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Meyer BI, Shoji MK, Zamani KA, Bozung AK, Lee WW. Beyond the Surface: A Systematic Review of Perforating and Penetrating Globe Injuries From Blepharoplasty. Ophthalmic Plast Reconstr Surg 2024; 40:374-379. [PMID: 38372611 DOI: 10.1097/iop.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
PURPOSE This study aims to address the infrequent but serious complication of globe injuries in blepharoplasty. METHODS A case series of 3 patients with globe injuries postblepharoplasty is presented, along with a systematic literature review that revealed 13 previously reported cases. Quantitative and comparative analysis is described. RESULTS Injuries ranged from deep thermal burns to full-thickness corneal or scleral lacerations, with one instance of traumatic cataract. The median time from surgery to symptom onset was 1 day, with a concerning median delay of 7 days to presentation to an ophthalmologist. Visual outcomes were generally poor, with nearly all patients experiencing permanent visual morbidity. The systematic review revealed 3 cases of endophthalmitis following perforating scleral injuries. Comparative analysis showed no significant differences in visual outcomes between penetrating and perforating injuries. CONCLUSIONS The findings of this study emphasize the need for increased vigilance for globe injuries that require prompt ophthalmological evaluation following blepharoplasty, especially considering the observed delay in presentation and the extent of visual morbidity. The study advocates for improved practitioner training in recognizing and managing these complications and underscores the importance of patient education regarding the potential risks and the necessity of timely postoperative care.
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Affiliation(s)
- Benjamin I Meyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
- Department of Oculofacial Plastic and Orbital Surgery, Shiley Eye Institute, University of San Diego California, San Diego, California, U.S.A
| | - Kambiz A Zamani
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
- Department of Ophthalmology, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Alison K Bozung
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Wendy W Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Kalaczyńska E, Fukushige K, Umemoto K, Wanibuchi S, Someda SK, Takahashi Y, Naito M. Thickness of the Medial Pretarsal Adipose Tissue in the Upper Eyelid among the Japanese Population. Ophthalmic Plast Reconstr Surg 2024; 40:340-345. [PMID: 38231617 DOI: 10.1097/iop.0000000000002596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE To investigate the medial pretarsal adipose tissue thickness of the upper eyelid in the Japanese population. METHODS Sixty-two whole upper eyelids were harvested from 35 Japanese cadavers and fixed in paraffin. The samples were cut into 5 µm sagittal microsections and stained with hematoxylin and eosin, as well as Masson's trichrome. Data obtained from images and measurements were taken with Aperio ScanScope and ImageScope software and underwent statistical analysis. RESULTS The samples were divided into 3 shapes sagittal cross-sections of the eyelid (triangular, rectangular, and flat) corresponding to the shape of the medial pretarsal adipose tissue. Type I (triangular shape, 48.4%) had a ratio of fat thickness at 1⁄2 tarsal height to peak fat thickness of <0.9, and type IIa (rectangular shape, 30.6%) and IIb (flat shape, 21.0%) had pretarsal adipose tissue thickness to tarsal height ratio of ≥0.2 and <0.2, respectively. The mean values of tarsal thickness at 1⁄2 tarsal height were 1021 µm for the type I group, 1100 µm for the type IIa group, and 764.4 µm for the type IIb group ( p = 0.01). The mean values of fat thickness at 1⁄2 tarsal height were 410.6 µm for the type I group, 303.3 µm for the type IIa group, and 242.6 µm for the type IIb group ( p = 0.26). CONCLUSIONS The thickness of the medial pretarsal adipose tissue was different according to the shape of the sagittal cross-section of the eyelid. Awareness of the medial pretarsal adipose tissue thickness contributes to effective suture placement and safe suture depth during blepharoptosis surgery.
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Affiliation(s)
| | - Kaori Fukushige
- Department of Anatomy, Aichi Medical University, Aichi, Japan
| | - Kanae Umemoto
- Department of Anatomy, Aichi Medical University, Aichi, Japan
| | - Sora Wanibuchi
- Department of Anatomy, Aichi Medical University, Aichi, Japan
| | - Steffani Krista Someda
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, Aichi, Japan
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Bonte AS, Ni Dhubhghaill S, Leysen I, Koppen C. Severe Corneal Damage After Minor Eyelid Surgery: A Case Series. Eye Contact Lens 2024; 50:194-197. [PMID: 38386977 DOI: 10.1097/icl.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To present three cases of serious corneal complications after seemingly minor and uncomplicated eyelid surgery. METHODS These cases emphasize the real-world risk of corneal damage after oculoplastic surgery. RESULTS The first case is a 46-year-old man referred to our department with a corneal perforation after bilateral blepharoplasty of both upper and lower eyelids. The second case concerns a 51-year-old woman who suffered an accidental coagulation of the cornea during the removal of upper eyelid papillomas, and the third case is a 55-year-old woman who had severe corneal thinning accompanied by visual loss after an upper lid blepharoplasty. All patients were stabilized without the need for corneal transplantation, although there were significant corneal scars and sequelae. CONCLUSIONS Although complications after esthetic oculoplastic surgery are rare, the reported cases show that corneal damage can have a major impact on the patient's vision and quality of life. Strategies such as the use of a corneal shield can be used to mitigate these risks, but their use is debated. Nevertheless, diligent postoperative care is paramount. At the first postoperative visit, a basic visual acuity measurement should be performed. In cases where reduced vision is reported, particularly when accompanied by pain, patients should be urgently referred for specialized eye care.
