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1.
Facial Plast Surg Clin North Am ; 30(2): 271-276, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35501064

RESUMO

This study investigated eye movement patterns using eye tracking technology when looking at preoperative and postoperative images of patients that underwent bilateral periorbital cosmetic surgery. The sequence of facial recognition before surgery was periorbital-nose-perioral, whereas following surgery it was nose-periorbital-perioral. This study revealed that the sequence of facial feature recognition is influenced by the aesthetic liking of the observer and that alteration to facial features influences the sequence of facial feature recognition. The eye movement pattern, however, seems to follow the internal representation of beauty where aesthetically pleasing facial features are observed later during first image exposure and are viewed shorter.


Assuntos
Blefaroplastia , Reconhecimento Facial , Blefaroplastia/efeitos adversos , Blefaroplastia/métodos , Tecnologia de Rastreamento Ocular , Pálpebras , Humanos , Transplante de Pele
2.
Ann Plast Surg ; 88(1s Suppl 1): S73-S77, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35225851

RESUMO

BACKGROUND: Fat grafting is increasingly used as an adjuvant surgery to blepharoplasty to refill the volume loss of an aged face and promote cellular regeneration. Complications, such as hematoma, infection, seroma, and palpable mass, may occur. We collected the patients that underwent lower blepharoplasty combined with fat graft to evaluate the incidence of oil cyst formation in the lower eyelid and to identify risk factors. MATERIAL AND METHODS: A retrospective review was performed of all patients who underwent lower or total blepharoplasty combined with fat graft at the authors' institution between January 2018 and June 2020. Complication rates were observed, and associations between preoperative variables and outcomes were assessed. RESULTS: A total of 119 patients were included in the series (all bilateral, 238 eyelids). The average patient age was 54.88 ± 11.94 years, and the average grafted fat was 1.88 ± 1.0 mL. On a per-eyelid basis for all patients, the complication rate of oil cyst formation was 6.72% (16 of 238 eyelids). The occurrence of oil cyst formation was associated with hypertension (P = 0.012; adjusted odds ratio, 9.27; 95% confidence interval, 1.62-52.99) and diabetes mellitus (P = 0.005; adjusted odds ratio, 14.02; 95% confidence interval, 2.22-88.45), but not associated with anticoagulants use (P = 0.931), age (P = 0.784), sex (P = 0.317), or fat volume (P = 0.215). The mean interval between the fat graft procedure and oil cyst noted was 236.5 ± 118.9 days. CONCLUSIONS: Oil cyst in lower eyelid can be defined as a palpable, firm, and persistent subcutaneous cystic lesion found postoperatively in any size during physical examination. The complication rate of oil cyst formation occurring after lower blepharoplasty with autologous fat grafting is 6.72%. Hypertension and diabetes mellitus maybe are risk factors of oil cyst formation. Steroid injection, needle capsulotomy, liposuction, and excision are safe and effective treatments. Reduce surgical trauma by diminishing anterior lamina trauma and capsulopalpebral fascia repair might decrease the complication rate of oil cyst formation.Transconjunctival lower blepharoplasty with fat graft or 2-stage surgery may be a choice to prevent oil cyst formation.


Assuntos
Blefaroplastia , Cistos , Lipectomia , Tecido Adiposo/transplante , Adulto , Idoso , Blefaroplastia/efeitos adversos , Cistos/etiologia , Pálpebras/cirurgia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Aesthet Surg J ; 42(3): 239-248, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-34618888

RESUMO

BACKGROUND: Periorbital fractional CO2 laser resurfacing has been employed for facial rejuvenation purposes. However, to the best of our knowledge, no study has objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. OBJECTIVES: The authors sought to objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. METHODS: Sixteen female patients presenting with dermatochalasis and periorbital rhytids were evaluated in a prospective and comparative study. All patients underwent unilateral periorbital fractional CO2 laser resurfacing 30 days before upper blepharoplasty. Quantification of types I and III collagen from laser-treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment and 1- and 6-month posttreatment digital images. RESULTS: Histochemical analysis showed significantly higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; P < 0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; P < 0.0001) in the fractional CO2 laser treatment samples; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed 1 month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). CONCLUSIONS: Periorbital fractional CO2 laser resurfacing was an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III.


