Assessment of self-esteem and psychological aspects in patients undergoing upper blepharoplasty / Avaliação da autoestima e aspectos psicológicos em pacientes submetidos à blefaroplastia superior

Abstract Objective: To evaluate the self-esteem and quality-of-life outcomes in patients undergoing upper blepharoplasty. Methods: A cross-sectional study was performed at Federal University of São Paulo. The self-esteem and quality-of-life of 29 patients undergoing upper blepharoplasty were compared with 20 age-matched volunteers from the general population. During preoperative assessment, the patients and volunteers underwent complete ophthalmological examinations and answered two questionnaires: the Rosenberg self-esteem scale (RSES) and the World Health Organization quality of life assessment (WHOQOL-BREF). The RSES is a ten-item questionnaire developed to measure self-esteem that are answered using a four-point scale. The scores range from 0 to 30, and lower scores indicate higher self-esteem. The WHOQOL-BREF is composed of 26 questions divided into four domains. Mean values greater than 5 are considered indicative of very good quality-of-life. Data from the RSES and quality-of-life scores were compared between the two groups using an unpaired t- test. Results: The mean self-esteem scores for the patients and volunteers were 10.31 ± 0.71 and 6.9 ± 0.99, respectively (p < 0.001). The mean response scores for the WHOQOL-BREF questionnaire for the patients and volunteers were 3.67 ± 0.08 and 3.76 ± 0.08, respectively (p = 0.449). For the psychological subscale of the WHOQOL-BREF questionnaire, the results for the patients and volunteers were 3.52 ± 0.09 and 3.78 ± 0.08, respectively (p = 0.041). Conclusions: Subjects who underwent upper blepharoplasty exhibited worse self-esteem based on the RSES. Regarding quality-of-life, as assessed using the WHOQOL-BREF questionnaire, significant differences between the groups were evident in the psychological aspects subscale. Our study confirms the importance of subjecting patients to psychological evaluation prior to upper blepharoplasty.

Resumo Objetivo: Avaliar os resultados de autoestima e qualidade de vida em pacientes submetidos à blefaroplastia superior. Métodos: Um estudo transversal foi realizado na Universidade Federal de São Paulo. A autoestima e a qualidade de vida de 29 pacientes submetidos à blefaroplastia superior foram comparadas com 20 voluntários pareados para idade. Durante a avaliação pré-operatória, os pacientes e voluntários foram submetidos a exames oftalmológicos completos e responderam a dois questionários: a escala de autoestima de Rosenberg (RSES) e a avaliação da qualidade de vida da Organização Mundial de Saúde (WHOQOL-BREF). O RSES é um questionário de dez itens desenvolvido para medir a autoestima que são respondidos usando uma escala de quatro pontos. Os escores variam de 0 a 30, e os escores mais baixos indicam maior autoestima. O WHOQOL-BREF é composto por 26 questões divididas em quatro domínios. Os valores médios acima de 5 são considerados indicativos de uma boa qualidade de vida. Os dados da RSES e os escores de qualidade de vida foram comparados entre os dois grupos usando um teste de t-teste não pareado. Resultados: Os escores médios de autoestima para pacientes e voluntários foram de 10,31 ± 0,71 e 6,9 ± 0,99, respectivamente (p <0,001). Os escores de resposta média para o questionário WHOQOL-BREF para pacientes e voluntários foram de 3,67 ± 0,08 e 3,76 ± 0,08, respectivamente (p = 0,449). Para a subescala psicológica do questionário WHOQOL-BREF, os resultados para pacientes e voluntários foram 3,52 ± 0,09 e 3,78 ± 0,08, respectivamente (p = 0,041). Conclusões: Aqueles submetidos à blefaroplastia superior apresentaram menor autoestima com base na RSES. Quanto à qualidade de vida, avaliada utilizando o questionário WHOQOL-BREF, diferenças significativas entre os grupos foram evidentes na subescala de aspectos psicológicos. Nosso estudo confirma a importância de submeter os pacientes à avaliação psicológica antes da blefaroplastia superior.

Cicatricial ectropion secondary to psoriatic arthritis.

