A Modified Subbrow Blepharoplasty for Correction of Severe Upper Eyelid Skin Laxity.

BACKGROUND: Periorbital aging is characterized by dermatochalasis, lateral hooding and malformation of multiple eyelid creases. Rejuvenation of periorbital region is of great concern in aging Asians, especially for the females. However, the conventional subbrow blepharoplasty was indicated for mild or moderate skin laxity. For severe laxity, double-eyelid incision is necessarily to be involved. This study aims to improve the severe upper eyelid dermatochalasis through an extended subbrow single-incision approach with desirable outcomes. METHODS: Patients underwent this surgical method from October 2020 to April 2022 were retrospectively reviewed. The redundant skin and orbicularis oculi muscle were excised through a spindle-like subbrow incision delicately designed in the sitting position. Surgical outcomes were evaluated by heights of designed line from the palpebral margin to the pupil center (HPPC), medial cornea (HPMC), and lateral canthus (HPLC) at different follow-ups. The overall satisfaction score of cosmetic outcomes was assessed by an independent surgeon and patients themselves based on the evaluation of: subbrow scar, eyelid symmetry, lateral hooding lifting, visual block improvement and brow shape. RESULTS: A total of 75 cases were reviewed, including 3 men and 72 women. The preoperative HPPC, HPMC, and HPLC were 4.27 ± 0.40, 4.72 ± 0.45 and 3.41 ± 0.35 mm. The values were postoperatively improved to 7.01 ± 0.46, 6.57 ± 0.34 and 5.69 ± 0.26 mm, respectively, presenting significantly different (p < 0.05). The mean surgeon satisfaction scores were 3.6 ± 0.6 (range, 2.0-4.0), and patient satisfaction scores were 3.5 ± 0.6 (range, 2.0-4.0). No hypertrophic scar, sunken upper eyelids or other complications was found. CONCLUSIONS: The modified subbrow blepharoplasty method is an effective and safe alternative for correcting severe upper eyelid skin laxity, which can achieve both good cosmetic outcomes and functional improvement. 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 .

A Modified Algorithm-Based Levator Aponeurectomy in Mild to Moderate Congenital Blepharoptosis.

BACKGROUND: Levator aponeurectomy is a common operation for mild to moderate blepharoptosis. The accuracy of ptosis correction relied on intraoperative judgement when patients were under local anesthesia. For patients who must receive the operation under general anesthesia, it would be an issue to determine how much length of levator aponeurosis to shorten. To solve this issue, we collected data from patients who underwent the operation under local anesthesia and concluded an algorithm. METHODS: This single-center, prospective bivariate regression study allocated patients of mild to moderate congenital blepharoptosis who received levator aponeurectomy under local anesthesia. Preoperative MRD1 and levator function, intraoperative amount of levator aponeurotic shortening, and postoperative MRD1 were measured. The follow-up period was right after the operation. RESULTS: Twenty-nine patients were included in this trial. Two subjects exited because of not receiving allocated operation and data of the other 27 subjects (including 34 eyelids) were analyzed. A scatter diagram was drawn where x axis referred to levator function and y axis referred to the ratio of the amount of shortening of levator aponeurosis over the height of MRD1 correction. Linear regression showed y = - 0.2717*x + 5.026, R2 = 0.8553. CONCLUSION: A modified algorithm to predict the amount of shortening of levator aponeurosis based on levator function and height of ptosis correction was concluded with better accuracy and clinical feasibility. 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 .

High-Quality Axions in a Class of Chiral U(1) Gauge Theories.

We show that there are many candidates for the quintessence and/or the QCD axions in a class of chiral U(1) gauge theories. Their qualities are high enough to serve as the dark energy and/or to solve the strong CP problem. Interestingly, the high quality of axion is guaranteed by the gauged U(1) and Z_{2N} symmetries and hence free from the nonperturbative quantum gravity corrections. Furthermore, our mechanism can be easily applied to the Fuzzy dark matter axion scenarios.

Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision.

BACKGROUND: Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision. METHODS: From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively. RESULTS: Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma. CONCLUSIONS: The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe complications. 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 .

A Modified Palpebral Marginal Incision Technique Using Levator Aponeurotic Flap in Blepharoplasty.

