-507, Warsaw, Poland.
| | - Małgorzata Dorobek
- Department of Neurology, National Medical Institute of the Ministry of Interior and Administration in Warsaw, Warsaw, Poland
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Pruksapong C, Jankajorn S, Burusapat C, Wanichjaroen N, Wongprakob N, Techasatian P. Comparison of Colorado Needle Electrocautery and Traditional Scalpel for Upper Eyelid Blepharoplasty Incision: A Randomized Controlled Trial and Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5045. [PMID: 37305197 PMCID: PMC10256415 DOI: 10.1097/gox.0000000000005045] [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: 05/19/2022] [Accepted: 04/11/2023] [Indexed: 06/13/2023]
Abstract
Upper eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains unclear, especially in Asian skin types. We aimed to compare the Colorado needle electrocautery pure cutting mode and the traditional scalpel to determine their efficacy, complications, and cosmetic outcomes. Methods A systematic review was performed to review the outcome with the conventional method (scalpel) and other methods in upper blepharoplasty procedures. Further, a prospective intraindividual randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and the scalpel in upper blepharoplasty. Study outcomes included scar quality at different times until 1-year postoperation, bleeding during incision, and postoperative ecchymosis. Results Five articles met the inclusion criteria for this systematic review. The prospective randomized controlled trial study included 30 patients; the average incisional time on the electrocautery side was significantly longer than that on the scalpel side, and the electrocautery side had less blood loss during incision than the scalpel side (2.4 versus 3.27 using average cotton bud sticks, respectively) (P < 0.001). Hypopigmented scarring occurred more frequently on the scalpel side; however, the difference was not statistically significant. Conclusions Colorado needle electrocautery pure cutting mode can be an alternative to traditional scalpel for upper eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery use has hemostatic benefits, leading to a decrease in bleeding that can obscure the incision site. However, the incision time on the electrocautery side was significantly longer than the scalpel side, which may be owing to an adaptation of surgical technique.
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Affiliation(s)
- Chatchai Pruksapong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Suttisun Jankajorn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chairat Burusapat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nutthapong Wanichjaroen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nuttadon Wongprakob
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Peeraya Techasatian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Katircioglu YA, Celik T, Acar DD, Burcu A. Rejuvenating the aging upper periorbita. Int Ophthalmol 2023:10.1007/s10792-023-02720-3. [PMID: 37184806 DOI: 10.1007/s10792-023-02720-3] [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: 02/12/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To investigate the efficacy of a comprehensive surgical approach in rejuvenating the aging upper periorbita. METHODS Three hundred and twenty eyes of 160 patients who were treated for dermatochalasis(D), eyebrow ptosis (EP) and blepharoptosis (BP) were included in the study. One hundred and ninety-eight patients had only dermatochalasis, 74 patients had D and EP, 39 patients had D and BP, 7 patients had D, EP and BP and 2 patients had D, EP and blepharospasm. The patients were evaluated before surgery, at 1 week, 1 month and 6 months after surgery. Dermatochalasis was scored between 0 and 3 points according to upper lid laxity and IP drooping. EP was scored between 0 and 2 points as normal, lateral EP and total EP. Aging was classified as mild in those with a total score of less than 3 points, moderate in those with a score of 3-6 and severe in those above 6 points. RESULTS Of the patients, 121 were female and 39 were male, with a mean age of 52 (40-87) years. The surgeries were performed as follows: upper eyelid blepharoplasty (UEB) 197(61.6%) patients, UEB + browpexy(B) 77(24.1%) patients, UEB + B + levator resection(LR) 7(2.2%) and UEB + LR 39 (12.2%) patients. While a statistically significant improvement was observed in patients who underwent UEB + B (p < 0.001), postoperative improvements were not found statistically significant compared to preoperative scores in other surgeries. The postsurgical scores showed statistically significant improvement in all age groups (p < 0.001). CONCLUSIONS A comprehensive surgical treatment can provide effective results in upper periorbital rejuvenation for patients with varying degrees of upper periorbital aging.
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Affiliation(s)
- Yasemin Aslan Katircioglu
- Department of Ophthalmology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Tuba Celik
- Department of Ophthalmology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Dudu Deniz Acar
- Department of Ophthalmology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ayşe Burcu
- Department of Ophthalmology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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Bonan P, Fusco I, Bruscino N, Madeddu F, Troiano M, Verdelli A, Piccolo D, Rampino G. Laser-assisted blepharoplasty: An innovative safe and effective technique. Skin Res Technol 2023; 29:e13351. [PMID: 37231919 PMCID: PMC10189347 DOI: 10.1111/srt.13351] [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: 03/31/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Blepharoplasty is one of the most popular esthetic procedures with an acceptable risk profile and a relatively quick procedure. METHODS The aim was to evaluate the efficacy and safety of a new CO2 and 1540-nm laser-assisted blepharoplasty technique applied to the upper and lower eyelids. A total of 38 patients were enrolled. Photographs were taken before the treatment and at 6-month follow-up. One "blind" observer assessed the performance of this technique by ranking the results in four categories of eyelid esthetic: 1 = no or poor results (0%-25%), 2 = slight improvement (25%-50%), 3 = moderate improvement (50%-75%) and 4 = marked improvement (75%-100%). All possible complications were monitored. RESULTS Thirty-two patients (84 %) achieved marked improvement, four patients (11%) moderate improvement, two patients (5 %) slight improvement, while zero subjects (0%) poor or no improvement. No serious adverse effects were observed. CONCLUSIONS Our results from clinical evaluations suggest that the CO2 and 1540-nm laser assisted blepharoplasty is proved to be a sophisticate intervention efficacious in improving the treatment of patients with various degrees of eyelid and periocular aging and also in reducing downtime.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | | | - Nicola Bruscino
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | | | - Michela Troiano
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | - Domenico Piccolo
- Skin Center – Dermal‐Aesthetic Laser Centres, Avezzano, Pescara and L'AquilaPescaraItaly
| | - Giuseppe Rampino
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
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Zhang-Nunes S, Guo S, Li J, Mehta P, Yu R, Shen A, Bokman C, Yau A, Chang JR. Demographic and physiological factors associated with clinically significant eyelid edema in patients following upper eyelid surgery. J Plast Reconstr Aesthet Surg 2023; 78:4-9. [PMID: 36680851 DOI: 10.1016/j.bjps.2022.12.007] [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: 05/28/2022] [Revised: 10/08/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate demographic and physiological variables associated with clinically significant edema after upper eyelid surgery. METHODS A retrospective chart review was performed on patients who underwent blepharoplasty or external levator advancement with or without lid crease formation between January 2018 and January 2021 at the University of Southern California. Age, sex, pertinent medical history (medications causing edema and comorbidities), and pertinent surgical procedures were all collected. Postoperative photos were graded by two independent physician graders on a newly developed photographic scale ranging from 0 (no edema) to 3 (severe edema). Clinically significant edema of the eyelids was defined as Grade 3 edema at any postoperative point or ≥ Grade 1 edema after 90 days post operation. Patients without postoperative photos were excluded. Mann-Whitney U test, Fisher's exact test, and χ2 test were used to compare groups with and without significant edema. All analyses were conducted using SAS version 9.4 (SAS Institute Inc.) with α=0.05. RESULTS Out of 217 patients, East Asian participants had higher odds of developing edema than White participants (odds ratio, 7.92; CI, 3.15-19.93, p < 0.0001) and Hispanic participants (odds ratio, 3.47; CI, 1.51-7.97, p = 0.003). Southeast Asian participants also had higher odds of developing CSEE than White participants (odds ratio, 6.19; CI, 1.71-22.43, p = 0.006). Fifty-four (24.9%) patients had clinically significant edema. Although BMI, medical comorbidities, medication use, and age did not affect edema, there was a statistically significant relationship between race and incidence of edema (p = 0.0001). Those in the CSEE group were also more likely to require reoperation (p = 0.0143). CONCLUSIONS There is a statistically significant relationship between Asian race and the incidence of clinically significant eyelid edema. CSEE is associated with a higher incidence of reoperation.
