Secondary upper lid blepharoplasty: a clinical series using the tarsal fixation technique.

BACKGROUND: One hundred consecutive secondary upper lid blepharoplasties were reviewed retrospectively to determine the lid characteristics of patients undergoing secondary blepharoplasty and the outcomes of all the procedures, which were performed using a tarsal fixation technique performed by one surgeon. METHODS: The median age of the patients was 54 years, and 99 percent of the patients were women. The median time since primary blepharoplasty was 8.7 years (range, 2 to 22 years). At surgery, no additional skin was removed in 37 percent, and the median amount excised in the remainder was only 2 mm. Revision surgery was performed in 13 percent, mainly for incomplete correction of asymmetry (5 percent) or ptosis (4 percent). Nonsurgical complications were mainly ocular (8 percent). There were no cases of persistent postoperative lagophthalmos or dry eyes. RESULTS: The term "postblepharoplasty look" was introduced to describe the different aging changes that follow primary blepharoplasty, mainly dermatochalasis (70 percent), with a high or absent and often poorly defined lid fold, with fat distribution irregularities. The tarsal fixation technique is advantageous in secondary blepharoplasty, as its benefit does not depend on further skin removal, minimizing the risk of lagophthalmos and dry eye syndrome. Lipoinfiltration for volume contouring is another major advance. The higher revision rate in secondary blepharoplasty reflects the incidence of asymmetry, lid ptosis, and scar from the original blepharoplasty, and from ongoing aging. CONCLUSIONS: The postblepharoplasty look of patients undergoing secondary upper lid blepharoplasty differs from the lid appearance of patients presenting for primary blepharoplasty. Tarsal fixation and lipoinfiltration are major advances in secondary upper lid blepharoplasty.

Fibrolipomatous hamartoma of the median nerve in the elbow: a case report.

A fibrolipomatous hamartoma-also known as a fibrofatty overgrowth, perineural lipoma, intraneural lipoma, and lipomatous hamartoma-is a rare, benign, congenital lesion most commonly found in the median nerve, usually at the level of the wrist or hand. To our knowledge, no published cases report a hamartoma arising from the median nerve at the level of the elbow. We report a case of a fibrolipomatous hamartoma in a 55-year-old woman that necessitated a surgical intervention because of its size and associated neurologic symptoms.

The accuracy of intraoperative subareolar frozen section in nipple-sparing mastectomies.

BACKGROUND: Intraoperative subareolar frozen sections are used to assess the nipple areolar complex's suitability for preservation for patients selected for nipple-sparing mastectomy. We aim to investigate the accuracy and value of the frozen section compared to formal histopathologic results. METHODS: In our 5-year retrospective study, 52 candidates for nipple-sparing mastectomies had subareolar frozen sections analyzed intraoperatively for malignant or atypical duct changes. Women were considered for nipple-sparing mastectomy if their primary breast malignancy was greater than 3 cm from the nipple-areolar complex and not multifocal in nature. Frozen-section results were compared to the formal histopathologic results, allowing analysis of the sensitivity, specificity, and predictive value. Causes of false negatives (negative frozen-section findings, positive histopathology findings) were then examined. RESULTS: Of 52 frozen sections, 47 (90%) yielded negative results and 5 (10%) yielded positive results. Of the 47 negative results, 39 were true negatives while 8 were false negatives. Of the 5 positive results, all were true positives with no false positives. Therefore, the positive predictive value of subareolar frozen section is 100%, negative predictive value 83%, sensitivity 38%, and specificity 100%. Of the 8 false negatives, 4 (50%) were due to sampling errors, 3 (37.5%) were due to interpretation errors, and 1 (12.5%) was due to diathermy artifact. CONCLUSION: Intraoperative subareolar frozen section is a specific but nonsensitive test. It is useful in nipple-sparing mastectomy because in 10% of cases a positive result allows immediate nipple and areolar excision. Its low sensitivity and negative predictive value means that 15% of patients will need a subsequent nipple and areolar excision. Eighty-five percent of patients can, however, have a single-stage excision.