Subtle Eyelid Retraction after Lower Blepharoplasty.

BACKGROUND: Lower blepharoplasty is one of the commonest cosmetic surgeries performed in the United States. The delicate balance of the lower eyelid may be detrimentally altered in lower blepharoplasty, leading to lower eyelid retraction with the attendant functional and cosmetic consequences. Marginal reflex distance-2 (MRD2) is an insensitive measure for subtle lower eyelid retraction, and the MRD2 at the lateral limbus (MRD2limbus) and tarsal marginal show (TMS) may be more sensitive in identifying eyelid retraction and eversion. METHODS: This is a cohort study of consecutive patients undergoing lower blepharoplasty with skin pinch removal, laser resurfacing, or skin pinch removal with prophylactic lateral canthal resuspension. Mean follow-up was 22.1 weeks. RESULTS: There was no significant difference in MRD2 after surgery after either laser resurfacing, skin pinch, or skin pinch with canthoplasty, either after surgery or between groups. MRD2limbus was significantly increased after surgery in the skin pinch only group (p < 0.05). There was a significant difference in postoperative MRD2limbus in the skin pinch with canthoplasty group compared to that in the skin pinch only group (p < 0.05). TMS was significantly increased after both laser resurfacing (p < 0.001) and skin pinch only (p < 0.05), and both postoperative groups demonstrated significantly increased TMS compared to skin pinch with canthoplasty (p < 0.05). CONCLUSIONS: MRD2limbus and TMS are more sensitive markers for lower eyelid retraction than MRD2. Subtle eyelid retraction and eversion occur after anterior lamellar work and can be prevented with prophylactic lateral canthal resuspension.

Objective Comparison of Nasojugal Fold Depth and Lower Eyelid Length After Fat Excision Versus Fat Transpositional Lower Blepharoplasty.

BACKGROUND: Lower blepharoplasty is one of the most commonly performed aesthetic surgeries in the world. However, there are no studies to directly compare patients who had fat excision vs fat transposition. OBJECTIVES: The authors sought to compare and contrast aesthetic results of fat excisional and fat transpositional lower blepharoplasty. METHODS: A retrospective review was conducted of 60 patients (120 eyelids) who underwent transconjunctival lower blepharoplasty, either with fat excision or fat transposition into a preperiosteal plane. Marginal reflex distance-2, lower eyelid length, nasojugal fold depth, and pretarsal orbicularis definition were measured. RESULTS: Mean follow-up was 5.6 months. Mean marginal reflex distance-2 did not significantly differ after either fat excision or fat transposition. Mean lower lid length decreased after fat excision only (P < 0.001), and postoperative fat excision patients had a shorter lower eyelid length than patients who underwent fat transposition (13.5 ± 2.1 mm vs 16.1 ± 1.9 mm, P < 0.0001). Pretarsal orbicularis definition increased after both surgeries (P < 0.001), and the groups did not differ (1.0 ± 0.8 vs 1.1 ± 0.9, not significant). Mean nasojugal fold depth was effaced after surgery in both groups (P < 0.001), although the nasojugal fold was significantly more effaced after fat transposition (1.5 ± 0.7 vs 0.48 ± 0.6, P < 0.001). CONCLUSIONS: In lower blepharoplasty, fat excision resulted in a shorter lower eyelid, and fat transposition resulted in a more effaced lid-cheek junction. Surgeons should be able to balance both techniques to deliver a customized aesthetic result.Level of Evidence: 3.

Minimal incision facelift surgery.

In today's active society and demanding workplace, patients are frequently searching for less invasive procedures with diminished morbidity and more rapid healing to address their cosmetic concerns. The goal of face-lift surgery is to reverse the effects of aging by removing excess skin of the lower face and neck with concomitant repositioning of the deeper ptotic tissues. Recent advances in understanding facial anatomy and aging have resulted in the development of new procedures that can achieve these goals with more limited surgery. As increasingly younger patients present for early restorative procedures, it is imperative that surgeons have alternative options within their armamentarium to achieve success. This article reviews the current trends in face-lift surgery, particularly the small incision face-lift.

Advances and controversies in face lift surgery.

PURPOSE OF REVIEW: The only constant in face lift surgery is the goal-rejuvenation of the lower two thirds of the face and neck. Societal shifts have focused patients on less invasive procedures, with less downtime and more rapid return to daily activities. RECENT FINDINGS: The lateral SMASectomy procedure has proven to be an effective technique, with a high degree of safety, minimal morbidity, and high patient satisfaction. Additionally, younger patients often require less extensive procedures to achieve an aesthetically desirable result. Recent advances such as the short scar face lift with SMASectomy, and the S-lift, have centered upon less invasive approaches to lower face and neck restoration. The optimal technique for correction of platysma bands also remains elusive, with multiple options available. All procedures dramatically benefit from the use of tumescent anesthesia to decrease operative time, postoperative morbidity, and recovery time. SUMMARY: There is no single ideal technique for each patient. The procedure used must be individualized for each patient's unique anatomy and goal for surgical restoration.

Combined cervicofacial rhytidectomy and laser skin resurfacing.

PURPOSE: To determine the safety and efficacy of simultaneous cervicofacial rhytidectomy (face lift) and laser skin resurfacing. METHODS: A retrospective study of 100 consecutive patients who underwent simultaneous face lift and carbon dioxide laser resurfacing procedures was performed. Patients received regional (periorbital and/or perioral), "T"-shaped (forehead and central face), or full face laser skin resurfacing, and were classified on this basis. All patients were assessed for flap necrosis, delayed reepithelialization, reactive hyperpigmentation, persistent erythema, scarring, or other unsatisfactory results postoperatively. RESULTS: One of 10 patients receiving full-face resurfacing, including the entire subcutaneously undermined flap, suffered full-thickness skin necrosis of the distal segment of one flap. Six of the 100 patients developed reactive hyperpigmentation postoperatively. One patient evidenced an imprint of the laser footprint over nonundermined skin, requiring a secondary procedure. Aside from the one patient with scar, no cases of delayed reepithelialization were identified. CONCLUSIONS: Carbon dioxide laser skin resurfacing combined with face lift procedures can achieve dramatic cervicofacial rejuvenation. Laser resurfacing over nonundermined skin during the face lift procedure does not appear to increase the risk of postoperative complication. Laser treatment over an undermined distal face lift flap appears to increase the potential for skin necrosis, and should not be considered a routine modality for facial rejuvenation.