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Affiliation(s)
- Sandy Zhang-Nunes
- Department of Ophthalmology, Roski Eye Institute, 1450 San Pablo St., 4th floor, Los Angeles, CA 90033, United States.
| | - Sarah Guo
- University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, United States
| | - Joy Li
- University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, United States
| | - Preeya Mehta
- University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, United States
| | - Roy Yu
- University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, United States
| | - Alice Shen
- Department of Ophthalmology, Roski Eye Institute, 1450 San Pablo St., 4th floor, Los Angeles, CA 90033, United States
| | - Christine Bokman
- Department of Ophthalmology, Roski Eye Institute, 1450 San Pablo St., 4th floor, Los Angeles, CA 90033, United States
| | - Anita Yau
- University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, United States
| | - Jessica R Chang
- Department of Ophthalmology, Roski Eye Institute, 1450 San Pablo St., 4th floor, Los Angeles, CA 90033, United States
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Abdolalizadeh P, Kashkouli MB, Khamesi V, Karimi N, Ghahvehchian H, Ghiasian L. Upper blepharoplasty: advanced techniques and adjunctive procedures. EXPERT REVIEW OF OPHTHALMOLOGY 2023. [DOI: 10.1080/17469899.2023.2175673] [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: 02/04/2023]
Affiliation(s)
- Parya Abdolalizadeh
- Department of Ophthalmology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohsen Bahmani Kashkouli
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Vahid Khamesi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Nasser Karimi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hossein Ghahvehchian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Leila Ghiasian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
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Brow and Eyelid Rejuvenation: Trends from the 100 Most Cited Articles over 30 Years. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020230. [PMID: 36837432 PMCID: PMC9959645 DOI: 10.3390/medicina59020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/28/2023]
Abstract
Background and Objective: Various periorbital rejuvenation techniques have been introduced over the last 3 decades. This study highlights important milestones in the evolution of periorbital rejuvenation surgery by identifying the 100 most-cited articles in this field. Material and Methods: The Web of Science citation index was used to identify the 100 most-cited articles concerning periorbital rejuvenation. Articles published in English from January 1989-April 2020 describing periorbital rejuvenation-related surgical techniques, facial aging, and anatomy were included. The terms "lower blepharoplasty", "upper blepharoplasty", "browlift", "browplasty", "endobrow lift", "endoscopic brow", "Foreheadplasty", "lower eyelid anatomy", "upper eyelid anatomy", "forehead lift", "eyelid rejuvenation", "canthopexy", "canthoplasty", "eyelid fat pad", "orbital fat pad", "tear trough", and "eyelid bags" were entered into the citation search. Web of Science Core Collection was the database used for the search. A manual review of the initial 159 studies was performed. Articles describing reconstructive or non-invasive techniques, injectable fillers, lasers, and neurotoxins were excluded. Of the 100 most-cited articles, the publication year, specialty journal, the corresponding author's primary specialty, the focus of the article, the corresponding author's country of residence, the type of study, and the level of evidence were analyzed. Results: The mean number of citations per article was 75 ± 42. There were more articles published from 1989-1999 (n = 53) than later decades. Most articles originated from the USA (n = 82) and were published in plastic surgery journals (n = 81). Plastic surgery was the primary specialty of the corresponding authors (n = 71), followed by oculoplastic surgery (n = 22). Most articles (n = 69) reported on surgical techniques. Of the clinical studies (n = 69), 45 (79%) provided level IV evidence. Conclusions: Of the 100 most-cited studies on periorbital rejuvenation, studies focusing on periorbital anatomy, aging, and surgical techniques comprised the most-cited publications. An anatomically based approach accounting for age-related changes in the periorbital structures is paramount in the field of contemporary periorbital rejuvenation.
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Alghoul MS, Vaca EE. Creating Harmonious Arcs: The Importance of Brow Shape in Determining Upper Lid Aesthetics. Clin Plast Surg 2022; 49:389-397. [PMID: 35710154 DOI: 10.1016/j.cps.2022.01.006] [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] [Indexed: 11/20/2022]
Abstract
Brow lifting, when indicated, can significantly improve upper eyelid aesthetics. Brow lifting is a powerful maneuver to shape and lateralize the curvature of the brow arc and directly influences the upper eyelid fold height and the curvature of the upper eyelid crease. This article reviews the importance of upper periorbital aesthetic assessment because it lays the foundation to tailor the appropriate operative intervention. Highlighted are the authors' preferred approach to aesthetically shape the brow along with other complimentary upper eyelid aesthetic procedures including upper blepharoplasty, blepharoptosis repair, fat grafting, and upper periorbital fat shifting to optimize brow lifting outcomes.
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Affiliation(s)
- Mohammed S Alghoul
- Private Practice, Abdali Hospital, 12th floor, Al-Istethmar Street, Abdali Boulevar, Amman 11190, Jordan; Division of Plastic & Reconstructive Surgery, Northwestern Feinberg School of Medicine, 675 N Street Clair, Galter 250, IL 60611, Chicago.
