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1.
Facial Plast Surg ; 37(2): 149-159, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33657627

RESUMO

Facial aging in the midface has been described to encompass both soft tissue descent and volumetric change. Currently, there is no established and widely accepted grading system for midfacial ptosis. We propose a simplified grading system for midfacial ptosis ranging from mild to severe in terms of Grades I through III. Using this classification system, we describe an algorithm to help select the facelift approach most appropriate for each patient. The sub-superficial musculoaponeurotic system rhytidectomy, deep plane rhytidectomy, and subperiosteal midface lift techniques are described in detail. The nuances of the selection process also include a discussion on the various approaches to the orbital fat, namely a transconjunctival lower lid blepharoplasty with skin pinch versus a lower lid blepharoplasty with fat transposition, as well as the aging neck. Furthermore, we integrate the addition of postoperative adjunctive procedures which include injectables, chemical peels, and dermabrasion to address facial rejuvenation from not only a gravitational aspect but also the volumetric and textural components.


Assuntos
Blefaroplastia , Ritidoplastia , Sistema Musculoaponeurótico Superficial , Pálpebras/cirurgia , Humanos , Rejuvenescimento
4.
Facial Plast Surg ; 37(2): 198-204, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33634449

RESUMO

The subciliary lower eyelid blepharoplasty has evolved considerably to create a more harmonious natural appearance with a fuller and unoperated look and also to minimize the complications. While lower eyelid malposition was very common in the past, now this complication is significantly reduced by attention to preoperative evaluation, meticulous surgical planning, precise surgical technique, and postoperative care. Various prophylactic maneuvers maintaining/strengthening lower lid support can be utilized to prevent lower lid malposition including preservation of the pretarsal orbicularis oculi muscle, conservative resection of skin and muscle, and suspension of the orbicularis oculi muscle and/or tarsus to the periosteum of the lateral orbital rim. The release of the orbicularis retaining ligament and surgical transposition of orbital fat over the rim rather than excision allows for smoothing of the lid-cheek junction, filling the tear trough deformity, and reducing the appearance of bulging fat in the lower eyelid. In this article the reader will find a comprehensive approach for achieving a smooth contour with gradual blending at the lower eyelid-cheek junction while maintaining/restoring normal lower lid support. A descriptive outline of postoperative care is also provided to help in optimal healing for the patient.


Assuntos
Blefaroplastia , Doenças Palpebrais , Bochecha/cirurgia , Pálpebras/cirurgia , Músculos Faciais , Humanos
5.
Facial Plast Surg ; 37(2): 194-197, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33517576

RESUMO

Upper eyelid surgery is a common procedure performed by a variety of subspecialists including facial plastic surgeons, oculoplastic surgeons, general otolaryngologists, and plastic surgeons. Traditionally, a skin incision is marked in the preoperative setting to allow for an excision that eliminates upper eyelid hooding while preventing lagophthalmos. Many different methodologies have been proposed to maximize results and minimize complications. In this article, the authors propose a unique way to safely and effectively address dermatochalasis. The pinch technique allows for an accurate assessment of excess skin and provides a method that requires less operative time than traditional techniques. The use of both local anesthetic with epinephrine and hyaluronidase helps achieve the appropriate plane and attain better hemostasis. Importantly, the presented technique allows for reassessment and revision of the amount of skin excision before incision creation. It is a useful methodology for any surgeon performing upper lid blepharoplasty.


Assuntos
Blefaroplastia , Doenças Palpebrais , Pálpebras/cirurgia , Face , Humanos , Rejuvenescimento
6.
Klin Monbl Augenheilkd ; 238(1): 33-40, 2021 Jan.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33445184

RESUMO

Patients with Graves' orbitopathy often develop eyelid changes. These may be the result of a volume effect or a malposition. Both dermatochalasis with fat tissue increase and eyelid retraction may lead to functional or aesthetic impairment. The present article reviews indications, timing and principles for corrective eyelid surgery. If at all possible, surgical eyelid correction in Graves' orbitopathy should be performed once the disease became inactive and stabile. Surgical details of eyelid lengthening procedures for upper and lower eyelid retraction are presented. Meanwhile anterior blepharotomy became the primary procedure for upper eyelid lengthening. However, there is no such standard procedure for lower eyelid lengthening, although it is recommended to use a spacer. For blepharoplasty it is mandatory to distinguish between orbital fat prolapse and subbrow fat pad. A prolapse of the lacrimal gland should not be missed and generally, skin excision performed sparingly.


