Monopolar radiofrequency treatment of human eyelids: a prospective, multicenter, efficacy trial.

BACKGROUND/OBJECTIVE: To evaluate the efficacy of a novel 0.25 cm(2) monopolar radiofrequency (RF) treatment tip for aesthetic rejuvenation of the eyelids. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective, multicenter trial in which the eyelids of 72 patients were treated. Patients underwent a single treatment session and were then followed on a serial basis for 6 months. Cutaneous anesthesia was not required to perform the treatments. Assessments were made by the treating physician, the subjects, and by masked physician observers evaluating photographs taken at each data point. RESULTS: Upper eyelid tightening and reduction of hooding was noted in 88 and 86% of subjects, respectively. Lower eyelid tightening was noted in 71-74% of subjects. The majority of patients treated achieved at least up to 25% improvement while a smaller percentage achieved more dramatic results. There was no correlation between the amount of energy applied to the eyelids and the clinical outcome. There were no serious adverse sequelae. CONCLUSION: Human eyelids can be safely treated with monopolar RF energy delivered via a novel 0.25 cm(2) treatment tip. Using this technology non-invasive eyelid rejuvenation was achieved in the majority of subjects treated. The factors differentiating those patients who achieve the most impressive changes from others remain unclear. Further development and testing of this technology is warranted.

Modification of the Cutler-Beard procedure using donor achilles tendon for upper eyelid reconstruction.

PURPOSE: Large upper eyelid defects are typically repaired by the two-stage Cutler-Beard procedure. Replacing the tarsal plate is integral in reconstructing the upper eyelid. Currently, autogenous cartilage is the most frequently used tarsal substitute. We propose using donor Achilles tendon as an alternative for increased stability of the upper eyelid when repairing large defects by the Cutler-Beard procedure. METHODS: We present a retrospectively reviewed case series of four patients with large upper eyelid defects. Each had the traditional Cutler-Beard procedure with the variation of using donor Achilles tendon as the tarsal replacement. Patients were examined and photographed in follow-up ranging from 6 months to 4 years. RESULTS: All cases were successful in recreating the upper eyelid without complication. The tendon graft supplied structure, motility, and cosmesis throughout follow-up. The human Achilles tendon was investigated by literature review and compared with currently available posterior lamellar substitutes. CONCLUSIONS: The replacement of upper eyelid tarsus with Achilles tendon as part of the Cutler-Beard procedure was successful in repairing large upper eyelid defects in four patients. The tendon graft is easily placed and incorporated in the normal eyelid anatomy. It is pliable and mobile yet stable. Repair is not limited by the size of the defect, as the tissue is readily available. The modification produced excellent functional and cosmetic results.