| | - Elbert E Vaca
- Private Practice, 660 Glades Road, Suite 210, Boca Raton, FL 33431, USA
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13
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Wong CH, Hsieh MKH, Wei FC. Asian Upper Blepharoplasty with the Hinge Technique. Aesthetic Plast Surg 2022; 46:1423-1431. [PMID: 35355108 DOI: 10.1007/s00266-021-02703-8] [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: 09/16/2021] [Accepted: 11/27/2021] [Indexed: 11/01/2022]
Abstract
Asian upper blepharoplasty is one of the most commonly requested procedures in Asian patients. Many incisional and suture methods have been described in the literature. While the suture method is advantageous for its simplicity and quick recovery, the incision method is more versatile and able to deliver predictable and reproducible results for Asian patients presenting with a diverse range of anatomy and requests. Accordingly, the incision method remains the preferred approach for many surgeons performing Asian upper blepharoplasty. In this paper, we detail our open incision hinge upper blepharoplasty technique to create dynamic upper eyelid creases in Asian patients. The surgical videos associated with this paper present our surgical technique in detail, highlighting technical refinements and surgical nuances to perform the surgery precisely and predictably. The conceptual core of our approach is the use of a vascularized orbital septum as a flap to create a fibrous extension from the levator aponeurosis to the dermis at the location of eyelid crease. This vascularized flap securely connects the posterior lamella with the anterior lamella to securely form the eyelid crease with eye opening. This most accurately recreates the anatomy that is present in attractive Asian patients with naturally occurring double eyelid and predictably creates a dynamic and crisp upper eyelid crease. LEVEL OF EVIDENCE V: 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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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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16
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Castillo-Campos P. Rhytidoplasty Through Minimal Incisions (Rhythmic). Aesthet Surg J Open Forum 2022; 4:ojac059. [PMID: 35975217 PMCID: PMC9373946 DOI: 10.1093/asjof/ojac059] [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] [Indexed: 11/14/2022] Open
Abstract
Background In the present report, an innovative alternative approach for rhytidoplasty is described. Rhytidoplasty Through Minimal Incisions (Rhythmic) is an effective, efficient, safe, and reproducible alternative procedure for facial rejuvenation. It has several advantages over traditional procedures. Objective The main objective of this report is to describe the surgical technique of Rhythmic. Methods The surgical technique for the foreheadplasty requires only a transverse ~7-mm incision ~1 cm behind the hairline at the midline. The upper and lower blepharoplasty are made with incisions of ~3 mm, and no suture is needed. Liposuction of the neck can also be performed, and the face-lift can be achieved through preauricular incisions. Results Here, we summarize the results obtained in 741 patients subjected to rhytidoplasty through minimal incisions. The follow-up of these patients extended up to 20 years. This technique drastically reduced the length of scars; the eyebrows elevated 8-13 mm, and in some cases, the tip of the nose was also elevated ~7 mm. It minimized or eliminated the vertical frown lines and the horizontal furrows in the forehead. The use of this technique allowed an excellent definition of the cervicofacial angle in the patients. Conclusions In conclusion, rhytidoplasty through minimal incisions drastically reduced the length of scars, bleeding, surgical time, avoided the use of drains, reduced costs, and shorted the convalescent period. It also offered the patients a natural appearance with minor complications. Level of Evidence 2
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Affiliation(s)
- Porfirio Castillo-Campos
- Corresponding Author: Dr Porfirio Castillo-Campos, Avenida Paseo de la Reforma # 2608, Piso 9, Colonia Lomas Altas, México D.F., C.P. 11950, México. E-mail: ; Instagram: dr.porfiriocastillocampos
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Irawati Y, Pratama A, Paramita C, Bani AP, Primacakti F. Spontaneous Retrobulbar Hemorrhage in a Previously Healthy Infant. J Pediatr Hematol Oncol 2022; 44:e302-e305. [PMID: 34054048 DOI: 10.1097/mph.0000000000002218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/25/2021] [Indexed: 11/26/2022]
Abstract
Spontaneous retrobulbar hemorrhage is a rare yet vision-threatening condition. We reported a 5-month-old male infant with sudden onset of left eye proptosis with no prior history of getting vitamin K injection after birth. Head computed tomography scan revealed retrobulbar and intracranial hemorrhages. Laboratory results showed anemia, prolonged prothrombin and activated partial thromboplastin time, supporting the diagnosis of vitamin K deficiency bleeding. After the bleeding and clotting profile were stabilized, lateral canthotomy and cantholysis; and drainage following orbital decompression were successfully performed, yielded in a completely resolved proptosis. The right timing for surgery with the goal of releasing intraorbital pressure represent the merit of this paper. Our case also led to a crucial emphasis on vitamin K prophylaxis at birth.
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Affiliation(s)
- Yunia Irawati
- Department of Ophthalmology, Division of Plastic and Reconstructive Surgery
| | - Avisena Pratama
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Dr Cipto Mangunkusumo Hospital
| | - Carennia Paramita
- Department of Ophthalmology, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anna P Bani
- Department of Ophthalmology, Division of Pediatric and Strabismus
| | - Fitri Primacakti
- Department of Child Health, Division of Pediatric Hematology-Oncology
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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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Takayanagi S. Invited Discussion on: Is Orbicularis Oculi Muscle Resection Necessary in Blepharoplasty? A Systemic Review. Aesthetic Plast Surg 2021; 45:2199-2200. [PMID: 33660012 DOI: 10.1007/s00266-021-02175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Susumu Takayanagi
- Mega Clinic, 7-1-20 Nishinakajima, Yodogawa-ku, Osaka, 5320011, Japan.
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Is Orbicularis Oculi Muscle Resection Necessary in Upper Blepharoplasty? A Systematic Review. Aesthetic Plast Surg 2021; 45:2190-2198. [PMID: 33538853 DOI: 10.1007/s00266-021-02131-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Our objective is to evaluate the evidence on the aesthetic effect and complications of skin-OOM strip resection compared to skin only upper blepharoplasty. METHODS A systematic search of EMBASE, PubMed, Cochrane and Google Scholar databases was performed using our search strategy through to 31 December 2019. Only comparative studies of the two upper blepharoplasty techniques were included. Three reviewers performed study selection process, data extraction, and quality assessment. RESULTS A total of six articles were eligible for final inclusion. The included studies consist of two controlled retrospective cohorts and four small randomized controlled studies (RCT). Three of which, were double blinded. Those RCTs were assigned level 2 evidence due to small size and methodological limitations. The sample size of included was studies 407 in the two retrospective studies and 57 in the four RCTs. The outcomes showed that resection of OOM along with skin in upper blepharoplasty showed no difference in long-term aesthetic outcome when skin only procedure is performed. Muscle strip resection was associated with initially higher ophthalmological morbidity (edema, bruising, pain, dry eye, sluggish eye closure and lagopthalmos). Those resolved a few weeks later with conservative treatment. CONCLUSION The resection of OOM along with skin in upper blepharoplasty showed no difference in long-term aesthetic outcome and was associated with initially higher ophthalmological morbidity compared to skin only procedure. While we are not suggesting that OOM resection is never required, the evidence strongly support its preservation during standard upper blepharoplasty. LEVEL OF EVIDENCE III 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Carqueville JC, Chesnut C. Histologic Comparison of Upper Blepharoplasty Skin Excision Using Scalpel Incision Versus Microdissection Electrocautery Needle Tip Versus Continuous Wave CO2 Laser. Dermatol Surg 2021; 47:1376-1378. [PMID: 34352836 DOI: 10.1097/dss.0000000000003178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The various techniques of upper blepharoplasty have been compared based on surgical time to perform the procedure, postoperative healing, scar cosmesis, and cost. Few studies have evaluated the histology of the excised tissue, and no study has compared the tissue histology of 3 blepharoplasty methods using scalpel, microdissection needle with electrocautery, and CO2 laser excision in the same patient. OBJECTIVE To evaluate the histologic changes of tissue after removal of upper eyelid skin using scalpel incision, microdissection electrocautery needle, and CO2 laser. METHODS Upper blepharoplasty skin excisions were examined from specimens obtained using scalpel incision, microdissection needle tip with electrocautery, and CO2 continuous wave beam. The specimens were sent for permanent sections for histologic evaluation. RESULTS The skin that was removed using cold steel scalpel incision showed no cellular necrosis or heat artifact. The tissue treated with the CO2 laser demonstrated significant thermal injury, including loss of cellular polarity, keratinocyte necrosis, and separation of the epidermis from the basement membrane. The skin excised using the electrocautery microdissection needle demonstrated fulguration artifact, including spindling of the epidermal nuclei with palisading of the keratinocytes. Necrosis was not prominent in the electrocautery microdissection needle specimens. CONCLUSION The amount of histologic tissue injury was greatest in the skin treated with continuous wave CO2 laser, followed by the microdissection needle with electrocautery. The cold steel scalpel incision showed no cellular necrosis.