Ectropion is characterized by the eversion of the eyelid margin and the consequent exposure of the conjunctiva and cornea. The shortening of the anterior lamella of the lid causes cicatricial ectropion. We described a case of skin pathology causing cicatricial ectropion. The case is about a 68-year-old woman with a 2-year history of psoriatic arthritis. She complained of eyelid tearing and redness for two years. Due to the psoriasis, she presented a very dry skin, also in the periocular region, resulting in cicatricial ectropion. A skin graft was indicated to correct the eyelid malposition. Careful investigation should be performed in patients who have a skin disease that can lead to cicatricial ectropion.

Blefaroplastia inferior: poderia a cirurgia proporcionar satisfação aos pacientes? / Lower blepharoplasty: would the surgery provide satisfaction to the patient?

OBJETIVO: Foi realizado um estudo prospectivo com objetivo de avaliar os resultados de cinquenta pacientes submetidos a blefaroplastia inferior transcutânea, visando a análise do resultado clínico e a satisfação dos pacientes na Universidade Federal de São Paulo, entre abril de 2005 e maio de 2007. MÉTODOS: Os pacientes foram alocados aleatoriamente em dois grupos cirúgicos. O Grupo Cirúrgico 1 (Grupo Controle) foi composto por 25 pacientes submetidos a blefaroplastia inferior tradicional e cantopexia lateral de rotina. O Grupo Cirúrgico 2 (Grupo Experimental) foi composto por 25 pacientes submetidos a blefaroplastia inferior com transposição das bolsas adiposas e cantopexia lateral de rotina. Para avaliar os resultados obtidos foi utilizado a avaliação da autoestima dos pacientes, por meio da Escala de Autoestima de Rosenberg UNIFESP/EPM. O outro método utilizado foi solicitar a participação de três cirurgiões independentes que avaliaram as fotografias de pré e pós-operatório e com auxílio de uma escala topográfica, quantificaram os resultados. RESULTADOS: A média de idade foi de 48,8 anos, com predomínio do sexo feminino (96%). A análise das fotografias mostrou que 96% dos pacientes apresentaram melhora significativa. A autoestima melhorou de um escore médio no pré-operatório de 5,1 (desvio padrão = 4,1) para um valor médio de 3,6 (desvio padrão = 3,5) após 6 meses da cirurgia (p=0,001). CONCLUSÃO: Os autores concluíram que ambos os procedimentos seriam seguros e eficazes, com baixo índice de complicação, apresentando melhora da autoestima, visível após seis meses da cirurgia.

PURPOSE: The purpose of this study was to analyze prospectively fifty patients submitted to lower eyelid blepharoplasty at the Federal University of São Paulo, between April 2005 and May 2007. METHODS: Fifty patients were assigned to interventions into two surgical groups by using random allocation. The Surgical Group1 (control group) was composed of 25 patients who were submitted to conservatively standard fat-resection lower eyelid blepharoplasty, and routine lateral canthal support. The Surgical Group 2 (experimental group) was represented by 25 patients submitted to lower eyelid blepharoplasty with periorbital fat mobilization and arcus marginalis redrape, and routine lateral canthal support. The self-esteem of all patients was compared with those in 25 age-matched volunteers from the general population. The parameters of the Rosenberg Self-Esteem Scale were determined preoperatively and at 6-month interval postoperatively. Standardized photographs obtained before and after surgery were evaluated by three independent observers. RESULTS: The median follow-up was 395 days (range 364 to 547 days). The mean age was 48.8 years, the population's gender was predominantly female (96%). Analysis of preoperative and postoperative photographs showed that 96% patients achieved significant improvement. Self-esteem scores improved from baseline preoperative mean levels of 5.1 (Standard Deviation = 4.1) to a mean level of 3.6 (Standard Deviation = 3.5) at 6 months post-surgery (p=0.001). No patients had orbital hematoma, blepharitis, lagophthalmos or ectropion. CONCLUSIONS: The authors concluded that both procedures are safe and effective with low complication rates, and marked improvement in self-esteem was observed in patients at 6-month follow-up.

Standardized clinical photography: the role of flash.

