Evaluation of visual field and ocular surface parameters by clinical comparison after blepharoplasty for dermatochalasis

PURPOSE

To evaluate the effect of upper eyelid blepharoplasty surgery on corneal topography, visual field, ocular surface, meibography, corneal biomechanics and dry eye parameters.

METHODS

This prospective study included a total 80 eyes of 40 patients. Following a detailed ophthalmological examination, standardized patient satisfaction questions were posed to patients before and after upper eyelid blepharoplasty surgery. Visual field test, non-invasive break up time (NIBUT), meibography, and corneal topography parameters were analyzed and evaluated.

RESULTS

The mean (+) visible areas in the visual field were found to be 46.20±24.96 preoperatively, 56.73±21.98 at the 1st postoperative month and 65.96±18.5 at the 3rd month, which were statistically significant. NIBUT values preoperatively, at 1 month and at 3 months were 11.26±4.48, 11.16±4.5 and 10.14±4.0, respectively, which were statistically significant. Meibomian gland loss rates on meibography preoperatively and postoperatively at 1 and 3 months were found to be 30.24±8.3, 29.36±8.2 and 28.22±7.7 respectively and were statistically significant. With the scoring system after blepharoplasty, patients reported improvement in their symptoms.

CONCLUSION

Upper eyelid blepharoplasty surgery is predicted to increase the quality of vision. It was observed that there was a functional and cosmetic improvement in the complaints of the patients after blepharoplasty. However, blepharoplasty may cause changes in eyelid dynamics and cause dry eye syndrome.

[Eye feminization]

Eye feminization embraces surgical and non-surgical aesthetic procedures used in order to feminize upper third of the face. Eye feminization is indicated for transwomen during facial gender affirming surgery, and also for aging women. During aging, volume of facial osseous and soft tissues is decreasing, the orbit is squeletonizing, with skin sagging, evolving in a more masculine appearance of the orbital area. Upper eye area analyze (forehead, temple, eyebrow, eyelid, external canthus) as lower eye area analyze (zygoma, dark circle, palpebral bags, eyelid skin) must be assessed in preferential order in order to maximize good post-therapeutic results. Procedures include bony surgery (frontoplasty, orbitoplasty), browlift, external canthoplasty, fat grafting, and also classic eyelid surgery or aesthetic medicine injections.

Upper eyelid blepharoplasty and associated ancillary procedures to improve cosmesis

PURPOSE

To present combined procedures performed for cosmesis in patients with dermatochalasis who underwent upper lid blepharoplasty (ULB).

METHOD

This retrospective cross-sectional study evaluated patients who underwent ULB with associated surgical procedures from 2012 to 2016. Data were collected on patient demographics and types of procedures. The primary outcome measure was ancillary procedures combined with ULB. Data were analyzed for correlation. Statistical significance was defined as P<0.05.

RESULTS

A total of 1,068 ULBs were performed in 825 (86.3%) females and 131 (13.7%) males. The median age was statistically higher in males (P<0.001). Isolated ULB was performed in 296 (31%) patients, and correction of brow ptosis was the most common associated procedure (206/21.5%), followed by repair of eyelid ptosis (183/19.1%).

CONCLUSION

The majority of patients required combined surgical procedures to correct periorbital involutional changes. A detailed preoperative evaluation is fundamental for choosing the appropriate surgical technique for each case, which can determine the final aesthetic result.

[Secondary eyelid pockets: Pitfalls in blepharoplasty surgery]

INTRODUCTION

Requests for cosmetic eyelid surgery are frequent. The surgeon must carry out a complete clinical examination in order to rule out any orbital pathologies responsible for eyelid pockets.

METHODS

Study of ten patients who have consulted in the oculopalpebral surgery department of La Fondation Ophtalmologique de Rothschild for cosmetic surgery of the eyelid pockets and in whom an underlying pathology was diagnosed.

RESULTS

The clinical examination allows to look for signs of alarms, such as medical history, unilateral involvement, pain and the presence of exophthalmos. These should lead to perform orbital imaging and surgical biopsy if an orbital mass has been identified for histological analysis which will make the diagnosis. We identified four cases of orbital lymphoma, one foreign body granuloma, chronic bilateral dacryoadenitis, sarcoidosis involvement, AAPOX syndrom, cavernous hemangioma, and simple fatty hernia.

CONCLUSION

These cases shows the importance of not ignoring an underlying orbital pathology before proposing cosmetic surgery for eyelid pockets.

[Treatment of malar mounds by direct excision]

OBJECTIVES

The treatment of malar mounds is challenging. We report a case series of direct excision of malar mounds and review the existing literature.

MATERIAL AND METHODS

The procedure is carried out under local anesthesia with light sedation. A pinch test allows to estimate the width of the resection. The skin is resected, and if needed, some of the sub-orbicularis oculi fat. The orbicularis muscle is not closed, and the skin is closed in two layers.

RESULTS

Eight patients were treated by the same surgeon between January and December 2013. The ages ranged from 41 to 74, with an average of 53. The patients were highly satisfied. The results were considered excellent for 5 patients and good for 3. There were no complications, in particular no scleral show, no ectropion, and no hematoma.

CONCLUSION

Direct excision of malar mounds is simple, efficient, and reproducible. The scars are most often inconspicuous, in particular in the elderly.

[Evaluation of a short incision double eyelidplasty for Asian patients]

BACKGROUND

Creation of a double upper eyelid is a popular procedure in Asian countries. Many incisional and non-incisional approaches have been described to create a new suprapalpebral fold.

OBJECTIVE

The authors recommended a short incision technique to create a double eyelid and evaluated the results.

METHODS

The location of the partial incision was determined pre-operatively with the patient. A one-centimeter partial incision was made on the middle one-third of the upper eyelid, and the orbicularis oculi muscle was dissected. Three anchoring stitches were placed for the creation of the permanent suprapalpebral fold. Those stitches were inverted single knots which linked the tarsal plate to the lower margin's dermis or dermomuscular junction of the incised skin. Intra-operative adjustment of position and curvature of the new fold was done by the active opening of the upper eyelid. Global results, symmetry and design were evaluated by the patient and one independent surgeon.

RESULTS

Between January 2012 and January 2013, a total of 10patients were operated using this technique. All patients were satisfied, with 8results graded excellent and 2results graded good. The average operation time was 20minutes. There were no serious complications, the only unfavorable outcome was one persistent bruise. The follow-up period was one year. Recovery time varied from 2weeks to a month. No correction procedure was needed.

CONCLUSIONS

The short central incisional technique for creation of a double eyelid described here provides excellent permanent and natural results, with no visible scar nor serious complications.