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Affiliation(s)
- Anne-Sophie Bonte
- Department of Ophthalmology (A.-S.B., N.D.S., I.L., C.K.), Antwerp University Hospital, Edegem, Belgium; and Faculty of Health Sciences (A.-S.B., N.D.S., I.L., C.K.), University of Antwerp, Edegem, Belgium
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Mahmood Fars BJ. Modified lateral canthopexy with upper and lower blepharoplasties for aesthetic refinements: My personal technique. Asian J Surg 2024; 47:933-937. [PMID: 37977931 DOI: 10.1016/j.asjsur.2023.11.017] [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: 06/06/2023] [Revised: 10/06/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Blepharoplasty is a surgical procedure that modifies the shape and structure of the eyelids to restore a more youthful appearance. The procedure comprises the removal of extra muscle, fat, and skin. In order to get the optimum functional and aesthetic result, supporting components like canthal tendons can also be tightened. AIM To evaluate the efficacy of canthopexy in conjunction with the upper and lower blepharoplasty technique and its complications. METHODS A total of 400 individuals who underwent these procedures between January 2020 and January 2021 had been recruited for this study. The frequency and clinical complications were analyzed. RESULTS The complications were found to be 17 (4 %) cases of relapse, 12 (3 %) temporary hematoma formation, 11 (3 %) cases of epiphora, 8 (2 %) cases of unequal eyelid positioning, 5 (1 %) patients developed conjunctivitis and chemosis. CONCLUSION This method appears to be effective since it is simple, practicable, and capable of delivering positive functional and aesthetic effects with a minimum of side effects.
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Affiliation(s)
- Bayad Jaza Mahmood Fars
- Head of Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Sulaymaniyah, Iraq.
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Whang K, Brocks D. Case report: Utilization of a scleral lens to mitigate exposure keratopathy and associated mental health decline. Cont Lens Anterior Eye 2023; 46:101871. [PMID: 37308351 DOI: 10.1016/j.clae.2023.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE To report a case of acute exposure keratopathy with comorbid depression and improvement of both conditions with the use of a scleral lens (SL). OBSERVATIONS A 72-year-old male with a past ocular history significant for extensive basal cell carcinoma (BCC) excision of the right upper and lower eyelids presented for evaluation of exposure keratitis and consideration of a SL for the right eye. Examination was notable for post-surgical irregular lid margins with lagophthalmos, trichiasis and an Oxford Grade I staining of the central exposed cornea. Medical history was notable for chronic severe depression and anxiety with suicidal ideation. Upon treatment with a SL, the patient noted ocular comfort, and reported significantly improved affect. CONCLUSION AND IMPORTANCE Currently, there is no peer reviewed literature reporting on the management of exposure keratopathy in the setting of comorbid affective disorders. This case highlights the improvement in quality of life for a patient with exposure keratitis and severe depression with suicidal ideation and points to the potential utilization of a SL to mitigate the risk of mental health decompensation.
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Affiliation(s)
- Ken Whang
- Department of Ophthalmology, BostonSight, Needham, MA, USA
| | - Daniel Brocks
- Department of Ophthalmology, BostonSight, Needham, MA, USA.
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Reducing Surgical Risks in a Blepharoplasty. Facial Plast Surg Clin North Am 2023; 31:227-238. [PMID: 37001926 DOI: 10.1016/j.fsc.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Blepharoplasty is one of the commonest procedures performed for facial rejuvenation. The eyelids play a vital role in maintaining ocular surface integrity and visual functioning. Care must be taken to avoid complications that pose a risk to vision and ocular comfort. In addition, cosmetic complications can adversely affect patient satisfaction. Here the authors review the common complications encountered with blepharoplasty surgery and discuss how to minimize the risk of these and how to treat them if they do arise. With careful preoperative patient counseling, sound intraoperative technique, and appropriate postsurgical care, blepharoplasty remains a safe and well-tolerated procedure.