Medical photographic documentation is important for professional, research, and ethical concerns. This study analyzed the possible interference that the flash could cause on evaluation of lower eyelid cosmetic results. Standardized photographs with and without flash were taken of 10 patients with dermatochalasis. The photographs were evaluated by 3 independent observers, as before (without flash) and after (with flash) an alternative esthetic treatment of the lower eyelid. The observers rated the overall cosmetic improvement of the lower eyelid photographs on a visual analog scale. The 3 surgeons believed that there was improvement in cosmetic outcome from the first (without flash) to the second (with flash) picture. The results indicate that a simple flash addition in one of 2 consecutive photographs, taken seconds apart, could influence the impression of experienced surgeons on the final outcome of oculoplastic surgeries and may constitute a bias in observer-dependent studies.

[Lower blepharoplasty: would the surgery provide satisfaction to the patient?]. / Blefaroplastia inferior: poderia a cirurgia proporcionar satisfação aos pacientes?

PURPOSE: The purpose of this study was to analyze prospectively fifty patients submitted to lower eyelid blepharoplasty at the Federal University of São Paulo, between April 2005 and May 2007. METHODS: Fifty patients were assigned to interventions into two surgical groups by using random allocation. The Surgical Group1 (control group) was composed of 25 patients who were submitted to conservatively standard fat-resection lower eyelid blepharoplasty, and routine lateral canthal support. The Surgical Group 2 (experimental group) was represented by 25 patients submitted to lower eyelid blepharoplasty with periorbital fat mobilization and arcus marginalis redrape, and routine lateral canthal support. The self-esteem of all patients was compared with those in 25 age-matched volunteers from the general population. The parameters of the Rosenberg Self-Esteem Scale were determined preoperatively and at 6-month interval postoperatively. Standardized photographs obtained before and after surgery were evaluated by three independent observers. RESULTS: The median follow-up was 395 days (range 364 to 547 days). The mean age was 48.8 years, the population's gender was predominantly female (96%). Analysis of preoperative and postoperative photographs showed that 96% patients achieved significant improvement. Self-esteem scores improved from baseline preoperative mean levels of 5.1 (Standard Deviation = 4.1) to a mean level of 3.6 (Standard Deviation = 3.5) at 6 months post-surgery (p=0.001). No patients had orbital hematoma, blepharitis, lagophthalmos or ectropion. CONCLUSIONS: The authors concluded that both procedures are safe and effective with low complication rates, and marked improvement in self-esteem was observed in patients at 6-month follow-up.

Clinical outcomes, patients' satisfaction and aesthetic results after lower eyelid blepharoplasty.

OBJECTIVE: To evaluate the results of fifty patients undergoing transcutaneous lower eyelid blepharoplasty. METHODS: We conducted a prospective, randomised, controlled trial between April 2005 and May 2007. Patients were randomly divided into two groups: Group 1 consisted of 25 surgical patients undergoing traditional lower blepharoplasty and routine lateral canthopexy; Group 2 consisted of 25 patients undergoing lower blepharoplasty with fat bags transposition and routine lateral canthopexy. We used the Rosenberg Self-Esteem Scale UNIFESP / EPM to assess patients' self-esteem. We also requested the participation of three independent surgeons, who examined the pre and postoperative photographs and quantified the results with the aid of a topographic scale. RESULTS: The mean age was 48.8 years, predominantly females (96%). The analysis of photographs showed a 96% significant improvement. Self-esteem scores improved from a preoperative average of 5.1 (SD = 4.1) to a mean of 3.6 (SD = 3.5) six months after the operation (p = 0.001). CONCLUSION: Both procedures are safe and effective with low complication rates, causing improvement of self-esteem assessed six months after the operation.

Resultados clínicos e satisfação dos pacientes após blefaroplastia inferior / Clinical outcomes, patients' satisfaction and aesthetic results after lower eyelid blepharoplasty