Assuntos
Blefaroplastia , Terapia a Laser , Lasers de Gás , Envelhecimento da Pele , Blefaroplastia/efeitos adversos , Blefaroplastia/métodos , Colágeno , Feminino , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Lasers de Gás/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento
4.
Rev. bras. oftalmol ; 81: e0005, 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1360915

RESUMO

ABSTRACT Objective: To describe the upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture in order to evaluate the efficacy of the technique. Methods: This is a retrospective study in which the medical records of 5,882 patients who underwent this technique between January 1999 and July 2015 were evaluated. The frequency and main causes of clinical complications and surgical reoperation were analyzed. Results: The incidence of complications found was 12.7% (n=750), being 0.8% (n=47) due to persistent chemosis, 3% (n=176) due to poor lower eyelid positioning, 4.17% (n=245) due to mild eyelid retraction and 4.8% (n=282) because of mild to moderate chemosis. Conclusion: The technique appears to be effective as it is simple and practical, and capable of resulting in positive functional and aesthetic outcomes with low rates of complications.


RESUMO Objetivo: Descrever a técnica de blefaroplastia superior e inferior associada à cantopexia associada à dupla elevação do músculo orbicular pré-septal em uma única sutura e avaliar sua eficácia. Métodos: Trata-se de estudo retrospectivo, no qual foram avaliados 5.882 prontuários de pacientes submetidos à blefaroplastia superior e inferior com a utilização da cantopexia, entre janeiro de 1999 e julho de 2015. Taxas e principais causas de complicações clínicas e reintervenção cirúrgica foram analisadas. Resultados: A incidência de complicações encontradas foi de 12,7% (n=750), sendo 0,8% (n=47) de caso de quemose persistente, 3% (n=176) de mau posicionamento palpebral inferior (ectrópio), 4,17% (n=245) de leve retração pálpebra e 4,8% (n=282) de quemose leve a moderada. Conclusão: A técnica mostra-se eficaz por ser simples e prática, podendo ter resultados funcionais e estéticos positivos e com baixo índice de complicações.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Blefaroptose/cirurgia , Técnicas de Sutura , Blefaroplastia/efeitos adversos , Blefaroplastia/métodos , Doenças Palpebrais/cirurgia , Complicações Pós-Operatórias/etiologia , Envelhecimento da Pele , Registros Médicos , Estudos Retrospectivos , Doenças da Túnica Conjuntiva/etiologia , Edema/etiologia , Pálpebras/cirurgia , Músculos Faciais/cirurgia
5.
Biomed Res Int ; 2021: 1837458, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840967

RESUMO

OBJECTIVE: To explore the role of conjoint fascial sheath (CFS) suspension in the treatment of severe ptosis. METHODS: A total of 110 patients with severe ptosis who were admitted to our hospital from May 2018 to December 2020 were included. Fifty-seven patients treated with frontalis suspension were assigned into group A, and the remaining 53 patients treated with CFS suspension were assigned into group B. The curative effect, ocular surface alterations, complications, and satisfaction in the two groups were compared. RESULTS: Patients in group B suffered from severe upper eyelid retraction and lid lag than those in group A, as well as more limited range of motion (ROM) (P < 0.05). The curative effect and patient satisfaction in group B were higher than those in group A (P < 0.05). Postsurgical complications in group B were fewer than those in group A (P < 0.05). CONCLUSION: CFS suspension is effective in the treatment of severe ptosis.


Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Adolescente , Adulto , Blefaroplastia/efeitos adversos , Blefaroptose/fisiopatologia , Pálpebras/fisiopatologia , Pálpebras/cirurgia , Fasciotomia/métodos , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
6.
PLoS One ; 16(8): e0255988, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383823

RESUMO

Epiphora and dermatochalasis are common presentations in the ophthalmology clinic. To evaluate the change of epiphora before and after functional blepharoplasty, this retrospective cohort study reviewed 39 medical records of epiphora patients who underwent upper blepharoplasty. Severity of epiphora using MUNK score was collected and compared between before and at 6 months after blepharoplasty. The analysis model was performed to measure tear breakup time (TBUT) and frequency of artificial tears use. Subgroups of subjects before blepharoplasty to short baseline TBUT (≤ 10 seconds) and long TBUT (≥ 10 seconds) were also evaluated for the MUNK score change. From the analysis of 39 patients, the results showed a statistically significant decrease in post blepharoplasty MUNK score compared to the baseline (all P < 0.001). There was no significant difference between baseline and post-operative TBUT (P > 0.05). Twenty patients were in the short TBUT group and 19 in the long TBUT group. The reduction of MUNK score after blepharoplasty in the short TBUT group was not different to the long TBUT group (P = 0.50, 95% CI -0.84 to 0.41). However, in short TBUT group, frequency of artificial tears use after surgery was less than pre-operation. From the study, upper eyelid blepharoplasty might be one technique reducing the bothersome epiphora in dermatochalasis patients.


Assuntos
Blefaroplastia/efeitos adversos , Blefaroptose/cirurgia , Pálpebras/fisiologia , Doenças do Aparelho Lacrimal/patologia , Lágrimas/metabolismo , Idoso , Blefaroptose/patologia , Feminino , Humanos , Doenças do Aparelho Lacrimal/etiologia , Lubrificantes Oftálmicos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Dermatol Surg ; 47(10): 1376-1378, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34352836

RESUMO

BACKGROUND: The various techniques of upper blepharoplasty have been compared based on surgical time to perform the procedure, postoperative healing, scar cosmesis, and cost. Few studies have evaluated the histology of the excised tissue, and no study has compared the tissue histology of 3 blepharoplasty methods using scalpel, microdissection needle with electrocautery, and CO2 laser excision in the same patient. OBJECTIVE: To evaluate the histologic changes of tissue after removal of upper eyelid skin using scalpel incision, microdissection electrocautery needle, and CO2 laser. METHODS: Upper blepharoplasty skin excisions were examined from specimens obtained using scalpel incision, microdissection needle tip with electrocautery, and CO2 continuous wave beam. The specimens were sent for permanent sections for histologic evaluation. RESULTS: The skin that was removed using cold steel scalpel incision showed no cellular necrosis or heat artifact. The tissue treated with the CO2 laser demonstrated significant thermal injury, including loss of cellular polarity, keratinocyte necrosis, and separation of the epidermis from the basement membrane. The skin excised using the electrocautery microdissection needle demonstrated fulguration artifact, including spindling of the epidermal nuclei with palisading of the keratinocytes. Necrosis was not prominent in the electrocautery microdissection needle specimens. CONCLUSION: The amount of histologic tissue injury was greatest in the skin treated with continuous wave CO2 laser, followed by the microdissection needle with electrocautery. The cold steel scalpel incision showed no cellular necrosis.


Assuntos
Blefaroplastia/efeitos adversos , Cicatriz/diagnóstico , Pálpebras/patologia , Ferida Cirúrgica/complicações , Blefaroplastia/instrumentação , Cicatriz/etiologia , Cicatriz/patologia , Eletrocirurgia/efeitos adversos , Eletrocirurgia/instrumentação , Estética , Pálpebras/cirurgia , Humanos , Lasers de Gás/efeitos adversos , Necrose/diagnóstico , Necrose/etiologia , Necrose/patologia , Agulhas/efeitos adversos , Índice de Gravidade de Doença , Ferida Cirúrgica/patologia , Resultado do Tratamento , Cicatrização
8.
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
10.
Aesthet Surg J ; 41(9): 1003-1010, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34128526

