Refractive, visual, and subjective quality of vision outcomes for very high myopia LASIK from - 10.00 to - 13.50 diopters.

BACKGROUND: To evaluate laser-assisted in situ keratomileusis (LASIK) outcomes, subjective quality of vision (QoV) and patient satisfaction in eyes with very high myopia (VHM) above - 10.00 diopters (D). METHODS: Consecutive myopic and myopic-astigmatism eyes with spherical equivalent (SEQ) ranging between - 10.00 to - 13.50 D underwent LASIK with the WaveLight® Allegretto Wave® Eye-Q 400 Hz excimer laser. Treatment accuracy, efficacy, safety, stability, cylinder vectors, and higher-order aberrations were evaluated, together with subjective QoV and night vision disturbances (NVDs). RESULTS: 114 eyes had a preoperative SEQ of - 11.02 ± 0.81 D, with a median follow-up of 24 months. A total of 72, 84, and 94% of eyes were within ± 0.50, ± 0.75 and ± 1.00 D of intended SEQ (R2 = 0.71). The efficacy index was 0.93 ± 0.20, with 51 and 81% of eyes achieving 20/20 and 20/25. The astigmatism correction index was 0.95 ± 0.33. The safety index was 1.05 ± 0.12. The average myopic regression was - 0.51 ± 0.38 D. Preoperative QoV scores improved significantly postoperatively (7.5 ± 0.8 vs. 9.1 ± 0.7; P <  0.001), with less NVDs (P <  0.001). Total, spherical and coma root mean square (RMS) postoperative ocular higher-order aberrations were 1.07 ± 0.34, 0.67 ± 0.25, and 0.70 ± 0.40 µm. CONCLUSIONS: Very high myopia LASIK between - 10.00 to - 13.50 D is safe and results in good visual outcomes, with high patient satisfaction and a significant improvement in patient-reported QoV after surgery. Appropriately selected patients within this very high myopia group can be included as LASIK candidates.

Photogrammetric Analysis of Orolabial Region in South Indians.

In lip reconstructive surgery, knowledge of orolabial dimensions and position according to ethnicity, age, and gender are important to obtain satisfactory results. Unfortunately, there is a dearth of information related to these values in South Indians. The objective of the present study was to quantify the orolabial dimensions and position in South Indians. Evaluation of orolabial features was performed on standardized frontal and lateral of 400 South Indian subjects (200 males and 200 females), aged 18 to 30 years. The measured parameters were evaluated by an independent t-test. Significant sexual dimorphism was found in 12 of 13 measurements. Except upper lip reference to E plane, all other linear measurements such as mouth width, philtrum width, lower lip reference to E plane, upper lip height, cutaneous upper lip, upper and lower vermilion height, cutaneous lower lip height, lower lip height, and labiotragial distance were significantly greater in males than females. Angular measurements, interlabial angle, and labiomental angle were significantly greater in females. Clinically significant sexual dimorphism existed for mouth width, labiotragial distance, interlabial angle, and labiomental angle (mean difference > 3 mm). Out of the four orolabial indices, only intercanthal/mouth width indices showed a significant sexual difference. In both sexes, the triangular shape of philtral column was most common. Comparative analysis between South Indians and North American whites revealed significant differences in all measurements and some resemblance to the Han Chinese. The knowledge of the obtained mean values might be useful in the maintenance of the functional and aesthetic quality of this region during surgical planning.

Anthropometric and Anthroposcopic Analysis of Periorbital Features in Malaysian Population: An Inter-racial Study.

In oculoplastic operations, knowledge of the dimensions of periorbital features based on age, gender, and race is essential for achieving better aesthetic result. This article seeks to determine the racial and gender differences of periorbital features among Malaysian Malay (MM), Malaysian Indian (MI), and Malaysian Chinese (MI) subjects. Evaluation of periorbital features was done on photographs of 200 MM, 200 MI, and 200 MC subjects, aged 18 to 26 years. The measured values were evaluated by an independent t-test. A significant difference was found between MM and MI in all measurements except interbrow distance in males, eyebrow thickness in females, and apex to lateral limbus distance in both sexes. Between MI and MC the difference was insignificant for interbrow distance in male groups, apex to lateral limbus distance in females, and palpebral fissure inclination and eyebrow apex angle in both sexes. Between MM and MC, significant differences were found for eyebrow thickness and medial canthus tilt in female group. Male groups showed significant difference for apex to lateral limbus and lateral canthus distance and eyebrow apex angle. Eyebrow height, palpebral fissure width, and intercanthal distance were significantly different in both sexes. Sexual dimorphism was found for all measurements in MI, but MM and MC showed insignificant difference for eyebrow apex angle. Four types of epicanthus were observed in MM and MC and three types in MI. Eyebrow apex between lateral limbus and lateral canthus was the most common position in all racial groups. Significant racial and gender differences exist for certain periorbital measurements. The knowledge of these differences is expected to influence the surgical outcome.