OBJETIVO: Avaliar os resultados de cinquenta pacientes submetidos à blefaroplastia inferior transcutânea. MÉTODOS: Estudo prospectivo, randomizado e controlado realizado entre abril de 2005 e maio de 2007. Os pacientes foram alocados aleatoriamente em dois grupos: Grupo Cirúrgico 1 composto por 25 pacientes submetidos à blefaroplastia inferior tradicional e cantopexia lateral de rotina e Grupo Cirúrgico 2 composto por 25 pacientes submetidos à blefaroplastia inferior com transposição das bolsas adiposas e cantopexia lateral de rotina. Para avaliar os resultados obtidos foi utilizada a avaliação da autoestima dos pacientes, através da Escala de Autoestima de Rosenberg UNIFESP/ EPM. O outro método utilizado foi solicitar a participação de três cirurgiões independentes que avaliaram as fotografias de pré e pós-operatórios e com o auxílio de uma escala topográfica, quantificaram os resultados. RESULTADOS: A média de idade foi de 48,8 anos, com predomínio do sexo feminino (96 por cento). A análise das fotografias mostrou que 96 por cento dos pacientes apresentaram melhora significativa. A autoestima melhorou de um escore médio no pré-operatório de 5,1 (desvio padrão = 4,1) para um valor médio de 3,6 (desvio padrão = 3,5) seis meses após a operação (p = 0,001). CONCLUSÃO: Os autores concluíram que ambos os procedimentos seriam seguros e eficazes, com baixo indíce de complicação, apresentando melhora da autoestima, avaliada seis meses após a operação.

OBJECTIVE: To evaluate the results of fifty patients undergoing transcutaneous lower eyelid blepharoplasty. METHODS: We conducted a prospective, randomised, controlled trial between April 2005 and May 2007. Patients were randomly divided into two groups: Group 1 consisted of 25 surgical patients undergoing traditional lower blepharoplasty and routine lateral canthopexy; Group 2 consisted of 25 patients undergoing lower blepharoplasty with fat bags transposition and routine lateral canthopexy. We used the Rosenberg Self-Esteem Scale UNIFESP / EPM to assess patients' self-esteem. We also requested the participation of three independent surgeons, who examined the pre and postoperative photographs and quantified the results with the aid of a topographic scale. RESULTS: The mean age was 48.8 years, predominantly females (96 percent). The analysis of photographs showed a 96 percent significant improvement. Self-esteem scores improved from a preoperative average of 5.1 (SD = 4.1) to a mean of 3.6 (SD = 3.5) six months after the operation (p = 0.001). CONCLUSION: Both procedures are safe and effective with low complication rates, causing improvement of self-esteem assessed six months after the operation.

[Treatment of tear trough deformity with hyaluronic acid gel filler]. / Tratamento dos sulcos palpebromalar e nasojugal com ácido hialurônico.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. PURPOSE: The aim of this study was to evaluate the results of ten patients submitted to periorbital filling with hyaluronic acid gel filler. METHODS: Between June and August, 2008, 10 patients have had their tears troughs treated with hyaluronic acid gel filler. The filler was introduced by a serial puncture technique and approximately 0.1 ml was injected at each pass. The filler was placed in the pre-periosteal tissue. Patients photographs before and after the procedure were reviewed to assess the outcomes. RESULTS: The mean volume per side needed to achieve correction was on the right side 0.61 ml (SD=0.25) and on the left side 0.65 ml (SD=0.26). The most common complications were bruising, erythema, local swelling, and pain at the injection site. The effect of treatment lasted up to 12 months. CONCLUSIONS: This pilot study showed that the treatment of tear trough deformity with hyaluronic acid gel filler was feasible, predictable and effective. All patients were very satisfied with their results.

Treatment of the tear trough deformity with hyaluronic acid.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. OBJECTIVE: The authors evaluate the results of periorbital filling with hyaluronic acid (HA) in a small series of patients. METHODS: Between June 2008 and December 2009, 25 patients were treated with HA to correct tear trough deformities. The HA was administered into the preperiosteal tissues with a serial puncture technique and approximately 0.1 mL was injected at each pass. Each patient's before and after photographs were reviewed by three surgeons; to objectively assess the outcomes, a quantitative scale was used to grade the pre- and postinjection results. The significance of subjective aesthetic evaluation of the photographs was evaluated with the Mann-Whitney U-test. Differences were regarded as significant if probabilities were less than 0.05. RESULTS: The mean (SD) volume per side needed to achieve correction was 0.54 (0.27) mL on the right and 0.61 (0.30) mL on the left. Complications included some degree of bruising, erythema, and local swelling. Most patients (88%) had cosmetic improvement according to the independent evaluation. CONCLUSIONS: All patients were very satisfied with their results. During the course of the study, the authors determined that the ideal candidates for this treatment are young, with thick skin and a definite hollow.