RESUMO

BACKGROUND: Lower blepharoplasty is a common cosmetic operation that relies on minimal postoperative scarring, but Asian patients are at higher risk than Caucasians for hypertrophic and/or widened scars. Botulinum toxin type A (BTX) injections are widely employed to alleviate dynamic facial rhytids and also can improve scar quality by reducing scar tension. The authors assessed whether simultaneous transcutaneous lower blepharoplasty and BTX injections could improve subciliary scar quality. OBJECTIVES: The objective of this study was to assess whether simultaneous transcutaneous lower blepharoplasty and BTX injections could improve subciliary scar quality. METHODS: This is a prospective, randomized, vehicle-controlled, double-blinded clinical trial. Between May 2015 and May 2018, 40 adults who underwent bilateral transcutaneous lower blepharoplasties were randomized to receive BTX (n = 20) or vehicle (normal saline; n = 20) injections into the lateral orbicularis oculi muscle immediately after wound closure. Vancouver Scar Scale, Visual Analogue Scale, and photographic scar width measurements at 3 reference points were recorded at the final clinical follow-up. RESULTS: Thirty-seven patients completed the trial. Vancouver Scar Scale and Visual Analogue Scale scores in the experimental and vehicle control groups were similar, but scar widths in the experimental group at all measured points were significantly narrower than in the vehicle control group (P < 0.001, P = 0.027, and P < 0.001 at each measured point, respectively). CONCLUSIONS: Transcutaneous lower blepharoplasty scars in Asians can be significantly narrowed by simultaneous BTX injections without additional complications.


Assuntos
Blefaroplastia , Toxinas Botulínicas Tipo A , Adulto , Blefaroplastia/efeitos adversos , Cicatriz/etiologia , Cicatriz/prevenção & controle , Humanos , Estudos Prospectivos , Resultado do Tratamento
11.
Dermatol Surg ; 47(7): 914-920, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33988553

RESUMO

BACKGROUND: Determining which postsurgical scar assessment instruments, if any, cover important eyelid outcome measures can either attest to the strength of one or more instruments or reveal the need for a more comprehensive scale. OBJECTIVE: To systematically review validated outcome measures after eyelid surgery and postsurgical scar assessment tools to see whether any individual or combination of 2 assessment tools encompass all relevant, validated eyelid outcome measures. METHODS: Systematic reviews of validated eyelid outcome measures and postsurgical scar assessment tools were conducted using PubMed/MEDLINE and Ovid. Outcome measure papers that met inclusion criteria were sorted into 8 categories: Patient Subjective, Visual Function, Mechanical Function, Daily Activities, Adverse Effects, Aesthetic Quantitative: Clinical Measurements, Aesthetic Qualitative: Global, and Aesthetic Qualitative: Specific. Outcome measure papers were categorized into tiers of evidence support, and assessment tools were evaluated based on which outcome measures each covered. RESULTS: No one or combination of 2 assessment tools covered all selected eyelid outcome measures. Although measures related to the subjective patient experience were included in several of the assessment scales, none covered measures of visual function or eyelid-specific clinical measurements. CONCLUSION: There is currently no existing postsurgical scar assessment instrument that covers all important eyelid-specific outcome measures.


Assuntos
Blefaroplastia/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/etiologia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Humanos , Estudos de Validação como Assunto
12.
J Drugs Dermatol ; 20(4): 475-476, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852245

RESUMO

This case series demonstrates an exaggerated form of the clinical presentation of a known distressing late complication of retained hyaluronic acid filler – the “pale puffy pillow.” This presentation is often, unfortunately for the patient, misdiagnosed as festoons. However, the correction with liberal hyaluronidase is simple. Additionally, we have demonstrated that ablative fractional carbon dioxide laser resurfacing is an excellent tool that may be utilized after hyaluronidase to correct the residual skin laxity.J Drugs Dermatol. 20(4):475-476. doi:10.36849/JDD.5509.