Assuntos
Blefaroplastia , Doenças Palpebrais , Oftalmopatia de Graves , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Oftalmopatia de Graves/cirurgia , Humanos , Resultado do Tratamento
7.
Aesthet Surg J ; 41(5): NP198-NP209, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33346340

RESUMO

BACKGROUND: Patients presenting for upper blepharoplasty can exhibit different aging patterns and we have anecdotally observed wide variability in upper blepharoplasty approaches among surgeons. However, upper blepharoplasty practice patterns have not been systematically analyzed among members of The Aesthetic Society. OBJECTIVES: The aim of this study was to report upper blepharoplasty practice patterns, the recognition of different patient presenting features, and to assess the incidence and management of ptosis as reported by members of The Aesthetic Society. METHODS: A 29-item electronic questionnaire was distributed to 1729 Aesthetic Society members with available email addresses. RESULTS: In total, 214 Aesthetic Society members submitted the questionnaire, for a response rate of 12.4%. There was a significantly increased rate of volume preservation among surgeons with greater experience (≥10 years in practice) and a high-volume (≥100 cases in past 12 months) of upper blepharoplasty cases. Furthermore, high-volume upper blepharoplasty surgeons were significantly more likely to perform concomitant upper lid fat grafting (P = 0.03), browlift (P = 0.02), and ptosis repair (P = 0.01). Ninety-five percent of respondents reported a mild/moderate ptosis (MRD1 2 to <4mm) incidence of <25%. Among surgeons who perform ptosis repair, 97.4% utilize levator advancement or plication as their most commonly used technique. CONCLUSIONS: High-volume upper blepharoplasty surgeons are more likely to preserve upper lid volume and perform concomitant browlift and ptosis repair. Our data suggest that different upper eyelid aging patterns and mild/moderate ptosis are underrecognized.


Assuntos
Blefaroplastia , Blefaroptose , Ritidoplastia , Blefaroplastia/efeitos adversos , Blefaroptose/cirurgia , Estética , Pálpebras/cirurgia , Humanos , Estudos Retrospectivos
8.
Facial Plast Surg ; 36(5): 563-574, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33368080

RESUMO

Differences between Oriental and Caucasian eyelids have been explained in great detail in several reports in the past. The purpose of this article is to discuss the functional aspects of Asian double fold upper blepharoplasty and to present techniques that help to improve both the functional and cosmetic outcomes and satisfaction after surgery. The eyes of Asians are relatively small with thick skin in the eyelids and periorbital area. They typically lack the upper eyelid crease (creating the so-called double eyelid) due to burden factors like thick skin, hypertrophied orbicularis oculi muscle (OOM), submuscular fibroadipose tissue, thick orbital septum, abundant preaponeurotic fat, and lower positioned transverse ligament. Asian eyes may also have a superior visual field defect due to skin overriding the upper lid margin (skin-OOM-fat complex slide down). These burden factors result in the eyelashes appearing short and becoming misdirected and pressed toward the globe, causing functional discomfort. As a compensatory mechanism, Asian people tend to engage the frontalis muscle to lift the eyebrow to help them open their eyes. Along with aesthetic enhancement, double-eyelid surgery in Asian burden lids can improve the functional deficiencies helping the patients to open the eyes more easily. In addition, treatment of the Mongolian fold (medial epicanthal fold), caused by medial hypertrophy of preseptal OOM, augments the surgical results. In this report, we present the appropriate preoperative assessment, surgical technique, and postoperative care that should be employed to achieve consistently good functional and aesthetic outcomes in these patients.


Assuntos
Blefaroplastia , Grupo com Ancestrais do Continente Asiático , Estética Dentária , Pálpebras/cirurgia , Músculos Faciais/cirurgia , Humanos
9.
Facial Plast Surg ; 36(5): 575-583, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33368081

RESUMO

Blepharoplasty is a commonly performed aesthetic surgery, especially in Asians. Nevertheless, as in all surgeries, postoperative complications still occur. Asymmetry is the most common complication after double eyelid surgery. Preexisting asymmetries in patient appearance and technical faults during surgery are associated with postoperative asymmetrical double eyelids. In this review, we discuss how to prevent unfavorable outcomes after this procedure and how to manage asymmetrical double eyelids when they do occur.


Assuntos
Blefaroplastia , Cirurgia Plástica , Grupo com Ancestrais do Continente Asiático , Blefaroplastia/efeitos adversos , Pálpebras/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia
10.
Facial Plast Surg ; 36(5): 592-601, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33368082

RESUMO

Double eyelid surgery remains one of the most popular aesthetic surgeries, especially among East Asian populations. Complications related to double eyelid surgery can be divided into various categories: (1) patient dissatisfaction, (2) problems with the eyelid crease, (3) problems with the eyelid height, (4) suture-related complications, and (5) complications related to eyelid surgery in general. As with all eyelid surgeries, it is important to understand and appreciate the normal and abnormal function and anatomy of the Asian eyelid to reduce the risk of complications. It is also important to recognize the various complications and their underlying causes so that the surgeon can confidently revise the surgery to achieve optimal outcomes.