Tratamento dos sulcos palpebromalar e nasojugal com ácido hialurônico / Treatment of tear trough deformity with hyaluronic acid gel filler

OBJETIVO: Verificar a eficácia do preenchimento dos sulcos nasojugal e palpebromalar deprimidos através da injeção de ácido hialurônico e analisar as complicações observadas. MÉTODOS: Foi realizado um estudo piloto, prospectivo, aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo, com pacientes recrutados no Serviço de Plástica Ocular do Departamento de Oftalmologia da UNIFESP/EPM. Foram selecionados pacientes de ambos os sexos, com idade entre 25 e 60 anos, que apresentavam os sulcos nasojugal e/ou palpebromalar deprimidos, que não haviam sido submetidos à cirurgia na pálpebra inferior nem apresentavam histórico de trauma nesse local. O ácido hialurônico foi aplicado via transcutânea e depositado na região supraperiosteal em pequenos volumes. Todo paciente foi tratado pelo mesmo cirurgião (GAPV), tendo sido examinado no pós-operatório em intervalos regulares e fotografado no pré-operatório, no pós-operatório imediato, na 4ª semana, no 6º e no 12º mês após o procedimento. Ao final deste período todas as fotos foram analisadas por profissional não ligado a esta pesquisa, visando verificar a eficiência da técnica em atingir seus objetivos. RESULTADOS: Entre junho e agosto de 2008, 10 pacientes foram incluídos neste estudo piloto. Oito pacientes foram tratadas uma única vez, enquanto duas precisaram de retoque na 4ª semana após a aplicação inicial. O volume injetado foi em média de 0,61 ml (DP=0,25) no lado direito e de 0,65 ml (DP=0,26) no lado esquerdo. As complicações observadas foram equimose em 6 casos, edema local maior que 48 horas em um paciente e lesão cutânea semelhante à acne em um participante. CONCLUSÕES: O estudo piloto demonstrou que o tratamento dos sulcos nasojugal e pálpebro-malar com uso de ácido hialurônico se mostrou eficaz e previsível, com alto nível de satisfação dos pacientes e com resultado duradouro.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. PURPOSE: The aim of this study was to evaluate the results of ten patients submitted to periorbital filling with hyaluronic acid gel filler. METHODS: Between June and August, 2008, 10 patients have had their tears troughs treated with hyaluronic acid gel filler. The filler was introduced by a serial puncture technique and approximately 0.1 ml was injected at each pass. The filler was placed in the pre-periosteal tissue. Patients photographs before and after the procedure were reviewed to assess the outcomes. RESULTS: The mean volume per side needed to achieve correction was on the right side 0.61 ml (SD=0.25) and on the left side 0.65 ml (SD=0.26). The most common complications were bruising, erythema, local swelling, and pain at the injection site. The effect of treatment lasted up to 12 months. CONCLUSIONS: This pilot study showed that the treatment of tear trough deformity with hyaluronic acid gel filler was feasible, predictable and effective. All patients were very satisfied with their results.

Upper blepharoplasty with or without resection of the orbicularis oculi muscle: a randomized double-blind left-right study.

PURPOSE: To compare the aesthetic outcomes of the upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle. METHODS: An interventional randomized double-blind left-right study was conducted in 15 consecutive patients with dermatochalasis of the upper eyelid. One side was randomly chosen for resection of the preseptal orbicularis oculi muscle (group 1). The orbicularis oculi muscle of the contralateral side was preserved (group 2). All patients scored differences between both sides on the seventh day, the thirtieth day, and the ninetieth day after the surgery regarding the following symptoms: edema, hematoma, itching, and pain. Three masked ophthalmic plastic specialists analyzed the aesthetic outcomes by the visual analogical scale. RESULTS: The scoring of symptoms was significantly higher in group 1 than in group 2 on the seventh postoperative day. On the thirtieth and ninetieth days, there were no significant differences between groups 1 and 2. The analysis by 3 masked observers showed that the aesthetic result was worse in group 1 than in group 2 on the seventh postoperative day. There were no significant differences between groups 1 and 2 on the thirtieth and ninetieth days. CONCLUSIONS: Upper blepharoplasty causes more postoperative symptoms and presents worse initial aesthetic outcome when the preseptal orbicularis oculi muscle is excised. However, the final aesthetic outcome is the same when the preseptal orbicularis oculi muscle is excised or preserved.

Effect of lower blepharoplasty on self-esteem.

