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1.
BMC Ophthalmol ; 21(1): 435, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34911482

RESUMO

BACKGROUND: To evaluate a modified technique for involutional entropion correction in a retrospective cohort study. METHODS: The patients with involutional entropion eyelid were corrected by tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid. The patients received correction surgery from April 2013 to March 2019 were followed up for more than 6 months postoperatively. The outcome measures included the complications and the recurrence rates. RESULTS: Total 152 patients (169 eyes) were included. The mean follow-up period was 29.6 months (range: 6-36 months). Postoperative ectropion (over-correction) was observed in 1 patient with 1 eyelid (0.59%); yet, no further surgery was needed for this patient. Recurrence of entropion was found in 1 patient (0.59%). The patient with recurrent entropion received repeated surgery with the same method and achieved a good eyelid position. CONCLUSIONS: This study demonstrated that tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid could be an effective surgical method to correct lower eyelid involutional entropion. This method is technically easy with a low recurrence rate and not associated with significant complications in Asians.


Assuntos
Blefaroplastia , Entrópio , Entrópio/cirurgia , Pálpebras/cirurgia , Humanos , Músculos , Estudos Retrospectivos
2.
Zhonghua Yan Ke Za Zhi ; 57(11): 844-849, 2021 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-34743470

RESUMO

Objective: To evaluate the demographics, etiology composition, clinical characteristics and surgical outcomes of acquired ptosis patients. Methods: Retrospective case-series study. The clinical records of 176 consecutive patients (312 eyes) with acquired ptosis were reviewed from January 2009 to December 2018 in the Ophthalmology Department of Tianjin Medical University General Hospital. The demographics, etiology composition, clinical characteristics, surgical strategies and outcomes were analyzed. Results: There were 59 male (33.5%) and 117 female (66.5%) patients suffering acquired ptosis, with an average age of (64±7) years. The disease was bilateral in 136 cases and unilateral in 40 cases. There were four etiological components of acquired ptosis: 145 cases (82.4%) of aponeurotic ptosis, 17 cases (9.6%) of neurogenic ptosis, 10 cases (5.7%) of myogenic ptosis and 4 cases (2.3%) of traumatic ptosis. The clinical characteristics of acquired ptosis varied significantly depending on etiology. Ptosis surgeries were performed on 152 cases (279 eyes), and the success rate was 92.1% (140/152). Surgical procedures included levator aponeurosis surgeries on 148 cases (275 eyes), frontal muscle suspensions on 2 cases (2 eyes) and conjunctival-Müller's ectomies on 2 cases (2 eyes). Conclusions: Acquired ptosis is more likely to occur in senile and female populations with bilateral eyelids involved mostly. Aponeurotic ptosis is the predominant type of acquired ptosis. The treatment is performed according to the clear etiological diagnosis based on clinical features, and operations are efficient for most patients with acquired ptosis. (Chin J Ophthalmol, 2021, 57: 844-849).


Assuntos
Blefaroplastia , Blefaroptose , Idoso , Blefaroptose/etiologia , Blefaroptose/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
4.
Ann Plast Surg ; 87(4): 389-395, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34559709

RESUMO

BACKGROUND: The double eyelid operation is the most common cosmetic procedure conducted in Asians. However, the epicanthal fold presents a conundrum that limits the cosmetic results of double eyelid surgery. Despite not being a pathologic condition, numerous procedures have been developed and introduced to address this issue, but these techniques have potential disadvantages that include an unnatural ciliary position of the lower lids and prominent scarring. METHOD: A total of 156 patients who underwent a double eyelid operation with medial epicanthoplasty using the modified skin redraping method using a horizontal point incision and staged dog ear correction between 2015 and 2019 at our medical center were enrolled in the study. A single senior plastic surgeon performed all surgical procedures. The Patient-Reported Outcome Measures (PROM) questionnaire was used to obtain objective satisfaction scores, and patient satisfaction scores were obtained using some criteria. RESULT: Of 147 patients, 8 (0.05) complained of visible scarring at the medial epicanthal and upper fold line region; there were only 2 (0.01%) epicanthal fold recurrences and 1.36% wound-related complications. The PROM scores and patient satisfaction scores showed a strong positive linear correlation according to linear regression analysis (P < 0.001). CONCLUSION: We performed double eyelidplasty with epicanthoplasty by using "a modified skin redraping method using a horizontal point incision and a staged 'Y-shaped' dog ear correction." Few complications were encountered, and almost all patients were satisfied with their surgical outcome as determined by the PROM questionnaire.