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Affiliation(s)
- Jordan C Carqueville
- Derm Institute of Chicago, Chicago, Illinois
- Division of Dermatology, Cook County Hospital
- Department of Dermatology, Rush University, Chicago, Illinois
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15 Years of Upper Eyelid Micro-fat Graft: the Good, the Bad and the Ugly. Aesthetic Plast Surg 2021; 45:1035-1046. [PMID: 32944851 DOI: 10.1007/s00266-020-01946-1] [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: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
This report is the product of investigation to review the result of Micro-fat graft (MFG) for upper eyelid rejuvenation compelled by Dr. Mark Codner and discusses the variety of suboptimal outcomes and rationale for their occurrence. METHODS This retrospective review included 1047 patients who underwent upper eyelid rejuvenation between 2001 and 2016. RESULTS The follow-up ranged from 3 to 190 months. Twenty-one patients were judged to have bad outcomes, and on four patients, the results were categorized as "ugly". These undesirable outcomes are categorized and discussed. CONCLUSION This report documents a variety of poor outcomes and the rationale for their development over a long-term follow-up and discusses the way in which these can be minimized. 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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Vaca EE, Bricker JT, Alghoul MS. Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members. Aesthet Surg J 2021; 41:NP198-NP209. [PMID: 33346340 DOI: 10.1093/asj/sjaa369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients presenting for upper blepharoplasty can exhibit different aging patterns and we have anecdotally observed wide variability in upper blepharoplasty approaches among surgeons. However, upper blepharoplasty practice patterns have not been systematically analyzed among members of The Aesthetic Society. OBJECTIVES The aim of this study was to report upper blepharoplasty practice patterns, the recognition of different patient presenting features, and to assess the incidence and management of ptosis as reported by members of The Aesthetic Society. METHODS A 29-item electronic questionnaire was distributed to 1729 Aesthetic Society members with available email addresses. RESULTS In total, 214 Aesthetic Society members submitted the questionnaire, for a response rate of 12.4%. There was a significantly increased rate of volume preservation among surgeons with greater experience (≥10 years in practice) and a high-volume (≥100 cases in past 12 months) of upper blepharoplasty cases. Furthermore, high-volume upper blepharoplasty surgeons were significantly more likely to perform concomitant upper lid fat grafting (P = 0.03), browlift (P = 0.02), and ptosis repair (P = 0.01). Ninety-five percent of respondents reported a mild/moderate ptosis (MRD1 2 to <4mm) incidence of <25%. Among surgeons who perform ptosis repair, 97.4% utilize levator advancement or plication as their most commonly used technique. CONCLUSIONS High-volume upper blepharoplasty surgeons are more likely to preserve upper lid volume and perform concomitant browlift and ptosis repair. Our data suggest that different upper eyelid aging patterns and mild/moderate ptosis are underrecognized.
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Affiliation(s)
- Elbert E Vaca
- Division of Plastic & Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mohammed S Alghoul
- Division of Plastic & Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Li T, Liu HP, Wang JQ, Zhang D. Role of Orbicular Oculi Muscle Resection in Double Eyelid Surgery to Correct Ptosis of Young Adults: A Retrospective Review in 121 Chinese Patients. Ann Plast Surg 2021; 86:257-264. [PMID: 32881745 DOI: 10.1097/sap.0000000000002539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A plump single eyelid with ptosis is the morphological feature of Asians. Orbicularis oculi muscle (OOM) technique can correct ptosis and get a good appearance. METHODS A retrospective study was conducted in 121 Chinese patients who underwent double eyelid surgery with medial epicanthoplasty using OOM resection technique from December 2016 to December 2019. Preoperatively, all the patients had good or excellent levator function while skin fold overlapping the upper eyelid margin was found. Palpebral fissure height, upper eyelid margin reflex distance, complications, and cosmetic results were evaluated. Comparisons were performed preoperatively and postoperatively. RESULTS The study included 121 patients. Mean follow-up time was 12.8 months (range, 6-32 months). Mean margin reflex distance increased from 1.96 ± 0.60 mm preoperatively to 3.74 ± 0.50 mm postoperatively (P < 0.001), mean palpebral fissure height increased from 6.31 ± 0.51 mm preoperatively to 8.33 ± 0.52 mm postoperatively (P < 0.001). Most patients obtained satisfactory results. Only 1 patient was under correction, 2 patients were with mild asymmetry 6 months postoperatively. CONCLUSIONS Ptosis of the upper eyelid can be corrected by the OOM resection technique without any procedure on levator muscle. This technique can be an alternative method for the correction of ptosis of the upper eyelid.
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Affiliation(s)
- Tian Li
- From the Department of Plastic and Reconstructive Surgery, First Hospital of Jilin University, Jilin, China
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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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Upper Blepharoplasty with Endoscopically Assisted Brow Lift to Restore Harmonious Upper Lid Arc Curvatures. Plast Reconstr Surg 2020; 146:565e-568e. [PMID: 33136949 DOI: 10.1097/prs.0000000000007285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Achieving excellent results in upper lid rejuvenation requires a balanced approach to address skin, muscle, fat, upper lid margin position, and brow aging changes. In the appropriately selected patient, brow lifting plays an essential complement to upper blepharoplasty to restore more youthful upper lid fold-to-pretarsal ratios. The goal of this study is to describe a safe and reproducible method to perform brow lifting and upper blepharoplasty. METHODS Medial to the temporal line of fusion, in-line with the brow peak, a 2-cm scalp incision is oriented parallel to the course of the deep branch of the supraorbital nerve to minimize the risk of nerve injury. The brow vector of pull is maximal in this location and secured to a monocortical bone channel with 3-0 polydioxanone. Lateral to the temporal line of fusion, an ellipse of scalp tissue is excised to gently elevate the brow tail. Upper blepharoplasty is performed in an individualized fashion to achieve a youthful contour of the upper lid fold. RESULTS The endoscopically assisted technique is designed to achieve tissue release under direct visualization. The brow-lift maximal vector of pull is centered over the brow peak and, to a lesser extent, at the brow tail to improve lateral upper lid fold height and a smooth contour of the pretarsal space. Muscle shaping sutures improve convexity of the lateral upper lid fold. CONCLUSION In the appropriately selected patient, combined brow lift and upper blepharoplasty with muscle contouring are safe and effective techniques that help improve aesthetic upper lid topographic proportions.