BACKGROUND: Cosmetic surgery is an increasingly common medical procedure whose benefits to patients have not been quantified objectively. Although physicians historically have focused on minimizing side effects and optimizing the physical outcome, a broad spectrum of patient needs also factors in treatment success. Unfortunately, few data are available regarding the effects of cosmetic procedures on patient's self-esteem. OBJECTIVE: To prospectively examine long-term self-esteem outcomes for patients undergoing lower blepharoplasty at São Paulo Federal University between April 2005 and May 2007. METHODS: The self-esteem of 50 patients undergoing blepharoplasty at São Paulo Federal University was compared with that of 25 age-matched volunteers from the general population. The parameters of the Rosenberg Self-Esteem Scale (RSES) were determined preoperatively and at 6-month intervals postoperatively. The data from the instrument were analyzed using the Wilcoxon test. RESULTS: Self-esteem scores improved from a baseline preoperative mean level+/-standard deviation of 5.1+/-4.1 to 3.6+/-3.5 6 months after surgery (p=.001). The self-esteem of 31 (62%) subjects improved after the surgery. CONCLUSION: Marked improvement in self-esteem, evaluated using RSES at 6-month follow-up, was observed in patients undergoing blepharoplasty.

Comparison between two surgical techniques for lower eyelid rejuvenation: safety analysis and outcomes.

BACKGROUND: The purpose of this study was to analyze prospectively 50 patients submitted to lower blepharoplasty allocated to two surgical groups at Federal University of São Paulo, between April 2005 and May 2007. METHODS: Fifty patients were assigned for interventions into two surgical groups by using random allocation. The SG1 (control group) was composed of 25 patients who were submitted to conservatively standard fat-resection lower blepharoplasty, and routine lateral canthal support. The SG2 (experimental group) was represented by 25 patients submitted to lower blepharoplasty with periorbital fat mobilization and arcus marginalis redrape, and routine lateral canthal support. Preoperative demographic and morphological data from patient charts and standardized photographs obtained before and after surgery were evaluated by an independent observer. Surgical techniques and management of complications were determined from operative reports and clinical notes. RESULTS: The median follow-up was 395 days (range 364 to 547 days). The mean age was 48.8 years; the population's gender was predominantly female (96%). Analysis of preoperative and postoperative photographs showed that all patients achieved significant improvement. Lateral canthal support was performed in all patients with statistically significant results. CONCLUSION: The authors concluded that both procedures are safe and effective, with low complication rates.

Prolapsed orbital fat: 15 consecutive cases.

Prolapsed orbital fat has rarely been described and is often confused with other conjunctival tumours, such as dermolipoma. We describe the clinical features and treatment of 15 patients with prolapsed orbital fat. We report here our experience in 15 consecutive patients who presented to the Vision Institute of Federal University of São Paulo, Brazil, between July 2004 and December 2007. Age, sex, presenting complaint, physical findings, associated local and systemic diseases, type of treatment, and complications were recorded. Ten patients were men, and ages ranged from 44-86 (mean 68). Eleven patients presented with unilateral disease. Thirteen had superotemporal prolapse, and two atypical superonasal prolapse. Two gave a history of trauma. All patients had the prolapsed fat excised for cosmetic reasons. There were no complications. Orbital fat prolapse is usually superotemporal, mainly in men, and is easily differentiated from other lesions, such as prolapsed lacrimal gland. Excision is always indicated, usually for cosmetic reasons.

Superficial thrombophlebitis (Mondor's Disease) after breast augmentation surgery.

Although the aetiology of Mondor's disease remains unclear, the most commonly cited cause is trauma of some sort. Although surgical trauma has frequently been quoted, reports that specifically implicate aesthetic breast surgery are unusual in the literature. In this article, the authors report a case of superficial thrombophlebitis of the anterolateral chest wall secondary to breast augmentation surgery in a woman, five months after the procedure. The authors performed an analysis of the disease's main etiologic components and preponderant clinical aspects, and determined all appropriate therapeutic measures.

