Effects of Topical Mandelic Acid Treatment on Facial Skin Viscoelasticity.

Mandelic acid is an α-hydroxy acid with reported benefit in treating acne and hyperpigmentation. The authors have developed a topical mandelic acid formulation that subjectively improves the quality of aged skin. Although the gold standard for assessing outcomes, photographic documentation is limited by subjective interpretation. Tools for measuring physical skin properties allow for an objective assessment of changes in skin quality. The authors sought to objectively study the viscoelastic changes to the skin following treatment with topical mandelic acid, using the Cutometer MPA 580. Twenty-four patients, twenty females and four males, aged 42 to 68 years, were studied over a four-week period. Mandelic acid was applied topically to the face twice a day for four weeks. The lower eyelid skin viscoelastic properties were assessed weekly using the Cutometer. After four weeks of topical mandelic acid treatment, the elasticity of lower eyelid skin increased 25.4% (P = .003). Skin firmness increased 23.8% (P = .029). Improvement in photographic appearance correlated with these findings. Mandelic acid is another topical treatment option for improving skin quality, and is well tolerated by patients. The authors feel that the Cutometer or similar device should be used routinely in facial plastic surgery to objectively assess outcomes of various treatment modalities.

Prophylactic lateral canthopexy in lower blepharoplasties.

Lower eyelid malposition is a known complication of lower (lid) blepharoplasty surgery. The prevention of this complication is easier than its treatment. Over the past 5 years in my practice, 247 patients have had lower blepharoplasties with a canthopexy procedure and in some cases a tarsal strip canthoplasty. The criterion for a lateral tarsal strip canthoplasty was a lid distraction distance greater than or equal to 10 mm. Lid distraction distance is the distance the eyelid can be pulled away from the globe after the initial skin incision has been made and measured with calipers. If the eyelid can be pulled away from the globe less than 10 mm, then a canthopexy is performed, which occurred in 98% of cases. Patients had lateral canthopexies regardless of age or preoperative assessment. Herein, I describe a simple method of canthopexy that can be performed on most patients having a lower blepharoplasty, to not only achieve a cosmetically superior result but also to prevent eyelid malposition or ectropion.