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Wang HC, Ting W, Tong D, Dong R, Long X, Huang J, Cao H, Tianyu Sun E, Yu N, Wang X, Zhao R. Will the patient's double eyelid shape be like that of the surgeon performing the procedure? A study of surgeons' aesthetics in East Asian Blepharoplasty. J Cosmet Dermatol 2020; 20:1208-1213. [PMID: 32936505 DOI: 10.1111/jocd.13699] [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: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND No reports of the potential areas of surgeons' aesthetics in blepharoplasty. AIMS To explore the association between the surgeons' own double eyelid morphology and their aesthetics and surgical outcome. METHODS An investigation of 1605 patients was carried collecting the data of double eyelid shape, based on which to propose a preliminary double eyelid classification for analyzing the aesthetics of surgeons. Ten double eyelid surgical cases were randomly collected from each surgeon according to the inclusion criteria, whose double eyelid shape, ideal shape, the selection tendency of surgical approach, most cared factor during surgery, and design concept of eyelid shape were collected. Structural equation modeling (SEM) was performed to assess the association between participants' double eyelid shape, aesthetics, and blepharoplasty outcome. RESULTS Fifty-three double eyelid surgeons were enrolled for study, whose double eyelids shapes mostly were obviously fan-shaped (37.74%) and low-parallel eyelid (26.42%), and the ideal shapes were obviously fan-shaped (41.51%) and high-parallel eyelid (24.53%). 54.72% of the subjects preferred to use the full-incisional method. 45.28% cared for long-term outcome most. Regarding blepharoplasty outcome style, 49.06% of the subjects preferred obviously fan-shaped type and 24.53% for high-parallel type. SEM showed that aesthetics rank increased by 0.692 points for surgeons' shape (P < .001), and surgical outcome rank increased by 0.861 points for aesthetics (P < .001). However, their eyelid shape had no direct contribution to surgical outcome (P = .96). CONCLUSIONS The findings indicated that surgeons' double eyelid shape positively affected their aesthetics, which affected their surgical outcomes further, but their double eyelid shape failed to affect the surgical outcomes directly.
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Affiliation(s)
- Hayson Chenyu Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wenyun Ting
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dandan Tong
- HSBC Business School, Peking University, Beijing, China
| | - Ruijia Dong
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hairu Cao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | | | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ru Zhao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Liao ZF, Hong WJ, Cong LY, Luo CE, Zhan WF, Ke JQ, Luo SK. A case series: 3-dimensional computed tomographic study of the superior orbital vessels: Superior orbital arcades and their relationships with the supratrochlear artery and supraorbital artery. J Am Acad Dermatol 2020; 84:1364-1370. [PMID: 32592875 DOI: 10.1016/j.jaad.2020.06.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular complications from periorbital intravascular filler injection are major safety concerns. OBJECTIVE To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections. METHODS Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm. RESULTS Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries. LIMITATIONS The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection. CONCLUSION This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.
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Affiliation(s)
- Zhi-Feng Liao
- Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Wen-Feng Zhan
- Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Jia-Qia Ke
- Department of Neurology, Integrated Hospital of Traditional Chinese Medicine, The Third School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China; Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China.
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Hollander MHJ, Schortinghuis J, Vissink A, Jansma J, Schepers RH. Aesthetic outcomes of upper eyelid blepharoplasty: a systematic review. Int J Oral Maxillofac Surg 2019; 49:750-764. [PMID: 31722817 DOI: 10.1016/j.ijom.2019.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/01/2019] [Accepted: 10/18/2019] [Indexed: 12/20/2022]
Abstract
Although upper blepharoplasty is a common cosmetic surgical intervention, a better scientific understanding of the aesthetic results and the preferred surgical technique to achieve the best aesthetic results is still needed. A systematic search using four search engines (PubMed, Embase, CINAHL, and Cochrane) was performed to identify any study on the aesthetic outcome of a solitary upper blepharoplasty; these were subjected to quality assessment for possible inclusion. Eligible studies were randomized controlled trials, controlled trials, cohort studies, and case series (n ≥ 10). A total of 4043 studies were assessed, of which 26 were included. Aesthetic outcomes included patient-reported outcome measures, scarring, eyebrow height, tarsal platform show, and panel or expert evaluation. Meta-analysis was not possible. Patients were generally satisfied with the aesthetic result and scar formation after an upper blepharoplasty. The amount of tarsal platform show increases, which positively affects the aesthetics. The eyebrow seems to move down slightly. The surgical technique used (skin only or skin/muscle removal) did not influence patient satisfaction or the physician-assessed aesthetic outcomes. Patients are generally satisfied after an upper blepharoplasty. The optimal design of the skin excision is still a matter of debate, especially when addressing lateral hooding. Further objective research is advised.
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Affiliation(s)
- M H J Hollander
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - J Schortinghuis
- Department of Oral and Maxillofacial Surgery, Treant Scheper Hospital, Emmen, The Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - J Jansma
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - R H Schepers
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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Choi SG, Suk SW, Yoon KC. Limited retromuscular fibrofatty tissue resection in upper blepharoplasty for senile patients. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2019. [DOI: 10.14730/aaps.2019.01851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Steinsapir KD, Kim YD. Pathology Of "Post-Upper Blepharoplasty Syndrome": Implications For Upper Eyelid Reconstruction. Clin Ophthalmol 2019; 13:2035-2042. [PMID: 31802837 PMCID: PMC6802536 DOI: 10.2147/opth.s211289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background The anatomical basis for eyelid changes after upper blepharoplasty is largely uninvestigated. The post upper blepharoplasty syndrome (PUBS) is here defined as upper eyelid ptosis, hollow sulcus, high or absent upper eyelid crease, eyelash ptosis, loose eyelid platform skin, and compensatory brow elevation. Objective The anatomical basis for the post-upper blepharoplasty syndrome was investigated. Methods A retrospective, case-controlled, consecutive series of patients was explored for blepharoptosis after cosmetic blepharoplasty (cases) or ptosis surgery (controls). The upper eyelid crease was lowered, blepharoptosis was corrected by anterior levator aponeurosis resection ptosis surgery, eyelash ptosis was corrected with anchor blepharoplasty, and upper eyelid fold volume was restored using anterior orbital fat. Morphologic and anatomical findings were compared between case and control eyelids. Results Data were available for 42 patients (81 eyelids). Case and control eyelids presented with a clinically similar appearance but internally had a marked difference in their anatomical findings. Eyelids with post-upper blepharoplasty syndrome (n= 24 patients, 48 eyelids) were internally found to have a white-line disinsertion of the levator aponeurosis. The disinserted, central levator aponeurosis was bound into the septal scar created by removal of anterior orbital fat at blepharoplasty. Among the 18 controls (33 eyelids), levator disinsertion was not identified. Conclusion Hollowness and ptosis in post-upper blepharoplasty syndrome eyelids are related to a white-line disinsertion of the levator aponeurosis and matting of anterior orbital fat in the internal septal scar created during fat removal with blepharoplasty. Knowing where to look for the disinserted central levator is critical to surgically repairing these post-blepharoplasty eyelids.