Assuntos
Blefaroplastia , Pálpebras/cirurgia , Humanos , Satisfação do Paciente , Resultado do Tratamento
7.
J Craniofac Surg ; 32(6): 2024-2028, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34516069

RESUMO

ABSTRACT: Fat repositioning is an effective way to treat tear trough deformity (TTD) in Asians. Recent techniques mainly focused on the fixation technique, whereas how to precisely shape and individually quantify the fat pedicle has been ignored. This article introduced an individualized, targeted, and tension-free technique to fabricate a fan-shaped thin septum fat pedicle for repositioning. Furthermore, a layer-level fixation method was advocated to provide sufficient, continuous, uninterrupted filling of the TTD. From January 1, 2009, to December 31, 2018, 492 patients underwent this procedure. Through a transconjunctival incision, a continuous fan-shaped, tension-free, customized septum fat pedicle was precisely designed to match the TTD anatomy. The pedicle could either be elongated, or thickened, or debulked, or translocated, to meet the patients' individual needs. At the same time, a layer-level fat pedicle fixation technique was applied to fully interrupt the TTD. The mean operation time was 60 ±â€Š9.3 minutes. All patients demonstrated a significant improvement with elimination of both eye bags and TTD. High satisfaction was noted among the patients. No obvious resorption of the fat pedicles was observed, and the lower lid contour improvements were durable. One infection occurred after 3 days of surgery, and was resolved by removal of the suture followed by topical application of iodine and oral antibiotics for 3 to 5 days. No other complications were observed. Precisely repositioning transconjunctival fat using a layer-level fixation technique with a fan-shaped thin fat pedicle under a subperiosteal plane is an effective, lasting, and safe approach for individually treating TTD.


Assuntos
Blefaroplastia , Tecido Adiposo/transplante , Pálpebras/cirurgia , Humanos , Suturas
8.
Ann Plast Surg ; 87(5): 523-527, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34469913

RESUMO

OBJECTIVE: This study aims to evaluate the clinical effect of modified maximal levator palpebrae superioris shortening method for severe congenital ptosis. METHODS: A retrospective case series was performed including 66 eyes from 62 patients who underwent modified maximal levator palpebrae superioris shortening surgery to treat severe congenital ptosis between February 2015 and November 2018. Preoperative and postoperative margin reflex distance 1 and levator muscle function were recorded. The surgical results were graded as good, satisfied, and poor for functional and cosmetic improvement of the eyelids, and the incidence of complications was also documented. RESULTS: The mean patient age at the time of surgery was 4.6 ± 1.8 years (2-9 years), and the mean follow-up time was 36.3 ± 14.1 (12-55 months). A mean significant improvement in margin reflex distance 1 and levator function after operation was noted (P < 0.01). The eyelid height and symmetry were satisfied in 59 patients, with success rate of 95.2%. For the patients in the levator function (≤2 mm) group, the success rate was 87.5%. Moreover, the levator function (≤2 mm) group had a higher rate of poor results than levator function (2-4 mm) group (12.5% vs 2.2%). Overcorrection (6.5%) and eyelid fold deformity (11.3%) were the most frequent postoperative complications. CONCLUSION: Modified maximal levator palpebrae superioris shortening was effective and endurable in the treatment of severe congenital ptosis with poor levator function, including in patients whose levator function was less than 2 mm.