Assuntos
Blefaroplastia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Grupo com Ancestrais do Continente Asiático , Blefaroplastia/efeitos adversos , Pálpebras/cirurgia , Humanos
12.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370943

RESUMO

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.


Assuntos
Fasciite Necrosante/complicações , Choque Séptico/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Pálpebras/microbiologia , Pálpebras/cirurgia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/terapia , Transplante de Pele , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Resultado do Tratamento
13.
Cesk Slov Oftalmol ; 76(3): 103-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33126805

RESUMO

The aim of this article is to present the basics of traumatology in oculoplastic surgery and to review the literature about this topic. This review sums up the problematic of injuries of the eyelid, lacrimal system and orbit. The most important types of trauma, their treatment options, and the most common complications are described. In majority of oculoplastic traumas, surgical reconstruction is the treatment of choice. The surgery is often performer immediately, but sometimes the reconstruction of eyelid and lacrimal injuries can be postponed up to 48 hours, if the immediate surgery is not possible. Although the recommendations from the literature on this topic are variable, most of the patients require at least local antibiotics, more complex traumas systemic antibiotics. Careful diagnostics and correctly performed surgical treatment, either only by ophthalmologist, or oculoplastic surgeon, or a multi-disciplinary team for more complex injuries, are the key to good functional and aesthetic results of the reconstruction.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Pálpebras/cirurgia , Humanos , Órbita/cirurgia
14.
Vestn Oftalmol ; 136(6): 19-25, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33084275

RESUMO

Palpebral eyelid weight implants are currently considered as the gold standard method for lagophthalmos correction. Manufactured from different precious metals, they have both benefits and drawbacks. The article presents the results of an experimental morphological study of biointegration of different eyelid weight implants used for correction of paralytic lagophthalmos. PURPOSE: To investigate biointegration properties of implants made of gold, platinum and platinum-gold alloy. MATERIAL AND METHODS: The study enrolled 4 Chinchilla rabbits (8 eyelids). Palpebral implants manufactured of gold, platinum and platinum-gold alloy were placed into the eyelids of the experimental animals. The morphological examination was performed 1 and 6 months after the implantation using paraffin sections. RESULTS: Light microscopy revealed that the implant beds were surrounded by pronounced fibrovascular capsule of uneven thickness over the whole follow-up. The capsule formed after the placement of an implant made of gold and platinum alloy was more loose. However, the emerging connective tissue bridges of the capsule contributed to its immobilization in the tissues and lower risk of extrusion. No signs of an inflammatory and/or allergic reaction were observed in any of the cases. CONCLUSION: The obtained results show that implants made of a 90/10% platinum-gold alloy and 999.9 fine platinum have similar biointegration in terms of morphological features during 6 months of the follow-up period.


Assuntos
Doenças Palpebrais , Paralisia Facial , Animais , Doenças Palpebrais/etiologia , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Paralisia Facial/cirurgia , Próteses e Implantes , Implantação de Prótese , Coelhos
16.
J Craniomaxillofac Surg ; 48(10): 985-993, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32863126

RESUMO

PURPOSE: The aim of this prospective study was to address the anthropometric changes in the morphology of the lower eyelid and esthetic outcomes after performing subciliary, subtarsal, and transconjunctival approaches in patients with orbital and periorbital fractures. PATIENTS AND METHODS: A prospective randomized controlled clinical study was undertaken on patients with orbital floor and infraorbital rim fractures. These were equally divided into three groups: in group 1, the fractures were approached via a stepped subciliary approach; in group 2, they were approached via a subtarsal approach; in group 3, a retroseptal transconjunctival approach was performed. The patients were assessed for anthropometric changes in the morphology of the lower eyelid, esthetic outcomes, and postoperative lower eyelid complications (LLCs). A one-way ANOVA test was used to analyze differences between the operated and non-operated sides and the effect of the surgical approach on anthropometric measurements. RESULTS: A total of 45 patients were included in the study. All the surgical approaches provided adequate surgical exposure of the infraorbital rim and orbital floor. The subtarsal approach allowed rapid access to the field (10.5 ± 1.9 min). All incisions resulted in adequate postoperative esthetic outcomes. Anthropometric analysis revealed that there were no significant differences between the three approaches, except for measurements of the eye fissure index (EFI) and lower iris coverage (LIC). Mean EFI measurements increased on all operated sides. The subciliary approach showed the highest percentage of increased measurements of this variable (34.5 ± 4.6), followed by the subtarsal approach (32 ± 2.1), and then the transconjunctival approach (31.1 ± 3.7), with p = 0.046. Furthermore, the subciliary approach significantly decreased the measurements of LIC. This change was also bigger with the subciliary approach (1.09 ± 2.3) than with the subtarsal approach (2.1 ± 2.4) or transconjunctival approach (3.4 ± 2.6), with p = 0.048. CONCLUSION: Based on the results of this study, the subtarsal approach is a minimally invasive incision that provides an adequate and direct approach to orbital floor and infraorbital rim fractures, with a favorable periorbital architecture and the lowest incidence of LLCs. Therefore, the subtarsal technique should be preferred over subciliary and transconjunctival approaches.