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Affiliation(s)
- Kenneth D Steinsapir
- Orbital and Ophthalmic Plastic Surgery Division, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yoon-Duck Kim
- Oculoplastic and Orbital Surgery Division, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Vaca EE, Bricker JT, Helenowski I, Park ED, Alghoul MS. Identifying Aesthetically Appealing Upper Eyelid Topographic Proportions. Aesthet Surg J 2019; 39:824-834. [PMID: 30689709 DOI: 10.1093/asj/sjz014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The goal of upper eyelid procedures is to restore or create the ideal proportions between the pretarsal space and the upper lid fold. OBJECTIVES The aim of this study was to define the topographic features of the attractive upper lid. METHODS Caucasian female frontal facial photographs were obtained from public media and periorbital areas were cropped. A total of 294 photographs of eyes were rated by 6 evaluators using a 4-point Likert scale. Eyes rating an average ≥3.5 were defined as "attractive," whereas those rated ≤2.0 were defined as "unattractive" and analyzed using Adobe Illustrator. RESULTS Fifty-one and 19 eyes were included in the attractive and unattractive cohorts, respectively. (Upper lid foldPretarsal) shows ratios averaged between 1.8 and 3.0 among attractive eyes, and larger ratios were observed laterally. These ratios were significantly larger laterally among attractive vs unattractive eyes (P ≤ 0.003). The lash line peak (P < 10-4), lid crease peak (P < 10-3), and brow peak (P < 0.05) were significantly more lateralized in attractive eyes. CONCLUSIONS Attractive eyes tend to exhibit decreased pretarsal show. However, there is pronounced variability in these ratios among attractive eyes, suggesting the importance of other features. Interestingly, progressive lateralization of the lash line, lid crease, and brow peaks appears to be an undescribed feature common to attractive eyes. Knowledge of attractive eyelid features may be an important consideration for planning and optimization of upper lid rejuvenation procedures.
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Affiliation(s)
- Elbert E Vaca
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Jonathan T Bricker
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Irene Helenowski
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Eugene D Park
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Mohammed S Alghoul
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
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Romeo F. Upper Eyelid Filling Approach [U.E.F.A.] Technique: State of the Art After 500 Consecutive Patients. Aesthetic Plast Surg 2019; 43:663-672. [PMID: 30607571 DOI: 10.1007/s00266-018-1296-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/02/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lately, it has become evident that eye physical aging is mainly due to depletion of the upper eyelid fat causing laxity and wrinkles of the eyelid skin, and new therapeutic strategies aimed at solving the volume loss have appeared in the literature. The aim of this study is to provide a clear classification of upper eyelid aging after 500 consecutive cases and to present a standardization of the therapeutic approach to be adopted when using hyaluronic acid (HA) as fillers or a surgical approach. METHODS The upper eyelid aging process of a total of 500 patients was classified based on the measurement of the pre-tarsal skin show m and the pre-septal skin show N. A total of 382 patients were treated exclusively with HA injections in the upper eyelid, 45 patients both with blepharoplasty surgery and HA filling, whereas only 73 patients underwent blepharoplasty only. RESULTS Patient satisfaction and at least 1-year clinical follow-up were used to evaluate the results. Pre-treatment and post-treatment photographic assessment was considered as well. A total of 447 patients were women, whereas 53 were men. The correct ratio between m and N was restored in all cases. CONCLUSIONS HA filling can be used as either the only volumization procedure or together with blepharoplasty to restore upper eyelid volume loss. The correct strategy has to be selected on the basis of a clear classification. The upper eyelid filling approach is a safe, manageable, lasting and low-cost technique providing excellent results when the correct procedure is followed. 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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Prantl L, Heidekrueger PI, Broer PN, Knoll S, Thiha A, Gründl M. Female eye attractiveness – Where beauty meets science. J Craniomaxillofac Surg 2019; 47:73-79. [DOI: 10.1016/j.jcms.2018.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/12/2018] [Accepted: 05/11/2018] [Indexed: 02/02/2023] Open
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Abstract
Blepharoplasty is one of the most commonly performed cosmetic surgical procedures. To date it remains the most powerful method of periorbital rejuvenation when compared to other nonsurgical modalities, especially in the aging face. Despite that, the procedure has its shortcomings that include a steep learning curve, prolonged recovery, and potential for appearance and life-changing complications. Attaining successful outcomes relies on a solid understanding of facial topography, patient and technique selection, and, when appropriate, following a conservative approach. Modern blepharoplasty relies on tissue conservation and volume enhancement rather than aggressive removal. This concept was conceived after the realization that older techniques resulted in a hollowed appearance, which accentuated the aging process. It was further reinforced by advances in knowledge of periorbital anatomy and aging changes. This Continuing Medical Education article will detail periorbital surgical anatomy, preoperative planning, and varied blepharoplasty approaches and techniques, with an emphasis on safety and tailoring the procedure to the patient's anatomy.
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Affiliation(s)
- Mohammed Alghoul
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
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Refinements in Upper Blepharoplasty: The Five-Step Technique. Plast Reconstr Surg 2018; 143:434e-435e. [PMID: 30516737 DOI: 10.1097/prs.0000000000005227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sun W, Wang Y, Song T, Wu D, Li H, Yin N. Orbicularis-Tarsus Fixation Approach in Double-Eyelid Blepharoplasty: A Modification of Park's Technique. Aesthetic Plast Surg 2018; 42:1582-1590. [PMID: 30191281 DOI: 10.1007/s00266-018-1218-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incisional double-eyelid blepharoplasty is widely applied because of its extensive indications and robust results. The orbicularis-levator fixation method is an incisional approach that provides stronger adhesion than traditional techniques. However, there remains the risk of postoperative relapse or suture spitting out. METHODS The authors introduced a modified technique for supratarsal crease formation. When necessary soft tissue removal was completed, the orbicularis oculi muscle was anchored on the tarsus. Then the muscle edges near canthus were reattached to prevent muscle retraction. For skin closure, the skin-pretarsal fascia-skin maneuver was adopted to enhance cicatricial adhesion. RESULTS Six hundred and fifty-nine patients underwent double eyelidplasty by the same surgeon using this modified technique. Patients were followed up from 2 to 38 months, with a mean period of 15 months. Short-term complications included mild edema, bruising or reddish change of the upper eyelid, yet all gradually relieved in 6-8 weeks. Fourteen cases of palpebral fold asymmetry and nine cases of unsatisfactory fold formation near the inner canthus were encountered, and all the defects had been well improved by revision surgeries. Ninety-five percent of the patients were satisfied with the long-term outcomes, which showed as natural and well-defined palpebral folds without scar hypertrophy, suture spitting out or crease depression. Besides, no supratarsal crease drooping or disappearing was observed 3 years postoperatively. CONCLUSIONS The authors introduced an orbicularis-tarsus fixation method for upper eyelid blepharoplasty. It is a reliable technique that enables high feasibility and long-lasting result, and with lower risk of suture spitting out. 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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Affiliation(s)
- Weiyi Sun
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Yongqian Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
| | - Tao Song
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Haidong Li
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Ningbei Yin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
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Hollander MHJ, Contini M, Pott JW, Vissink A, Schepers RH, Jansma J. Functional outcomes of upper eyelid blepharoplasty: A systematic review. J Plast Reconstr Aesthet Surg 2018; 72:294-309. [PMID: 30528286 DOI: 10.1016/j.bjps.2018.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/12/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Various functional outcomes after upper blepharoplasty are reported in the literature. We systematically reviewed the literature to assess the objective and subjective functional effects of upper blepharoplasty. METHODS After a systematic search of four search engines (Pubmed, Embase, Cinahl and Cochraine), any study on objective and subjective (patient reported) functional outcome after upper blepharoplasty was subjected to a quality assessment for possible inclusion in the review. The intervention was defined as a solitary surgical upper blepharoplasty containing the removal of skin, with or without the removal of a strip of orbicularis oculi muscle and/or upper orbital fat. Eligible studies were randomized controlled trials, controlled trials, cohort studies and case series (n ≥ 10). RESULTS A total of 3525 studies were assessed, of which 28 studies were included in this systematic review. Favorable outcomes after an upper blepharoplasty were reported and included enlarged visual field, enhanced quality of life related to fewer headaches and improved vision. Furthermore, sensitivity of the eyelids decreased, with differences in recovery. Outcomes for eyebrow height, astigmatism, contrast sensitivity and eyelid kinematics were not consistent between the studies. No meta-analysis could be performed due to the limited scope of included studies and the great variety in outcomes and blepharoplasty techniques. CONCLUSIONS Upper blepharoplasty is accompanied by a great variety of beneficial functional outcomes including an increased visual field and improvement in headache- and vision-related quality of life. Further research is needed, especially where results are conflicting (effects on eye dryness and eyebrow height) and/or the data are limited (contrast sensitivity, astigmatism).