Anthropometric Analysis of the South Indian Woman's Nose.

The normal values of nasal dimensions and position have been established for various racial and ethnic groups. Unfortunately, there is a dearth of information related to these values in South Indian females, leading to surgeons being forced to use statistical data from Caucasians in their decision making. The objective of the present study was to compare statistically the nasal anthropometric measurement of South Indian women (SIW) with published norms for North American white women (NAWW) using independent t-test. Anthropometric analysis was done on standardized frontal, lateral, and basal photographs of South Indian woman's noses (n = 375) ages 18 to 35 years. Comparative analysis showed significant differences between SIW and NAWW in 15 of 17 measurements. All 14 nasal indices revealed significant differences that were calculated. SIW had relatively shorter, wider, and more horizontally oriented noses, and the noses have ellipsoid appearance in submental view, deeper nasal root, underrotated nasal tip, flared alae, and rounded nasal tip. As cosmetic surgery becomes more popular among South Indians, the obtained normative mean values might serve as a prototype for facial surgery.

Photogrammetric analysis of eyebrow and upper eyelid dimensions in South Indians and Malaysian South Indians.

BACKGROUND: The eyebrow and eyelid are important sexually dimorphic and ethnic features of the face. In cosmetic surgery, maintenance of these landmarks is important to obtaining satisfactory results. OBJECTIVES: The authors quantify the dimension and position of the eyebrow and eyelid in South Indians and Malaysian South Indians and assess whether significant differences exist between the sexes and ethnic groups. METHODS: Evaluation of eyebrow and upper eyelid was performed on standardized photographs of 200 South Indian and 200 Malaysian South Indian subjects, aged 18 to 26 years. We measured eyebrow thickness, apex to lateral limbus distance, apex to lateral canthus distance, interbrow distance, medial end of the eyebrow to medial canthus, lateral end of the eyebrow to lateral canthus, eyebrow height, eyebrow apex inclination, and pretarsal skin height. The measured values were evaluated by an independent t test. We also assessed the prevalence of double lid crease and types of epicanthus and eyebrow apex positions. RESULTS: A significant difference was found between women in the South Indian and Malaysian South Indian groups for eyebrow apex to lateral limbus distance, medial end to medial canthus, pretarsal skin height, eyebrow height, and eyebrow apex inclination. Male groups showed significant ethnic difference for eyebrow apex to lateral limbus distance. Sexual dimorphism was found for all measurement categories. A double crease fold appeared in 99% of the subjects. Only epicanthus tarsalis (95%) and epicanthus superciliaris (5%) appeared in the subjects. Four types of eyebrow apex position were found. CONCLUSIONS: Ethnic and sex differences exist for eyebrow and eyelid dimensions in the 2 groups we studied. Knowledge of these trends is significant during surgical planning to obtain ideal outcomes.

Primary Topography-Guided LASIK: Treating Manifest Refractive Astigmatism Versus Topography-Measured Anterior Corneal Astigmatism.

PURPOSE: To investigate whether topography-guided laser in situ keratomileusis (LASIK) with anterior corneal astigmatism measured on the WaveLight Contoura (Alcon Laboratories, Inc., Fort Worth, TX) leads to better refractive outcomes compared to treating on the clinically measured manifest refractive astigmatism axis in eyes with primary myopic astigmatism. METHODS: Retrospective analysis of 1,274 consecutive LASIK eyes treated on the topography-measured anterior corneal astigmatism axis compared to eyes treated on the conventional clinical manifest refractive astigmatism axis. RESULTS: In eyes with a small axis discrepancy between anterior corneal astigmatism and refractive astigmatism of 5° to 20°, there was no significant difference in efficacy index, refractive astigmatism accuracy, and most Alpins vector analysis parameters. Both treatment modalities achieved 20/20 uncorrected distance visual acuity (UDVA) in 90% of eyes, with 95% having postoperative cylinder of 0.50 diopters (D) or less. In eyes with a large axis discrepancy between 21° and 45° treated on the anterior corneal astigmatism axis, outcomes were both statistically and clinically inferior. Fewer eyes achieved UDVA of 20/20 (88.9% vs 73.6%; P = .01) and fewer had a defocus equivalent of 0.25 (65.6% vs 52.7%), 0.50 (86.9% vs 80.0%), and 0.75 (97.5% vs 90.9%) D or less (P < .05 for all). Significantly more eyes achieved an angle of error greater than 15° (25.4% vs 8.1%; P = .004), had postoperative residual astigmatism of 0.75 D or less (18.2% vs 7.4%; P = .03), and needed an excimer laser re-treatment (11% vs 1.6%; P = .007). CONCLUSIONS: Topography-guided myopic astigmatism LASIK treated on the topography-measured anterior corneal astigmatism axis resulted in inferior refractive and visual outcomes compared to treating on the clinical manifest refractive astigmatism axis. [J Refract Surg. 2019;35(1):15-23.].