Assuntos
Blefaroplastia , Blefaroptose , Blefaroptose/cirurgia , Criança , Pálpebras/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
9.
Facial Plast Surg Clin North Am ; 29(4): 487-495, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34579832

RESUMO

Asians have anatomic and clinical characteristics to be considered before forehead lift. Because of the anatomic characteristics of Asians, for the better outcomes of blepharoplasty or augmentation rhinoplasty, forehead lift as a combined surgery must be considered beforehand. Forehead lift is frequently indicated in young Asian patients. Endoscopic browlift without visible scar is favored for patients, and it can be done in a modified multiplane fashion for better outcomes in patients with thick and redundant skin. There are rare but severe complications of endoscopic forehead lift, such as motor nerve paresis and diplopia, although they are temporary in most cases.


Assuntos
Blefaroplastia , Ritidoplastia , Pálpebras/cirurgia , Testa/cirurgia , Humanos
10.
Facial Plast Surg Clin North Am ; 29(4): 497-509, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34579833

RESUMO

The lower eyelids and midface are considered to be a contiguous aesthetic unit although they are different anatomic structures. Through in-depth understanding of complex anatomy and aging theory and appropriate surgical strategies according to the type of aging, surgical outcome of aging lower eyelid/midface can be more and more predictable. This article discusses the characteristics and theories of aging and 5 types of lower eyelid/middle face aging based on 4 key factors, namely, protruding fat in the orbital, excess skin on the lower eyelid, sagging midface and soft tissue deflation. Various combinations of surgical strategies are adopted accordingly.


Assuntos
Blefaroplastia , Ritidoplastia , Tecido Adiposo/transplante , Pálpebras/cirurgia , Face , Humanos , Rejuvenescimento
11.
Facial Plast Surg Clin North Am ; 29(4): 511-522, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34579834

RESUMO

The goal of Asian blepharoplasty is to create a lid crease configuration that resembles the natural-appearing crease found in other Asians. Because the Asian upper eyelid contains more prominent preseptal fat resulting in greater lid fullness, soft tissue work in blepharoplasty of the Asian eye is even more diverse and essential than that of whites in order for there to be the sustainability of the eyelid crease. Hence, Asian blepharoplasty should be performed specifically following the orbital anatomy of Asians. This article details the incisional method of blepharoplasty to create natural-appearing creases for Asians with single eyelids.


Assuntos
Blefaroplastia , Pálpebras/cirurgia , Humanos
12.
Facial Plast Surg Clin North Am ; 29(4): 523-532, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34579835

RESUMO

Various nonincisional techniques for double eyelid surgery have been introduced in the past. They are simple, noninvasive, and efficient techniques to create a double eyelid. The authors prefer the full-thickness single continuous method using the 7-0 nylon, round long needle. Appropriate choice of the patients and surgical method results in a natural, esthetically pleasing eyelid and decreases the loss of eyelid crease.


Assuntos
Blefaroplastia , Pálpebras/cirurgia , Humanos , Agulhas , Técnicas de Sutura
13.
Korean J Ophthalmol ; 35(5): 383-390, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34344132

RESUMO

PURPOSE: Even though it is stated that external levator advancement (ELA) has a much longer learning curve than Müller muscle-conjunctival resection (MMCR) in the treatment of aponeurotic ptosis, there is no study in the literature regarding the learning curves of these two surgical techniques. We aimed to objectively determine the length of the learning curves of ELA and MMCR using cumulative sum (CUSUM) analysis. METHODS: The first 30 unilateral ELA and the first 30 unilateral MMCR consecutively performed by a single surgeon were retrospectively reviewed. The CUSUM method was used to analyze the learning curves of ELA and MMCR based on operation times of consecutive surgeries and the clinical outcomes were compared. RESULTS: CUSUM analyses revealed that the operation time stabilized after around 11 ELA surgeries and 12 MMCR surgeries and R2 value for ELA and MMCR were 0.93 and 0.91, respectively. There was no significant difference in these stratified analyses. Mean operation time was 45.7 minutes in the ELA group and 34.1 minutes in the MMCR group (p = 0.002). Total number of intraoperative complications was 37 in the ELA group and 16 in the MMCR group (p = 0.015). Symmetry success rate was significantly higher (p < 0.0001) and reoperation rate was significantly lower in the MMCR group (p = 0.045). CONCLUSIONS: Even though ELA is more challenging than MMCR, comparable learning curves indicate that surgeons in training need to be encouraged to perform both techniques. The challenges and obstacles that the surgeons in training face in these two techniques need to be analyzed in detail.