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Affiliation(s)
- M H J Hollander
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), PO BOX 30.001, Groningen 9700 RB, The Netherlands.
| | - M Contini
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), PO BOX 30.001, Groningen 9700 RB, The Netherlands
| | - J W Pott
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), PO BOX 30.001, Groningen 9700 RB, The Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), PO BOX 30.001, Groningen 9700 RB, The Netherlands
| | - R H Schepers
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), PO BOX 30.001, Groningen 9700 RB, The Netherlands
| | - J Jansma
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), PO BOX 30.001, Groningen 9700 RB, The Netherlands
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Barmettler A, Wang J, Heo M, Gladstone GJ. Upper Eyelid Blepharoplasty: A Novel Method to Predict and Improve Outcomes. Aesthet Surg J 2018; 38:NP156-NP164. [PMID: 30007317 DOI: 10.1093/asj/sjy167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In some upper eyelid blepharoplasties, maximal skin removal may not result in desired outcomes; raising crease height can therefore be considered. Currently, there is no method to determine the amount of skin to be excised and/or crease elevation required to achieve a specific outcome. OBJECTIVE This study extrapolated an equation to determine amount of skin excision and/or lid crease elevation needed to achieve a specific eyelid margin to fold distance (MFD). METHODS This institutional review board-approved, HIPAA-compliant study was a prospective, nonrandomized clinical trial. Patients were included if aged 30 to 100 years old and underwent upper eyelid blepharoplasty with one surgeon between 2012 and 2014. Exclusion criteria were thyroid eye disease, myasthenia gravis, myotonic dystrophy, pregnancy, blepharoptosis, prior eyelid surgery or trauma, concurrent brow surgery, and topical alpha-agonists. The following data were collected preoperatively and at postoperative months 1 and 6: age, gender, BMI, brow position, MFD, margin to crease distance (distance between eyelid margin and crease, MCD), and vertical skin distance (distance between eyelid margin and brow, VSD). RESULTS A total 322 eyelids of 164 patients underwent 208 skin excisions, 26 crease elevations, and 88 combined skin excision and crease elevation. Age, gender, and BMI category were all nonsignificant and excluded from the final model. This equation was extrapolated with regression analysis: Change in MFD = -0.40 + (-0.28 × Change VSD) + (0.53 × Change MCD) with |R| = 0.28. CONCLUSION To better predict and obtain desired upper eyelid blepharoplasty outcomes, the authors created an equation. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Anne Barmettler
- Oculoplastic Surgery Division at Montefiore Medical Center, Albert Einstein College of Medicine in Bronx, New York
- Kresge Eye Institute, Detroit Medical Center in Detroit, Michigan
- William Beaumont Hospital, Oakland University William Beaumont School of Medicine in Royal Oak, Michigan
| | - Jessie Wang
- Montefiore Medical Center, Albert Einstein College of Medicine in Bronx, New York
| | - Moonseong Heo
- Epidemiology and Population Health at Montefiore Medical Center, Albert Einstein College of Medicine in Bronx, New York
| | - Geoffrey J Gladstone
- William Beaumont Hospital, Oakland University William Beaumont School of Medicine in Royal Oak, Michigan
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Abstract
Periorbital tissues are a keystone in facial beauty and a representation of youth. The aesthetically pleasing and youthful upper eyelids are full, with a defined tarsal upper lid crease and with smooth, taut pretarsal and preseptal skin. The upper blepharoplasty is a critical component of any facial rejuvenation procedure. This five-step procedure provides key steps in the correction of upper lid age-related changes and provides a reliable and reproducible method of achieving excellent results. Furthermore, the addition of fractionated fat restores volume and youthfulness of the upper lid, and also improves the skin quality of the upper lid.
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Asilian A, Bafandeh B, Shahmoradi Z, Faghihi G, Bostakian A, Mozafarpoor S, Hosseini SM. Micropunch blepharopeeling versus blepharoplasty; what is the best procedure for upper eyelid rejuvenation? J Cosmet Dermatol 2018; 17:1182-1188. [PMID: 29774642 DOI: 10.1111/jocd.12506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Periocular rejuvenation is the most common aesthetic plastic surgery. The aim of this study was to determine effects of micropunch blepharopeeling (MBP) approach vs blepharoplasty (BP) in periocular rejuvenation. METHODS AND MATERIALS This is a clinical trial study on 22 patients who underwent periorbital rejuvenation referred to University Skin Clinics. Patients were randomly divided into two groups of blepharoplasty or micropunch blepharopeeling. After procedure, all patients were followed in 2 weeks and 2 months and were asked about complications. Patients' satisfaction was scored based on 5-grade scale. Physician satisfaction was assessed based on patients' photographs taken before and 2 months after surgery based on 4-grade scale. RESULTS The mean age of group MBP was 48.45 ± 7.71 and group BP was 45.45 ± 7.20 (P-value = .36) and Fitzpatrick skin type was not significantly different. Scar was significantly different between groups that 4 (36.4%) patients of BP complained from scars, while none of MBP had significant scar (P-value = .04). Patients were statistically more satisfied with MBP in terms of symmetry, pain, and scar (P-value = .048, .040, and<.001, respectively). Also, MBP was significantly more satisfying for physicians in terms of symmetry and scar (P-value = .047 and <.001, respectively). CONCLUSION Micropunch blepharopeeling can be considered as an acceptable procedure of upper eyelid rejuvenation mentioned by patients and physicians. Micropunch blepharopeeling causes fewer scars, better symmetry, and less pain.
