Hyaluronic Acid Filler in the Treatment for Drooping Tip: Anatomical Concepts and Clinical Results.

The plunging nasal tip is a challenging condition because, although it is predominantly a dynamic deformity which occurs during smiling, it also indicates a structural problem. When a person smiles, the paired depressor septi nasi muscles pull the tip caudally at the same time as the levator labii superioris alaeque nasi muscles pull the alar base and lateral lip cephalically. This movement causes straightening of the alar rim. Even though surgical rhinoplasty is the gold standard to restore nasal appearance, the procedure may fail to treat the dynamic cause of the drooping tip. This article outlines the anatomical concepts that lead to a drooping tip and presents a technique that can treat both the dynamic and structural causes of the drooping tip using hyaluronic acid filler. Cases are also presented that illustrate these concepts. 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 .

Blefaroplastia inferior transconjuntival associada à ressecção cutânea com preservação do músculo orbicular / Transconjunctival lower blepharoplasty with skin resection and preservation of the orbicularis muscle

INTRODUÇÃO: A blefaroplastia inferior transconjuntival está cada vez sendo mais utilizada pelos cirurgiões por ser uma técnica reprodutível e com baixo índice de complicações quando comparada à via transcutânea. Esta técnica tem como vantagens em relação à transcutânea a preservação do septo orbital, da lamela média e a manutenção da inervação do músculo orbicular. Este estudo tem o objetivo de analisar os resultados e as complicações da blefaroplastia transconjuntival com ressecção de pele na pálpebra inferior sem descolamento em uma amostra de pacientes. MÉTODO: Foram avaliados 18 pacientes submetidos a esta cirurgia, associada ou não à cantopexia lateral. A técnica cirúrgica é descrita detalhadamente. RESULTADOS: Um total de 16 pacientes femininos e 2 masculinos foram avaliados, com idade média de 52,7 anos. Houve melhora do aspecto do aumento de volume da pálpebra inferior, da flacidez de pele e da flacidez ligamentar lateral em todos os casos. Não foram registradas complicações tardias como retrações palpebrais, ectrópio, cicatrizes inestéticas, diplopia ou bolsas gordurosas remanescentes. Em nenhum caso foi necessária reintervenção cirúrgica. CONCLUSÃO: A blefaroplastia inferior transconjuntival com ressecção cutânea sem descolamento e preservação do músculo orbicular, associada ou não à cantopexia, se mostrou uma excelente técnica, facilmente reprodutível, confiável, segura e com poucas complicações pós-operatórias para o tratamento das alterações senis das pálpebras inferiores.

INTRODUCTION: Transconjunctival lower blepharoplasty is increasingly used by surgeons, since it is reproducible and has a low rate of complications compared to transcutaneous technique. The advantage of the transconjunctival technique is the preservation of the orbital septum, middle lamella, and orbicularis muscle innervation. This study aims to assess the results and complications of transconjunctival blepharoplasty with skin resection in the lower eyelid without detachment. METHOD: Eighteen patients who underwent this surgery with or without lateral canthopexy were analyzed. The surgical technique is described in detail. RESULTS: A total of 16 female and 2 male patients were assessed, with an average age of 52.7 years. There was improvement in all cases in the appearance of increased volume in the lower eyelid, and a decrease in skin and lateral ligament laxity. Late complications such as eyelid retraction, ectropion, unaesthetic scars, diplopia, or remnant fat bags were not observed. Surgical reintervention was not required in any cases. CONCLUSION: Transconjunctival lower blepharoplasty with skin resection without detachment and with preservation of the orbicularis muscle, with or without canthopexy, is an excellent technique, and is easily reproducible, reliable, and safe, with few postoperative complications in treatment of age-related changes in the lower eyelids.