Risk factors for epithelial erosions in laser in situ keratomileusis.

PURPOSE: To determine the risk factors for an epithelial defect during laser in situ keratomileusis (LASIK). SETTING: LASIK Vision, Toronto, Ontario, Canada. METHODS: In this prospective cohort study, 926 patients (1852 eyes) presenting for LASIK over a 6-month period were evaluated for age, sex, Fitzpatrick Skin Type (FST), eye color, hair color at 3 years of age, facial skin wrinkling, ethnicity (Lancer Ethnicity Scale [LES]), keratometry, Schirmer I reading, corneal thickness, and preexisting signs of corneal epithelial dystrophy. In all patients, LASIK was performed using the Technolas 217 laser (Bausch & Lomb), the Hansatome(R) microkeratome (Bausch & Lomb), and the same nomogram settings. RESULTS: Fourteen percent of patients had significant epithelial fragility. In patients with FST I or II or LES 1 or 2, the relative risk of an epithelial defect was 10 times greater than in other patients; in those older than 40 years, it was 6 times greater than in other patients; in those with lighter hair or eye color, it was 2 to 3 times greater than in patients with darker hair or eyes. There was no significant difference in pachymetry, vertical or horizontal keratometry, or Schirmer readings between eyes with epithelial defects and eyes without. CONCLUSIONS: The risk of epithelial erosions during LASIK strongly correlated with patients' skin type and age.

Is medial canthal tilt a powerful cue for facial attractiveness?

PURPOSE: To identify medial canthal tilt as an important cue used by judges in evaluating human female facial attractiveness. METHODS: An experimental study was conducted with the use of SuperLab Pro, and judges had to make a forced choice between unmodified faces and faces that had their medial canthal tilt accentuated through the use of Adobe Photoshop CS. RESULTS: Female faces with accentuated medial canthal tilt were preferred 93% of the time over unmodified faces (p < 0.0001). CONCLUSIONS: Medial canthal tilt appears to be a powerful cue used in judging human female facial attractiveness. Its power may be due to its relation to the neotenic and sexually dimorphic cue of palpebral fissure inclination.

History and current concepts in the analysis of facial attractiveness.

BACKGROUND: Facial attractiveness research has yielded many discoveries in the past 30 years, and facial cosmetic, plastic, and reconstructive surgeons should have a thorough understanding of these findings. Many of the recent studies were conducted by social, developmental, cognitive, and evolutionary psychologists, and although the findings have been published in the psychology literature, they have not been presented in a comprehensive manner appropriate to surgeons. METHODS: The author reviews the findings of facial attractiveness research from antiquity to the present day and highlights and analyzes important concepts necessary for a thorough understanding of facial attractiveness. RESULTS: Four important cues emerge as being the most important determinants of attractiveness: averageness (prototypicality), sexual dimorphism, youthfulness, and symmetry. CONCLUSIONS: A surgeon planning facial cosmetic, plastic, or reconstructive surgery can potentially gain both profound insight and better quality surgical results by appreciating these findings.

An objective system for measuring facial attractiveness.

BACKGROUND: Research over the past 20 years has shown that judgments of facial attractiveness are universal; people from all cultures and backgrounds rank and rate faces for attractiveness the same. As such a model for objectively rating facial attractiveness is theoretically plausible, if designed, it would have many uses, including outcomes analysis in plastic surgery of the face. The authors tested a schematic facial composite/prototype mathematical model (the phi mask created by Dr. Stephen Marquardt) as a method for measuring facial attractiveness in an objective manner. METHODS: Thirty-seven male and 35 female faces of 18- to 30-year-old whites of European extraction were rated, as were 31 composite faces of each sex using both Internet and direct survey judges. The faces were tested against the phi mask model analyzing deviations of facial anthropometric points from corresponding phi mask nodal points using equivalent weightings, and weightings arrived at by way of multiple linear regression. RESULTS: The deviation from the phi mask significantly correlates with attractiveness, explaining from 25 to 75 percent of the variance in attractiveness judgments, depending on the methodology used. CONCLUSIONS: The phi mask model supports averageness or prototypicality of the face as being the major component of the facial attractiveness gestalt and is a first step in producing an objective system for measuring facial attractiveness.