Factors Influencing the Lagophthalmos and Lid Lag After Simple Congenital Blepharoptosis Correction.

BACKGROUND: Lagophthalmos and lid lag is the most common complication after ptosis correction. Great efforts had been made to control it, but little was known about the factors influencing it. So we ran this research to explore the possible mechanisms underlying it. This would be beneficial to solving this problem. MATERIALS AND METHODS: In this cohort study, patients treated with the forked frontalis muscle aponeurosis suspension and levator aponeurosis-Muller's muscle complex resection were identified. Lagophthalmos height and lid lag was measured at the postoperative week 1 visits. The Spearman correlation test was run to test whether lagophthalmos was related to patients' age, levator function, and severity of ptosis. Then we measured the contents of collagen and elastin fibers of frontalis muscle fascia and levator aponeurosis from the patients and levator aponeurosis from cadaver heads histologically and compared the contents in these 3 groups. RESULTS: No correlation was found between patients' age, levator function, the severity of ptosis, and with lagophthalmos height. However, the contents of collagen and elastic fibers were both higher in the frontalis fascia than in the normal aponeurosis tissues. The difference in collagen fibers content between frontalis muscle fascia and patients' aponeurosis was statistically insignificant. CONCLUSIONS: The severe lagophthalmos and lid lag may be caused by the poor mechanical features of the frontalis muscle. A better source of motive force to elevate the eyelids and a novel sling material with proper elasticity and stiffness would be the solution to improve the lagophthalmos and lid lag after ptosis correction.

What Patients Want During Follow-Up After Cosmetic Plastic Surgeries.

BACKGROUND: High follow-up rates are essential to minimize bias in clinical researches. And, now, social media is widely used in various fields of plastic surgeries. However, there are no reports about its usage in the follow-up after cosmetic plastic surgeries. PURPOSE: The authors conducted a survey based on interview and questionnaires to get an insight into social media's usage in improving the retention among patients seeking cosmetic plastic surgery and what the patients want during the follow-up in China. METHODS: The authors reviewed the works of literature and interviewed the surgeons who have rich experiences with the follow-up procedure with patients seeking cosmetic plastic surgery. And come up with the potential elements that may influence the retention, then they recruited the participants through both the new social media and the traditional way, then gathered the participants' preferences and opinions about the elements through questionnaires. Then the data were analyzed with SPSS. RESULTS: The choices which make the follow-up more convenient to attend are usually more welcomed among the participants than those making the follow-up more costly and time-consuming. However, those choices that make the patients feel less concerned are less appreciated even they are easy to practice and time-saving. CONCLUSION: Patients have preferences during the follow-up after cosmetic plastic surgeries. Clinicians should always consider such preferences and try to use appropriate follow-up approaches that are more acceptable to the patients. Other studies list out "tips to improve the retention." However, the authors believe that patients' need is the core to improve retention.

The Type and Content of Collagen Fibers of the Levator Aponeurosis in Patients With Simple Congenital Blepharoptosis.

BACKGROUND: The pathogenesis of congenital blepharoptosis remains controversial and most of the studies focused on the histologic changes of the levator muscle. However, thickening of the aponeurosis was reported in congenital blepharoptosis. And the thickness of the levator aponeurosis was found to be correlated with the levator function in congenital dysmyogenic blepharoptosis. PURPOSE: The authors conducted this research to investigate the histological changes of the levator aponeurosis of simple congenital blepharoptosis patients. PATIENTS AND METHODS: The authors analyzed 12 levator aponeurosis from ptosis patients and 21 levator aponeurosis from the cadaver specimens without relative medical history. The specimens were stained with hematoxylin and eosin as well as Sirius red. The sections were examined under light-microscopy. The content and type of collagen fibers were examined with the photos taken of the sections stained with Sirius red under polarized light-microscopy. RESULTS: The content and proportion of type I collagen increased significantly in the patient group compared with the cadaver group. The proportion of type I collagen was 97.5% in the patient group, while it was 51.5% in the cadaver group. However, no correlation was found either between the levator strength, degree of ptosis and the proportion of type I collagen in the patient group or between age, gender and proportion of type I collagen in the cadaver group. CONCLUSIONS: To our knowledge, this is the first time this phenomenon was discovered. The increase of type I collagen in the levator aponeurosis of the simple congenital blepharoptosis patients may imply the increased stiffness and undermined ability of transmitting forces, dissipate energy and prevent mechanical failure in the levator aponeurosis.

A New Surgical Technique Used for Correction of Congenital Blepharoptosis.

BACKGROUND: Blepharoptosis is defined as the drooping or lower displacement of the upper eyelids. Various kinds of surgical techniques and modifications have been introduced to improve the surgical outcomes, but the high recurrence rate and unsatisfying cosmetic results remain as a common problem. PURPOSE: To solve the problem mentioned above, we came up with our new surgical technique and conducted a retrospective review to verify its effectiveness. PATIENTS AND METHODS: A retrospective review was conducted among the patients diagnosed as genuine congenital blepharoptosis and receiving the surgical treatments where our unique technique was used between January 2016 and January 2019. The clinical records and preoperative and postoperative photographs were collected and evaluated. RESULTS: A total of 83 patients were included in our study, 78 (94%) of them acquired good surgical outcomes, while 4 (4.8%) of them got fair results, and 1 (1.2%) of them got a poor result. No long-term lagophthalmos, ectropion, entropion and fornix conjunctival prolapse were noted. CONCLUSIONS: Our surgical technique introduced here is effective in the management of genuine congenital blepharoptosis. LEVEL OF EVIDENCE III: 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.