Assuntos
Blefaroplastia , Blefaroptose , Blefaroptose/cirurgia , Pálpebras/cirurgia , Humanos , Curva de Aprendizado , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
14.
Aesthet Surg J ; 41(11): NP1408-NP1420, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34337655

RESUMO

BACKGROUND: The "time variable" assumes paramount importance, especially regarding facial rejuvenation procedures. Questions regarding the length of recovery time before returning to work, how long the results will last, and the ideal time (age) to undergo this particular type of surgery are the most commonly asked by patients during the initial consultation. OBJECTIVES: The authors endeavored to determine the healing time, optimal age to perform the surgery, and duration of the results after cosmetic face surgery. METHODS: A 35-year observational study of 9313 patients who underwent facial surgeries was analyzed. The principal facial rejuvenation interventions were divided into 2 subgroups: (1) eyelid and periorbital surgery, including eyebrow lift, blepharoplasty, and its variants and midface lift; and (2) face and neck lift. Significant follow-ups were conducted after 5, 10, and 20 years. To evaluate the course of convalescence, the degree of satisfaction with the intervention, and the stability of the results, a questionnaire survey was administered to a sample of 200 patients who underwent face and neck lifts. RESULTS: The answers given indicated that surgery performed according to rigorous standards allowed for a relatively rapid recovery, and the positive results were stable up to 10 years after surgery. The level of patient satisfaction also remained high even after 20 years. CONCLUSIONS: The "right time" for a facelift, taking into account age, recovery time, and the longevity of the results, is an important consideration for both the patient and the cosmetic surgeon.


Assuntos
Blefaroplastia , Ritidoplastia , Envelhecimento , Sobrancelhas , Humanos , Rejuvenescimento
15.
Plast Reconstr Surg ; 148(2): 195e-199e, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398084

RESUMO

SUMMARY: Patients with aponeurotic blepharoptosis who are treated with external levator advancement may experience complications such as upper eyelid height asymmetry and often require revision surgery. The authors assessed the efficacy of Müller muscle-conjunctival resection in cases with upper eyelid height asymmetry following bilateral external levator advancement. The authors used retrospective analysis of 11 cases between September of 2016 and October of 2018 with eyelid asymmetry following bilateral external levator advancement. Following a positive phenylephrine test, these patients underwent unilateral Müller muscle-conjunctival resection revision surgery to treat the undercorrected eyelid. Preoperative and postoperative marginal reflex distance 1, symmetry outcomes, and clinical outcomes of patients were evaluated after the Müller muscle-conjunctival resection. The average patient age was 54.81 ± 3.95 years (range, 37 to 69 years; median, 56 years); seven patients (63.6 percent) were women. Hering dependency was seen in all patients before the external levator advancement. A total of three patients underwent bilateral external levator advancement simultaneously, and eight patients underwent bilateral external levator advancement sequentially. The phenylephrine test was positive in all patients before the Müller muscle-conjunctival resection. Symmetry outcomes were assessed after the revision surgery as perfect (<0.5 mm), good (≥0.5 to <1 mm), or fair (≥1 mm) in four patients, six patients, and one patient, respectively. An optimal correction was noted in 13 of the 22 eyelids after the revision surgery, whereas eight of the 22 eyelids had minimal undercorrection, and one eyelid had minimal overcorrection. Müller muscle-conjunctival resection revision surgery for treatment of the ptotic eyelid following bilateral external levator advancement is viable and may represent a new alternative among the limited revision techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Reoperação/métodos , Adulto , Idoso , Blefaroplastia/estatística & dados numéricos , Túnica Conjuntiva/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
16.
BMC Ophthalmol ; 21(1): 313, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454463

RESUMO

BACKGROUND: Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data are unavailable. This study aimed to report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow-up. The prognosis of different clinical deformities was also investigated. METHODS: This was a retrospective cohort study, including consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were performed according to manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded. RESULTS: A total of 93 patients, with a mean age of 30.77 ± 14.04 (range: 9.00-70.00) years were included. Of all those 93 patients, 72.04% were females (67, P = 0.02). The mean follow-up was 5.29 ± 2.07 (range: 3-10) years before surgery, and 2.07 (range:1.54-4.22)years follow-up after surgery. The mean age of onset of blepharochalasis symptoms was 10.09 ± 3.32 (range: 5-16) years, and 83.87% patients got symptoms in puberty. With an average of 5 times per year, the mean duration of each acute attack was 28.12 ± 1.01 (rang: 2-192) hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4-10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity (29.04%), lower eyelid retraction (17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. CONCLUSIONS: Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, which might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.