Assuntos
Fraturas Orbitárias/cirurgia , Túnica Conjuntiva/cirurgia , Estética Dentária , Pálpebras/cirurgia , Humanos , Órbita/cirurgia , Complicações Pós-Operatórias , Estudos Prospectivos
17.
Facial Plast Surg ; 36(4): 453-461, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866982

RESUMO

Rhytidectomy, or facelift in layman's terms, is performed to reverse the appearance of facial aging. A lift can improve volume shifts with age, reposition sagging tissues, and eliminate skin redundancy. There are limitations to what can be accomplished with a facelift alone. Commonly performed adjuncts including surgery to the eyelids or brows, liposuction, and even rhinoplasty can be combined to improve the result. Further options exist that are more commonly overlooked or rarely offered to patients but can greatly enhance the surgeon's ability to remove years from the face. This article will cover some additional options that every facial plastic surgeon should be familiar with and experienced to both describe and perform.


Assuntos
Lipectomia , Rinoplastia , Ritidoplastia , Pálpebras/cirurgia , Face/cirurgia , Humanos
18.
Rev. argent. cir. plást ; 26(3): 140-142, 20200900. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1151322

RESUMO

Paciente masculino de 68 años con carcinoma basocelular lobulado recidivado en inferior izquierdo con colgajo de Hughes hace 5 años y posterior recidiva al siguiente año con escisión en cuña. Actualmente, con una segunda recidiva, se realiza una resección amplia del 75% del total del párpado cuya congelación informa márgenes libres, reconstruido en el mismo acto quirúrgico: la lamela posterior con colgajo pediculado de periostio y la anterior con un colgajo de Mustardé. El paciente evoluciona con un buen sostén y posición palpebral, sin recurrencia del tumor.


A 68-year-old man with recurrent lobulated basal cell carcinoma of the left lower eyelid. She has a history of reconstruction of the lower left eyelid with Hughes flap 5 year sago and later recurrence the following year with wedge excision. Currently, with a second recurrence, resection was performed under frozen section technique and the defect of 75% width free of tumor, is reconstructed in the same surgical act: the posterior lamella with a pedicled periosteal flap and the anterior with a Mustardé flap. One year follow-up, the patient evolves with good support and eyelid position, without recurrence of the tumor.


Assuntos
Humanos , Masculino , Idoso , Periósteo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Palpebrais/terapia , Pálpebras/cirurgia , Transplantes/cirurgia
19.
Facial Plast Surg ; 36(4): 478-483, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32629483

RESUMO

Lower blepharoplasty is a commonly performed procedure to improve the aesthetic of the lower eyelid and upper midface. Combined fat pad transposition and fat grafting has not been previously studied using three-dimensional (3D) analysis. The aim of the study is to demonstrate the benefits of fat pad transposition with concomitant autologous fat grafting in lower blepharoplasty and to determine quantitative volumetric effects on the tear trough and lower periorbital region using VectraXT 3D imaging and analysis. A retrospective review was performed to identify patients undergoing primary lower blepharoplasty with combined fat pad transposition and fat grafting. The study time period was from September 2017 to March 2019 with a mean 6.5-month postoperative follow-up. This study was performed in a private practice institution (Kovac Cosmetic Center, Oakbrook Terrace, IL). Nine subjects were enrolled in the study with four males and five females. All subjects underwent lower blepharoplasty with combined fat pad transposition and fat grafting without any additional procedures. Preoperative and postoperative photographs were taken with the VectraXT 3D camera system and software. 3D photographs were then compared to assess the volume changes in the periorbital region. The volume in the lower periorbital region was assessed using 3D analysis. All subjects were found to have an increase in volume in the periorbital region. There was a mean volume gain of 2.84 mL on the right and 2.87 mL on the left. There was no statistical difference among volume gains between sides (p = 0.95). Combined fat pad transposition and autologous fat grafting is an effective procedure for improving the tear trough deformity and periorbital area. The use of 3D volume assessment is able to accurately measure and quantify the volume changes of the postoperative results.


Assuntos
Blefaroplastia , Tecido Adiposo/transplante , Estética Dentária , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos
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