Anatomical position of hyaluronic Acid gel following injection to the infraorbital hollows.

PURPOSE: To examine with histology the anatomical location of hyaluronic acid gel injected to the infraorbital hollows of cadaver specimens. METHODS: The authors dissected 5 fresh hemifacial cadaver specimens following preperiosteal injection of hyaluronic acid gel to the infraorbital hollows. Following tissue fixation, full-thickness soft tissue sections were obtained along the medial, central, and lateral lower eyelid/midface of each specimen. Histologic examination of the anatomical location of hyaluronic acid gel was performed using hematoxylin and eosin and Hale colloidal iron stains. RESULTS: Histologic examination of the central and lateral lower eyelid/midface sections revealed a significant portion of hyaluronic acid gel in either a postorbicularis or a subcutaneous plane in 8 of 10 sections. Only 2 sections displayed hyaluronic acid gel solely within a preperiosteal plane. The medial sections revealed hyaluronic acid gel resting in either a preperiosteal or an intraorbicularis plane. Soft tissue structures such as deep fat compartment septa and the orbicularis oculi muscle appeared to play a significant role in influencing the resting position of hyaluronic acid gel. CONCLUSIONS: In most specimens, the location of a significant portion of hyaluronic acid gel following injection to the infraorbital hollows differed from the intended injection plane. Soft tissue structures including fat compartment septa and the orbicularis oculi muscle appear to influence the resting position of hyaluronic acid gel. Careful attention should be used to avoid overfilling the thin soft tissue layers of the medial infraorbital hollows or tear trough.

Madarosis as an indicator for malignancy in eyelid margin lesions.

PURPOSE: The purpose of this study was to determine the sensitivity of madarosis as an indicator for malignancy in eyelid lesions affecting the lid margin. METHODS: A retrospective medical record review was completed for patients who were diagnosed with lesions affecting the eyelid margin which were suspicious for malignancy. Suspicion was determined by considering an array of factors, including lesion characteristics, Fitzpatrick score, sun exposure history, and history of skin cancer. Presence of madarosis was assessed by clinical examination, and presence of malignancy was determined by biopsy. RESULTS: The association between madarosis and malignancy was statistically significant (p ≤ 0.001). Madarosis had a sensitivity of 0.643 and a specificity of 0.882 when used as a sole indicator for malignancy. The odds of malignancy were 13.4 times higher in the presence of madarosis. CONCLUSIONS: Madarosis is more common in malignant eyelid margin lesions than benign lesions. If madarosis is present, there is a 69.23% chance that the lesion is malignant. Therefore, biopsy of any suspicious lesion that demonstrates madarosis is recommended. However, many malignant eyelid margin lesions do not demonstrate madarosis, and so the sensitivity of madarosis as a sole indicator for malignancy is poor. In the absence of madarosis, it is important to consider other factors when determining malignant potential of eyelid lesions.

Closed meloplication percutaneous cable suture technique.

The aging midface is caused by a complex process of soft tissue volume loss, gravitational changes, and attenuation of the ligaments involved. This process results in a skeletonized appearance and elongation of the eyelid cheek complex and a medial and inferior descent of the malar fat pads. Standard facelifting techniques have been unsuccessful in addressing these issues. The authors describe the technical aspects of the closed meloplication percutaneous cable suture technique in detail, evaluate 55 cases as a retrospective chart review over a 5-year period, and address the complication rate.

Histologic comparison of autologous fat processing methods.

PURPOSE: To perform a quantitative analysis of adipocyte viability after fat processing during autologous fat transfer, comparing the processing methods of washing, centrifuging, and sedimentation. METHODS: An experimental study was conducted in which 24 fat samples were obtained after processing from 22 patients undergoing autologous fat transfer. Histologic analysis of periodic acid-Schiff-stained specimens was then performed. RESULTS: Cell counts per high-powered field of intact adipocytes and nucleated adipocytes and adipocyte cross-sectional area were significantly greater in samples processed by sedimentation, compared with those by centrifuging or washing. CONCLUSIONS: Of the various processing techniques currently used during autologous fat transfer, sedimentation appears to yield a higher proportion of viable adipocytes than does washing or centrifuging.

Severe subcutaneous emphysema following orbital blowout fracture.

A 19-year-old man sustained a blowout fracture to the left orbital floor. Subcutaneous emphysema developed after a protracted sneezing episode. Some signs of respiratory distress ensued, and the patient was emergently intubated. He underwent surgical repair of the fracture and then had further extension of the subcutaneous emphysema. The left nasal cavity was packed and the emphysema slowly resolved. Clinically significant subcutaneous emphysema is an uncommon complication of orbital blowout fracture. Informing the patient to avoid excessive nose-blowing and to avoid occluding the nose while sneezing may prevent this complication.