A Comprehensive Approach to Upper Eyelid Rejuvenation Surgery.

BACKGROUND: Upper eyelid aging results from comprehensive changes, and studies have failed to comprehensively address these changes. OBJECTIVES: This study proposes a comprehensive approach to the surgical treatment of aging upper eyelids. METHODS: Data of 116 patients with aging upper eyelids were analyzed. Each eye was scored on upper eyelid laxity, degree of blepharoptosis, and upper eyelid socket depression at preoperation and 6 months after surgery. Based on average scores of both eyes, three degrees of aging were considered: mild, moderate, and severe. All patients underwent comprehensive surgical treatments. Depending on its condition, loose skin was appropriately removed, and the levator palpebrae superioris (LPS) was corrected in patients with degenerative ptosis. Meanwhile orbital septum fat was released or periumbilical fat mass was used as a filler to correct upper eyelid socket depression. All cases were summarized based on a classification and grading system. Scores were reassessed, and satisfaction survey was conducted after 6 months follow-up. RESULTS: The preoperative and postoperative scores of the three groups were significantly different (p < 0.05), and the difference in preoperative and postoperative scores between the three groups was also statistically significant (p < 0.05). The severe aging group had the greatest difference in score. Aside from 8 patients requiring reoperation, patients reported satisfied results after the 6 month follow-up. CONCLUSIONS: Comprehensive surgical treatment for patients with different grades of upper eyelid aging can achieve a satisfactory effect of upper eyelid rejuvenation. 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.

Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography.

Tibial component of total knee arthroplasty (TKA) is designed according to morphology of proximal tibia to a large extent. Owing to racial difference, current design of tibial component based on Caucasian may not be suitable for Chinese patients. Meanwhile, data of proximal tibial morphology in Chinese population is lacking. The objective of this research was to investigate proximal tibial morphology of northeast Chinese population.Computer tomography (CT) image of 164 northeast Chinese participants was collected. After three-dimensional (3D) reconstruction, size of tibia plateau and TKA resected surface were gauged to guide the design of TKA tibia prothesis in northeast Chinese population. Measurement of tibial size mainly includes tibial mediolateral length (tML), tibial medial/lateral anteroposterior length (tMAP and tLAP). Afterwards, tML/tAP ratio of tibia plateau and TKA resected surface were calculated as feature point of tibia prothesis. tMAP/tLAP ratio of TKA resected surface was calculated to represent tibial asymmetry degree. Medial and lateral posterior tibial slope (MPTS and LPTS) were also measured to give reference to posterior angle of tibia prothesis and angle of tibia osteotomy in TKA. Independent sample t test was performed to conduct statistical analysis, P < .05 was regarded as statistically significance.Northeast Chinese male has larger knee size than female. Significant difference of tML/tAP ratio was also observed between male and female on tibia plateau (1.71 ±â€Š0.07 vs 1.77 ±â€Š0.09) but not on TKA resected surface (1.60 ±â€Š0.05 versus 1.61 ±â€Š0.06). Significant difference of tMAP/tLAP ratio between male and female was also found and they were 1.31 ±â€Š1.03 and 1.11 ±â€Š0.05 respectively. Northeast Chinese female has higher PTS than male (MPTS: 9.56 ±â€Š2.96° vs 8.81 ±â€Š2.87° and LPTS: 8.57 ±â€Š3.19° vs 8.44 ±â€Š2.76°).Significant gender-difference of tibial size and asymmetry degree of tibial resected surface were found between northeast Chinese male and female. Meanwhile, northeast Chinese population has smaller knee size, larger PTS and tML/tAP ratio than that of Caucasian population. Therefore, Chinese-specific and gender-specific tibial prostheses were strongly recommended to be designed.

Repair Techniques for Failed Double-Eyelids Involving Restoration of Eyelid Anatomical Structure and Function.

BACKGROUND: This study aimed to evaluate techniques for repairing previously failed double-eyelid surgeries based on different anatomical structure injuries. METHODS: A total of 120 patients with failed double-eyelids in our hospital were enrolled and classified into four types according to their anatomical structure damage: type I, unsmooth radians of the double-eyelid line; type II, upper socket depression; type III, iatrogenic ptosis; and type IV, comprehensive damage. Accordingly, methods of restoration included orbital septum fat supplement, repair of levator palpebrae superioris, and treatment of scar. Postoperative follow-up time points were 1 week, 1 month, and 6 months. Outcome observations were binocular symmetry, fluency of double-eyelid, scar recovery, height and contour profile of the upper eyelid margin, and plumpness of the upper eyelid. The eyelid morphological score was evaluated using photographs of preoperative and 6-month postoperative data, and the effect of eyelid repair was evaluated objectively by statistical analysis. RESULTS: At 1 month after surgery, the height of the upper palpebral margin was maintained in most patients and located at 1-2 mm below the superior limbus. At 6 months after surgery, most patients had better restorative effects. Comparison of mean eyelid morphological scores showed a statistically significant improvement following surgery (P < 0.001). CONCLUSIONS: The technique of restoring eyelid anatomical structure in failed double-eyelids not only recovered the normal function of injured eyelids but also produced satisfactory aesthetic effects. 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 .