Assuntos
Blefaroplastia/efeitos adversos , Edema/terapia , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase/administração & dosagem , Lasers de Gás/uso terapêutico , Adulto , Idoso , Blefaroplastia/métodos , Edema/etiologia , Pálpebras/efeitos dos fármacos , Pálpebras/efeitos da radiação , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/antagonistas & inibidores , Pessoa de Meia-Idade , Estudos Retrospectivos , Envelhecimento da Pele/efeitos dos fármacos , Resultado do Tratamento
17.
Aesthet Surg J ; 41(8): 893-902, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-33534896

RESUMO

BACKGROUND: Various methods on transconjunctival fat repositioning have been promoted to treat tear trough deformities in patients with eye bags. OBJECTIVES: The authors present a modified approach based on the facial soft-tissue spaces with the combined fixation method. METHODS: A total 226 patients underwent this procedure. Through a preseptal approach, the premaxillary and prezygomatic spaces were sequentially separated. Orbital fat was repositioned into the spaces together with the septum. The proximal part of the septum-fat flap was sutured to orbital rim with internal fixation, and their distal stumps were fixed to the end of the soft spaces with externalized percutaneous sutures. Surgical outcome was assessed by surgeons based on Hirmand's grading system. Patients' satisfaction and quality of life were measured using FACE-Q scales. Magnetic resonance imaging was employed to assess the long-term fate of the transposed fat. RESULTS: Tear trough deformities were eliminated in 86.7% of cases. Scores of lower eyelid FACE-Q decreased significantly (P < 0.05). Patients demonstrated enhanced social confidence (P < 0.05) and high satisfaction (74.3 ± 17.2) and were satisfied with their decision to undergo blepharoplasty (78.2 ± 18.7). Undercorrection occurred in 1 patient. Additional complications included transient granulomas, dye eye, unexplained swelling, and numbness, which resolved in all patients. Magnetic resonance imaging confirmed viability of the transposed fat within 6 to 8 months follow-up. CONCLUSIONS: Transconjunctival fat repositioning, utilizing a combination of internal fixation and external fixation, is an effective approach to treat eye bags and tear trough deformities with good patient and surgeon satisfaction.


Assuntos
Blefaroplastia , Tecido Adiposo/transplante , Blefaroplastia/efeitos adversos , Fixadores Externos , Pálpebras/diagnóstico por imagem , Pálpebras/cirurgia , Fixação de Fratura , Humanos , Qualidade de Vida
18.
Aesthet Surg J ; 41(12): 1346-1355, 2021 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33560294

RESUMO

BACKGROUND: Asian upper blepharoplasty is the most popular cosmetic procedure for Asian women. However, there is no standardized approach to this procedure and suboptimal results are still common. OBJECTIVES: The aim of this article was to describe a comprehensive approach to Asian upper blepharoplasty in women and report the clinical outcomes obtained with this approach. METHODS: The comprehensive approach described here for Asian upper blepharoplasty in women includes: (1) determining the height and length of the upper eyelid skin crease; (2) creating a more optimal anatomy of the upper eyelid by removing excess eyelid skin, a portion of the orbicularis oculi muscle, and septal fat; (3) reconstructing the desired anatomic structures of the upper eyelid skin crease through plication of the levator aponeurosis, if necessary, and closure of the upper eyelid skin incision through the septum and the mobile portion of the levator aponeurosis; (4) adding a medial epicanthoplasty if needed to enhance final cosmetic results. RESULTS: Over a 5-year period, 332 Asian women underwent upper blepharoplasty for creation of double eyelids, or conversion from less visible to more ideal double eyelids, with the above comprehensive approach. There were no surgical complications postoperatively and 326 patients (98.2%) rated their outcome satisfactory over a 5-year follow-up. Only 6 patients (1.8%) required surgical revision for asymmetry or suboptimal shape of the upper eyelid. CONCLUSIONS: The comprehensive approach to Asian upper blepharoplasty described here can be used for Asian women and produces a natural and aesthetically pleasing outcome and low revision rates.


Assuntos
Blefaroplastia , Ferida Cirúrgica , Blefaroplastia/efeitos adversos , Pálpebras/cirurgia , Músculos Faciais/cirurgia , Feminino , Humanos , Pele
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