BACKGROUND: Double-eyelid surgery is one of the most common cosmetic surgeries performed in Asians. The palpebral marginal incision technique (PMIT) conceals the incision scar and creates natural-looking double-eyelids. However, the amount of eyelid skin removed by conventional PMIT is limited, which potentially results in an unnatural crease or inferior skin below the palpebral crease that appears swollen. OBJECTIVES: The aim of this study was to introduce a modified PMIT which creates scarless, dynamic, and natural double-eyelids with a limited amount of eyelid skin excision. METHODS: From January 2018 to December 2020, 382 patients (764 eyelids) underwent double-eyelid surgeries with the described technique. The key point was to form a pretarsal levator aponeurotic flap, acting as a soft motor transmission to bridge tarsus, orbicularis oculi muscle, and skin dermis. Satisfaction with the overall aesthetic outcomes-as assessed by surgeon and patients-and complications were postoperatively evaluated at various follow-ups. RESULTS: The mean follow-up period was 7.6 months (range, 6-12 months). Of the patients, 332 (86.9%) reported self-assessment of outcomes as satisfactory and 37 (9.7%) as fair. Secondary operations were required for 13 (3.4%) patients for double-eyelid asymmetry or crease curve malformations. Early-stage hematoma (12 cases) and lagophthalmos (19 cases) were observed and completely recovered within 1 month. CONCLUSIONS: Our modified PMIT technique was capable of achieving scarless and natural-looking double-eyelids with a biomimetic anatomic structure.

A Modified Approach to Transconjunctival Levator Advancement Offering Intraoperative Options.

BACKGROUND: The transconjunctival technique is an effective approach to mild to moderate blepharoptosis repair that does not involve skin incision. However, accurate surgical manipulation of this method is greatly restricted by poor intraoperative evaluation. OBJECTIVES: The aim of this study was to introduce a modified transconjunctival approach with flexible intraoperative adjustments in order to achieve more accurate ptosis correction. METHODS: Taking a transconjunctival approach, the levator aponeurosis and Müller's muscle were folded with a square-like mattress suture for flexible adjustment and accurate correction. RESULTS: In 18 mild ptosis eyelids, 94.5% (17 eyelids) achieved adequate or normal correction. In 9 eyelids with moderate ptosis, 88.9% (8 eyelids) achieved adequate or normal correction. Of 24 ptosis patients, 23 (95.8%) achieved a good or fair symmetry result. CONCLUSIONS: This study presents a modified transconjunctival technique for repair of mild to moderate ptosis, which is characterized by flexible intraoperative adjustments that produce satisfying functional and aesthetic outcomes.

Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis.

In patients with severe blepharoptosis, the function of the levator muscle is usually weak. Even if a large amount of levator is resected, under-correction and recurrence often occur postoperatively. Frontalis suspension is the first choice for severe ptosis; however, the external orbital lifting force of the frontalis causes non-physiological eyelid movement. Conjoint fascial sheath (CFS) is a fibrous tissue which can provide dynamic movement of upper eyelids and has been applied for the treatment of mild and moderate blepharoptosis in recent years. This study aims to assess the efficacy and safety of CFS suspension combined with levator muscle advancement for treating severe blepharoptosis. A retrospective study included 44 patients (60 eyelids) with severe ptosis who underwent the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 (MRD1) were measured. Surgical outcomes, symmetry results and complications were evaluated postoperatively. At the 12-18 months follow-up, adequate or normal correction was achieved in 56 eyelids (93.3%), and 37 patients (84.1%) presented good or fair symmetry results. The most common complication was conjunctival prolapse, which was observed in six eyelids (10.0%), followed by lid fold deformity and under-correction. No exposure keratitis was recorded. In conclusion, the modified technique can physically elevate the eyelid with limited tissue injury and is effective for the correction of severe ptosis. Both satisfactory functional and esthetic results were achieved, and severe complications (such as exposure keratitis) were not observed.

Sub-brow skin excision Combined with retro-orbicularis fat resection: A Technique for upper eyelid bulkiness and laxity correction.