Síndrome da frouxidão palpebral: 10 casos consecutivos / Floppy eyelid syndrome: 10 consecutive cases

Introdução: A síndrome da frouxidão palpebral é caracterizada por apresentar tarso maleável, permitindo a eversão da pálpebra superior, conjuntivite papilar crônica e sintomas irritativos não específicos. Método: Os autores apresentam sua experiência no tratamento de 10 casos onsecutivos de síndrome da frouxidão palpebral, na Universidade Federal de São Paulo, no período de janeiro de 2005 a julho de 2006. Foram verificados: idade, queixa principal, achados do exame físico, presença de doença local ou sistêmica associada, tipo de tratamento e complicações. Resultados: A grande maioria dos pacientes era do sexo o masculino (60%). A idade variou entre 28 e 62 anos, média de 46,5 anos. Em cinco pacientes, havia comprometimento bilateral da pálpebra superior e, no restante, em apenas um lado. Nesta casuística, a queixa principal foi edema palpebral, sensação de corpo estranho, dor e lacrimejamento. Todos os pacientes apresentar am obesidade como comorbidade. Oito pacientes foram submetidos a tratamento cirúrgico, sendo realizado retalho lateral de tarso (tarsal strip). Dois pacientes foram tratados conservadoramente, com alguma melhora dos sinais e sintomas. Todos os pacientes operados tiveram resolução completa dos sintomas, com resultado duradouro após seguimento de 6 meses, em média. Conclusões: Os autores acreditam que o tratamento cirúrgico é a melhor opção terapêutica. A avaliação da flacidez horizontal por meio do distraction test, tanto da pálpebra superior quanto da inferior, deveria ser incluída de rotina no exame de todo paciente que apresentas e irritação crônica dos olhos e lacrimejamento.

Prolapso de gordura orbital / Orbital fat prolapse

Objetivo: O prolapso de gordura orbital é uma entidade pouco descrita e, muitas vezes, confundida com tumores de conjuntiva ou com prolapso de glândula lacrimal. O presente trabalho teve por objetivo descrever o quadro clínico e o tratamento de dez pacientes com prolapso de gordura orbital. Método: Os autores descrevem a experiência em dez casos consecutivos de prolapso de gordura orbital, tratados na Universidade Federal de São Paulo, entre julho de 2004 e dezembro de 2005. Verificou-se idade, sexo, queixa inicial, achados clínicos, doenças associadas, tipo de tratamento e complicações. Resultados: A grande maioria dos pacientes era do sexo masculino (80%). A idade variou entre 44 e 86 anos (média de 68 anos). Em seis casos, a lesão era unilateral e, em quatro pacientes, acometia ambos os olhos. Em todos os pacientes, a queixa foi apenas estética, não causando nenhum desconforto local. Em 90% dos casos, o prolapso estava localizado no quadrante súpero-temporal, enquanto que, em 10%, na região súpero-nasal. Houve um paciente com história de cirurgia prévia. Todos os dez pacientes foram submetidos a tratamento cirúrgico, não havendo complicação ou recidiva até o momento. Conclusão: O prolapso de gordura orbital é mais comum em homens, mais freqüente no quadrante súpero-temporal, sendo facilmente diferenciado de outras lesões como, por exemplo, o dermolipoma. Os autores acreditam que a cirurgia é a melhor forma de tratamento.

[Eyelid reconstruction with Fricke's flap: report of two cases]. / Reconstrução palpebral com retalho de Fricke: relato de dois casos.

Skin cancer is the most common neoplasm in human beings and among them, basal cell carcinoma is the most prevalent. This report shows two cases with this tumor, located in the lateral canthus, affecting both the superior and inferior eyelids. The first case was a female, 72 years old, with amaurosis of the right eye. One year ago, she noted a tiny papule at the left lateral canthus. The CT scan revealed that the tumor had compromised about 80% of the left superior eyelid, 70% of the inferior eyelid and showed superficial invasion of the lateral orbital wall. The histopathological test diagnosed basal cell carcinoma, with clear margins. The reconstruction of both eyelids was done with Fricke's flap. The second patient was a female, 68 years old, who had an accident with multiple scars at the left side of her face two years before. One year later, she noted a small lesion at the left side of the lateral canthus. The CT scan showed that the tumor had affected about 90% of the left superior eyelid, 65% of the inferior eyelid and showed superficial invasion of the lateral orbital wall. The histopathological test diagnosed basal cell carcinoma, with clear margins. The reconstruction of both eyelids was done with Fricke's flap. The authors believe that although this flap is not the first choice for a reconstructive procedure, it should not be forgotten because in some patients, it would be the only possible choice.