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Coscarelli JMM, Coscarelli S, Duarte TF, Barbi JSF, Jones KM. Upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lorden DS, Kim A, Tejawinata F, Samimi DB, Lo CC, Dresner SC, Burnstine MA. What is in a Name? It is Time to Retire the Term "Asian Blepharoplasty". Ophthalmic Plast Reconstr Surg 2021; 37:290-293. [PMID: 33315850 DOI: 10.1097/iop.0000000000001903] [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
PURPOSE This perspective explores the term "Asian blepharoplasty" and its socioemotional meaning to some patients. METHODS N/A. RESULTS Words have power. The term "Asian blepharoplasty" makes some patients uncomfortable. To our knowledge, it is the only medical descriptor that uses race. CONCLUSIONS The use of the term "Asian Blepharoplasty" may unwittingly make patients uncomfortable and pathologize Asian features. Therefore, we suggest replacing the term "Asian Blepharoplasty" with "Double Eyelid Surgery." For the subset of procedures which do not include the creation of an eyelid crease, "Blepharoplasty" is appropriate.
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Affiliation(s)
| | - Angela Kim
- Department of American Studies and Ethnicity, University of Southern California
| | | | | | | | - Steven C Dresner
- Eyesthetica, Oculofacial Plastic Surgery Associates
- Department of Ophthalmology, University of Southern California Roski Eye Institute, Los Angeles, California
| | - Michael A Burnstine
- Eyesthetica, Oculofacial Plastic Surgery Associates
- Department of Ophthalmology, University of Southern California Roski Eye Institute, Los Angeles, California
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Fodor L, Bran S, Armencea G, Onisor F. Novel "all-in-one" sandwich technique for reconstruction of full-thickness defects of the lower eyelid: a case report. J Int Med Res 2021; 48:300060520918697. [PMID: 32314632 PMCID: PMC7175061 DOI: 10.1177/0300060520918697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The current paper presents a case report of lower eyelid reconstruction after removal of a basal cell carcinoma. Our novel reconstruction method consists of translation and rotation of a paramedian forehead flap into the defect, conjunctivorhinostomy for reconstruction of the nasolacrimal duct, and placement of a sandwich ear cartilage graft that is primarily seated into the forehead flap to maintain the vertical dimension of the eyelid. This “all-in-one” technique has the advantage of one-step reconstruction, avoiding multiple surgical procedures.
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Affiliation(s)
- Lucian Fodor
- Department of Plastic and Reconstructive Surgery, Emergency District Hospital, Cluj-Napoca, Romania
| | - Simion Bran
- Department of Oral and Maxillofacial Surgery, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriel Armencea
- Department of Oral and Maxillofacial Surgery, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin Onisor
- Department of Oral and Maxillofacial Surgery, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Cho IC, Kim BJ, You HJ, Tark WH. Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms. Aesthet Surg J 2021; 41:NP1-NP9. [PMID: 32478840 DOI: 10.1093/asj/sjaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management. OBJECTIVES The aim of this study is to describe the authors' surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision. METHODS The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms. RESULTS A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ± 24.1 before surgery to 29.8 ± 23.3 (P = 0.006) after surgery. CONCLUSIONS The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Beom-Jun Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
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Abstract
We report a rare case of lacrimal ductal fistula in a patient who underwent esthetic lateral canthoplasty. A 37-year-old woman was referred to our hospital with tearing in right eye after cosmetic lateral canthoplasty of both eyes. The patient was treated with silicone tube intubation at a local medical center, but the symptoms were not resolved. Lacrimal sac irrigation tests and paranasal computed tomography (CT) were performed to analyze the possibility of lacrimal pathway obstruction. However, there was no evidence of acquired lacrimal duct stenosis. The teardrop leaked out through a small orifice in the right lateral canthal area and it increased in size over time. We identified lacrimal ductal fistula and performed lacrimal fistulectomy. The tearing at right lateral canthus area was resolved. There were no more recurrences nor any other complications 2 years after surgery.
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Namin A, Shokri T, Vincent A, Saman M, Ducic Y. Complications in Facial Esthetic Surgery. Semin Plast Surg 2020; 34:272-276. [PMID: 33380913 PMCID: PMC7759431 DOI: 10.1055/s-0040-1721764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Esthetic surgery continues to become increasingly popular both in the United States and globally. Facial esthetic procedures in particular account for a large proportion of procedures performed. This increase in popularity will inevitably result in the number of potential complications associated with these procedures. In this review, the authors describe common complications encountered with frequently performed cosmetic facial procedures and their associated management. This article is meant as a general overview and introduction to potential complications surgeons may encounter, interested readers are encouraged to further review comprehensive subspecialty literature for more detailed discussion.
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Affiliation(s)
- Arya Namin
- Department of Otolaryngology – Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aurora Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Masoud Saman
- Saman Center for Facial Plastic Surgery, Plano, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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