Assuntos
Blefaroplastia , Blefaroptose , Doenças Palpebrais , Adolescente , Adulto , Idoso , Blefaroptose/epidemiologia , Blefaroptose/cirurgia , Criança , Pré-Escolar , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/epidemiologia , Doenças Palpebrais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
17.
J Cosmet Dermatol ; 20 Suppl 2: 12-17, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34318987

RESUMO

BACKGROUND: Blepharochalasis, induced by the aging process, is an important esthetic blemish which can be solved by blepharoplasty, the most performed cosmetic surgical procedure in the world today to repair droopy eyelids. Nowadays, there is a greater interest to combine blepharoplasty with minimally invasive treatments to harmonize the oval shape of the face. Therefore, blepharoplasty technique could be associated with face thread lifting, a safe and effective technique that optimizes the rejuvenation of the central and lower part of the face. AIM: The aim of this study was to assess the overall safety and efficacy of blepharoplasty combined with suspension thread lifting. The author also aimed to demonstrate patients' satisfaction after treatment. METHOD: The study involved 12 patients undergoing blepharoplasty plus threads lifting to improve the mandibular line. Patient's satisfaction was valuated with global esthetic improvement score, visual analog scale score, before and after treatment clinical images. RESULTS: All patients showed optimized face rejuvenation and high satisfaction. Patients experienced an immediate improvement in face harmony in addition to the eye refinement and expressed their satisfaction. The combination of plastic surgery and minimal invasive technique did not cause adverse events to the patients and they would recommend it. CONCLUSION: Interest in thread lifting is currently high, and this study highlights the excellent outcome and the visible results of blepharoplasty and threads combination.


Assuntos
Blefaroplastia , Ritidoplastia , Blefaroplastia/efeitos adversos , Pálpebras/cirurgia , Face , Humanos , Rejuvenescimento
18.
J Craniofac Surg ; 32(5): 1734-1737, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34319677

RESUMO

PURPOSE: This study designed an efficient measurement method to evaluate the outcome of transconjunctival fat reposition in the tear trough and palpebromalar groove. METHODS AND TECHNIQUES: A total of 41 patients (82 eyes) who underwent transconjunctival fat reposition surgery between January 2016 and March 2019 were retrospectively analyzed. Preoperative and postoperative (at least six months) standardized digital images were taken from the patients. A satisfaction survey was conducted on all patients. Their images were analyzed by using the Adobe Photoshop CS5 software. Ratios of the tear trough and palpebromalar groove were calculated. These data were analyzed by SPSS 20.0. RESULTS: The overall satisfaction rate was 90.2%. With a partition in the infraorbital region, a line graph showed that the location of the tear trough and palpebromalar groove moved to the upper squares postoperatively. The number of patients whose end points of the tear trough and palpebromalar groove located outside the midline of the pupil decreased by 30.5%. When we processed all the parameters of the preoperative and postoperative groups by profile analysis, a significant difference in the tear trough and palpebromalar groove before and after surgery was observed (right: F = 79.844, P = 0.000 < 0.01; left: F = 161.799, P = 0.000 < 0.01). CONCLUSIONS: Digital image analysis is feasible and useful in investigating the improvement of the tear trough and palpebromalar groove. The tear trough and palpebromalar groove shifted up and became shortened, which provided a more reliable evidence for lower eyelid rejuvenation.


Assuntos
Blefaroplastia , Tecido Adiposo/transplante , Pálpebras/cirurgia , Humanos , Rejuvenescimento , Estudos Retrospectivos
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