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Affiliation(s)
- Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Bafandeh
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gita Faghihi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Anis Bostakian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohsen Hosseini
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim YH. Delayed reconstruction of posttraumatic facial deformities. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.12.740] [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] Open
Affiliation(s)
- Yong Ha Kim
- Department of Plastic & Reconstructive Surgery, Yeungnam University Hospital, Daegu, Korea
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Abstract
BACKGROUND Periorbital volume loss creates a shadow frame, and traditional excisional blepharoplasties may aggravate the situation. Divergence in filling treatments establishes a demand for simple and reproducible techniques to achieve consistent results. Here, the author's hollow upper eyelid evaluation and treatment approach are presented. METHODS A retrospective photographic analysis was conducted of 32 women who underwent fat grafting for hollow upper eyelids between 2012 and 2016. Preoperative and postoperative evaluations of upper eyelid ratios at the medial and lateral corneal limbus, together with lateral contour modifications, were used to determine the efficacy of the technique to restore youthful proportions and contours. RESULTS Preoperative analysis showed 20 eyelids with an inner shadow, or A-pattern; and 44 eyelids with the complete extension of the hollow, or C-pattern. Three patients presented mild blepharoptosis, and eight patients had undergone a previous upper blepharoplasty. Mean grafting volume was 0.4 cc in the deep plane and 2.8 cc in the superficial plane. Fat grafting exclusively was performed in six patients, improving all ratios and correcting the A-pattern deformity. Volumetric upper blepharoplasty combining fat grafting in two levels and orbicularis oculi muscle imbrication was performed in 26 patients, correcting every inverted ratio (p < 0.001). On the lateral view, all cases with a concave pattern changed to a convex one, regardless of the approach used. CONCLUSION Synergy between fat grafting and orbicularis imbrication proved adequate to restore the lateral convex contour and return youthful proportions to the hollow upper eyelids. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Matiasek J, Kienzl P, Otti GR, Turk BR, Djedovic G, Rieger UM. Aseptic surgical preparation for upper eyelid blepharoplasty via full-face octenidine antiseptic without antibiotic medication shows effective prophylaxis against post-surgical wound infection. Int Wound J 2017; 15:84-89. [PMID: 29057595 DOI: 10.1111/iwj.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/08/2017] [Indexed: 11/30/2022] Open
Abstract
Blepharoplasty is the third most common plastic surgical procedure in the USA. Due to the emergence of multiresistant bacteria, optimising the antiseptic procedure is crucial. Choice of antiseptics plays an important role as they may cause skin irritation and colouring of disinfected areas. In this study, the use of the aqueous antiseptic octenisept® (octenidine) was evaluated in the outcome of blepharoplasties: incidence of wound dehiscence; haematoma; and infection in correlation with gender, medication, smoking habits and time of year. This retrospective surveillance study included 352 patients (median age 58·3 years). Skin disinfection was performed thrice prior to blepharoplasty. Sutures were removed on day 6. None of the patients suffered from wound infection. The total rate of wound dehiscence was 6·3%, with a higher ratio among male patients. Smokers and patients on anticoagulant medication showed a significantly higher incidence of wound dehiscence. Throughout the year, rates of wound dehiscence were highest in summer. Aseptic surgical preparation for blepharoplasty via full-face scrub with octenisept® without oral antibiotic prophylaxis is well tolerated, with no report of wound infection, which may improve antibiotic stewardship as well as patient comfort. Elective upper eyelid blepharoplasty may ideally be performed in winter.
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Affiliation(s)
- Johannes Matiasek
- Department of Plastic and Reconstructive Surgery, St. Josef Hospital, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Philip Kienzl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria
| | - Gerlinde R Otti
- Department of Obstetrics and Fetal-Maternal Medicine, Reproductive Biology Unit, Medical University of Vienna, Vienna, Austria
| | - Bela R Turk
- Department of Plastic and Reconstructive Surgery, St. Josef Hospital, Vienna, Austria.,Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Gabriel Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ulrich M Rieger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria.,Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, St. Markus Hospital, Frankfurt, Germany
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Kashkouli MB, Abdolalizadeh P, Abolfathzadeh N, Sianati H, Sharepour M, Hadi Y. Periorbital facial rejuvenation; applied anatomy and pre-operative assessment. J Curr Ophthalmol 2017; 29:154-168. [PMID: 28913505 PMCID: PMC5587258 DOI: 10.1016/j.joco.2017.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/21/2017] [Accepted: 04/08/2017] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Since different subspecialties are currently performing a variety of upper facial rejuvenation procedures, and the level of knowledge on the ocular and periocular anatomy and physiology is different, this review aims to highlight the most important preoperative examinations and tests with special attention to the eye and periocular adnexal structures for general ophthalmologist and specialties other than oculo-facial surgeons in order to inform them about the fine and important points that should be considered before surgery to have both cosmetic and functional improvement. METHODS English literature review was performed using PubMed with the different keywords of "periorbital rejuvenation", "blepharoptosis", "eyebrow ptosis", "blepharoplasty", "eyelid examination", "facial assessment", and "lifting". Initial screening was performed by the senior author to include the most pertinent articles. The full text of the selected articles was reviewed, and some articles were added based upon the references of the initial articles. Included articles were then reviewed with special attention to the preoperative assessment of the periorbital facial rejuvenation procedures. RESULTS There were 254 articles in the initial screening from which 84 articles were found to be mostly related to the topic of this review. The number finally increased to 112 articles after adding the pertinent references of the initial articles. CONCLUSION Static and dynamic aging changes of the periorbital area should be assessed as an eyelid-eyebrow unit paying more attention to the anthropometric landmarks. Assessing the facial asymmetry, performing comprehensive and detailed ocular examination, and asking about patients' expectation are three key elements in this regard. Furthermore, taking standard facial pictures, obtaining special consent form, and finally getting feedback are also indispensable tools toward a better outcome.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Research Center, Oculo-Facial Plastic Surgery, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Pelle-Ceravolo M, Angelini M. Transcutaneous Brow Shaping: A Straightforward and Precise Method to Lift and Shape the Eyebrows. Aesthet Surg J 2017; 37:863-875. [PMID: 28333315 DOI: 10.1093/asj/sjw194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The height of the eyebrow is less crucial aesthetically than is the relationship between the lateral and medial portions of the brow. Although various surgical procedures are effective in raising the brow, the authors maintain that transcutaneous brow shaping (TBS) is the only technique that enables precise shaping of the brow and correction of minor asymmetries. OBJECTIVES The authors described their experiences with direct TBS alone or in conjunction with blepharoplasty and facelift. METHODS A total of 212 patients underwent TBS performed by the senior author (M.P.C). All patients were evaluated clinically and by means of pre- and postoperative photographs. Patients completed questionnaires indicating scar quality and satisfaction with the results. RESULTS There were no major complications. Scar visibility was low, and patients expressed a high level of satisfaction with the aesthetic results of TBS. CONCLUSIONS A misconception of transcutaneous browlift procedures is that they yield visible scars. TBS requires accurate planning, preservation of subcutaneous volume, limited undermining, preoperative application of botulinum toxin, and perioperative administration of local vasodilators. When these requirements are fulfilled, the authors have found that TBS does not yield a visible scar and is the easiest, most precise, and most reliable procedure for brow shaping. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mario Pelle-Ceravolo
- Dr Pelle-Ceravolo is a Professor at the University of Padua, Italy. Dr Angelini is a plastic surgeon in private practice in Rome, Italy
| | - Matteo Angelini
- Dr Pelle-Ceravolo is a Professor at the University of Padua, Italy. Dr Angelini is a plastic surgeon in private practice in Rome, Italy
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Asymmetry of Preoperative Incision Design Markings for Upper Blepharoplasty. J Craniofac Surg 2017; 28:e419-e422. [DOI: 10.1097/scs.0000000000003654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kashkouli MB, AbolfathZadeh N, Abdolalizadeh P, Sianati H, Karimi N. Upper blepharoplasty and eyebrow position. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1311207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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