A quantitative, objective method for evaluating the surgical outcomes of baggy eyelid correction using orbital gray scale analysis

Protocol Establishment and Reliability Verification of Three-Dimensional Digital Stereophotogrammetry in Lower Eyelid Anthropometry

BACKGROUND

Three-dimensional (3D) stereophotogrammetry has been widely used in anthropometry for both medical and esthetic purposes. However, no studies have assessed its reliability on measuring the lower eyelid by 3D imaging. This study aimed to establish a standardized 3D anthropometric protocol for lower eyelid region and validate its reliability.

METHODS

Fifty-eight participants (116 eyes) were recruited with mean age of 39.14 ± 11.25 years. Two sets of VECTRA 3D images were taken for each subject, and each set of images was individually measured twice by two raters. Twenty-seven landmarks were identified in the lower eyelid region, and then 19 linear, 4 curvilinear, 7 angular and 2 areal metrics were assessed for intrarater, interrater and intramethod reliability.

RESULTS

High reliability was found in this 3D imaging-based lower eyelid anthropometry. The mean absolute difference within 2 intrarater measurement were 0.22 and 0.08 units, the technical errors measurement were 0.31 and 0.15 units, the relative errors of measurement were 0.90% and 0.31%, the relative technical errors of measurement were 1.53% and 0.64%, and the intra-group correlation coefficient was 0.99 and 0.99. The results for interrater measurement were 0.53 units, 0.59 units, 2.94%, 3.41% and 0.96, and for intramethod measurement were 0.71 units, 0.77 units, 4.12%, 4.05% and 0.95 units, respectively.

CONCLUSION

3D stereophotogrammetry is reliable for lower eyelid anthropometry. The standardized protocol can be further applied for many purposes such as lower eyelid aging evaluation, surgical related assessment and periocular rejuvenation plan.

LEVEL OF EVIDENCE IV

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Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature

BACKGROUND

Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures.

MATERIAL AND METHODS

Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports.

RESULTS

A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references.

CONCLUSION

Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime.

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 .

Evaluation of Fat Excision versus Sparing in Lower Blepharoplasty Using Orbital Gray Scale Analysis

Orbital septum plication provides various benefits, including eliminating the necessity for a septal incision and the ability to relocate infraorbital fat in a more anatomically suitable manner. This study aimed to compare the results of traditional lower blepharoplasty with fat excision and the orbital septal plication method using orbital grey scale analysis as a new objective method for assessment.

Objective Assessment of the Effectiveness of the Transconjunctival Fat-Repositioning Technique Using Magnetic Resonance Imaging and Three-Dimensional Surface Imaging

Background: To quantify the surgical outcomes of transconjunctival fat repositioning technique, we study the lower periorbital area with magnetic resonance imaging (MRI) and three-dimensional (3D) surface imaging. Methods: The preoperative and postoperative images were analyzed. The T1-weighted MR images in the quasi-sagittal plane parallel to the long axis of the orbit and passing through the globe center were used to measure the transposed fat, and 3D comparison was performed to calculate the tear trough depth. Changes throughout the surgery and their relationships with clinical characteristics were statistically analyzed. Results: A total of 11 patients who underwent surgery were included. The mean follow-up period was 10.1 months. MRI measurements showed that the fat area beneath the tear trough increased from 0 to 22.7 ± 6.7 mm² after fat repositioning, whereas the fat area of the eyelid bag decreased from 46.3 ± 11.0 mm² to 25.5 ± 14.0 mm². The 3D results revealed an increase in thickness by 1.2 ± 0.4 mm in the tear tough areas. Conclusion: Both MRI and 3D imaging provide options to objectively assess the fat-repositioning technique.