BACKGROUND: Many people are characterized by a swollen appearance and loose skin of upper eyelids, especially Asians. Retro-orbicularis oculus fat (ROOF) lying in the lateral canthus area is a critical factor of the bulkiness formation. Although several approaches have been reported, most of them intend to remove orbicularis muscle and preaponeurotic fat through a double-eyelid incision, leaving ROOF untreated. Consequently, an unnatural eyelid fold is formed and the lateral supraorbital region remains bloated . METHODS: Sixty-seven patients underwent sub-brow skin excision combined with ROOF resection. The key point was to excise the loose skin and thick ROOF through an incision along with the lower 1/3 of the eyebrow. Surgical outcomes were evaluated 6 months postoperatively by the heights of the designed line from the palpebral margin to the pupil center (HPPC), medial cornea (HPMC), and lateral canthus (HPLC). The pinch test, photographs, and complications were also recorded. RESULTS: The preoperative average HPPC, HPMC, and HPLC were 9.68 ± 1.73, 7.68 ± 1.24, and 6.82 ± 1.12 mm, while the postoperative average measurements were 7.25 ± 0.51, 5.99 ± 0.54, and 5.54 ± 0.61 mm, respectively. The result of the pinch test was improved and postoperative scarring was inconspicuous. Two patients had transient numbness in the eyebrow region that subsided within seven days. Two patients had slight asymmetry of eyebrow position but did not need a second operation. CONCLUSIONS: Sub-brow skin excision combined with ROOF resection is an effective technique for improving upper eyelid bulkiness and skin excess with low revision rates.

Linking the supersymmetric standard model to the cosmological constant.

String theory has no parameter except the string scale M S , so the Planck scale M Pl, the supersymmetry-breaking scale , the electroweak scale m EW as well as the vacuum energy density (cosmological constant) Λ are to be determined dynamically at any local minimum solution in the string theory landscape. Here we consider a model that links the supersymmetric electroweak phenomenology (bottom up) to the string theory motivated flux compactification approach (top down). In this model, supersymmetry is broken by a combination of the racetrack Kähler uplift mechanism, which naturally allows an exponentially small positive Λ in a local minimum, and the anti-D3-brane in the KKLT scenario. In the absence of the Higgs doublets from the supersymmetric standard model, one has either a small Λ or a big enough , but not both. The introduction of the Higgs fields (with their soft terms) allows a small Λ and a big enough simultaneously. Since an exponentially small Λ is statistically preferred (as the properly normalized probability distribution P(Λ) diverges at Λ = 0+), identifying the observed Λobs to the median value Λ50% yields m EW ∼ 100 GeV. We also find that the warped anti-D3-brane tension has a SUSY-breaking scale ∼ 100 m EW while the SUSY-breaking scale that directly correlates with the Higgs fields in the visible sector is ≃ m EW.

Ginsenoside Rb2 inhibits osteoclast differentiation through nuclear factor-kappaB and signal transducer and activator of transcription protein 3 signaling pathway.

Ginsenoside-Rb2 (Rb2) is a 20(S)-protopanaxadiol glycoside extracted from ginseng possessing various bioactivities which has drawn considerable interest regarding the area of bone metabolism. However, the effect of Rb2 on osteoclast differentiation remains unknown. In this study, we aimed to investigate the potential role of Rb2 in regulating osteoclast differentiation and the underlying molecular mechanisms. Osteoclast differentiation was induced by receptor activator nuclear factor-kappaB (NF-κB) ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) in mouse RAW 264.7 cells. The results showed that Rb2 dose-dependently inhibited the formation of the tartrate resistant acid phosphatase (TRAP)-positive multinucleated cells and TRAP expression. Furthermore, Rb2 promoted osteoprotegerin expression and bone resorption. The expression of osteoclast marker genes including nuclear factor of activated T cells c1 (NFATc1), c-Fos, OSCAR, and cathepsin K were also markedly inhibited by Rb2 treatment. Moreover, Rb2 significantly inhibited the RANKL-induced NF-κB activation. In addition, Rb2 also markedly suppressed the activation of signal transducer and activator of transcription protein 3 (STAT3) signaling pathway. Interestingly, the knockdown of STAT3 significantly strengthened the inhibitory effect of Rb2 on osteoclast differentiation. Taken together, our study suggests that Rb2 inhibits osteoclast differentiation associated with blocking NF-κB and STAT3 signaling pathways.

Energy dynamics in a generalized compass chain.

We investigate the energy dynamics in a generalized compass chain under an external magnetic field. We show that the energy current operators act on three contiguous sites in the absence of the magnetic field, and they are incorporated with inhomogenous Dzyaloshinskii-Moriya interactions in the presence of the magnetic field. Under these complex interactions the Hamiltonian remains an exactly solvable spin model. We study the effects of the three-site interactions and the Dzyaloshinskii-Moriya interactions on the energy spectra and phase diagram. The results have revealed that the energy current of the pristine quantum compass model is conserved due to the associated intermediate symmetries, and for other general cases such a characteristic does not exist.