Reparo da pálpebra inferior por fechamento direto com cantopexia lateral e elevação da fáscia suborbicular dos olhos: uma técnica simples para evitar o ectrópio pós-operatório / Repair of the lower eyelid with primary closure with lateral canthopexy and elevation of the suborbicularis oculi fascia: a simple technique to avoid post-operatory ectropion

Os defeitos cutâneos da pálpebra inferior frequentemente requerem reconstruções com enxertos ou retalhos para evitar-se o ectrópio. A retirada de um carcinoma basocelular da pálpebra inferior de uma paciente de 39 anos resultou em um defeito exclusivamente cutâneo, com diâmetros transversal e vertical de 32 e 13mm, respectivamente. Apesar da grande dimensão do defeito, a elevação da fáscia suborbicular dos olhos para o periósteo da borda orbital lateral permitiu o fechamento primário. A posição da pálpebra inferior também foi reforçada com uma cantopexia lateral, com excelentes resultados estético e funcional.

Cutaneous defects of the lower eyelid frequently require reconstructions with grafts or flaps to avoid ectropion. Removal of a basal cell carcinoma from the lower eyelid of a 39-year-old patient resulted in an exclusively cutaneous defect, with transversal and vertical diameters of 32 and 13mm, respectively. Despite the large size of the defect, the elevation of the suborbicularis oculi fascia to the periosteum of the lateral orbital border made primary closure possible. The position of the lower was also reinforced with a lateral canthopexy, with excellent aesthetic and functional results.

Comparação entre ácido tioglicólico 2,5%, hidroquinona 2%, haloxyl 2 % e peeling de ácido glicólico 10 % no tratamento da hiperpigmentação periorbital / Comparison of 2,5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10 % thioglycolic acid peeling in the treatment of periorbital hyperpigmentation

Introduction: Periorbital hyperpigmentation is a multifactorial dyschromia that involves the eyelid's vascularization and melanin hyperpigmentation. Objective:To compare the efficacy of 2.5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10% thioglycolic acid peel in the reduction of dark circles. Methods: Eighty patients were divided into four groups. Groups 1, 2, and 3 underwent treatments with 2.5% thioglycolic acid, 2% hydroquinone, and 2% Haloxyl, respectively. Group 4 underwent five biweekly sessions of chemical exfoliation with 10% thioglycolic acid. All patients were evaluated by two physicians after the treatment: the one who performed the treatment, and another who was blinded to the outcome. The assessment was carried out using photographs and a clinical satisfaction questionnaire distributed to the patients. Results: The best results occurred in Groups 1 and 2. Group 3 had slightly inferior results, possibly due to the low concentration used. Group 4 had the least significant results, however this outcome may have been influenced by the higher age of the group members and the lack of daily use of medications. Conclusions: There is still not an ideal treatment for dark circles, with the currently available therapeutic resources only alleviating the difference in color between the lower eyelids and the rest of the face.

Introduction: Periorbital hyperpigmentation is a multifactorial dyschromia that involves the eyelid's vascularization and melanin hyperpigmentation. Objective:To compare the efficacy of 2.5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10% thioglycolic acid peel in the reduction of dark circles. Methods: Eighty patients were divided into four groups. Groups 1, 2, and 3 underwent treatments with 2.5% thioglycolic acid, 2% hydroquinone, and 2% Haloxyl, respectively. Group 4 underwent five biweekly sessions of chemical exfoliation with 10% thioglycolic acid. All patients were evaluated by two physicians after the treatment: the one who performed the treatment, and another who was blinded to the outcome. The assessment was carried out using photographs and a clinical satisfaction questionnaire distributed to the patients. Results: The best results occurred in Groups 1 and 2. Group 3 had slightly inferior results, possibly due to the low concentration used. Group 4 had the least significant results, however this outcome may have been influenced by the higher age of the group members and the lack of daily use of medications. Conclusions: There is still not an ideal treatment for dark circles, with the currently available therapeutic resources only alleviating the difference in color between the lower eyelids and the rest of the face.

Hiperpigmentação periorbital / Periorbital hyperchromia

A hipercromia cutânea periorbital ou "olheira" é queixa comum nos consultórios de dermatologia por interferir na autoestima dos pacientes. Os olhos são o centro das atenções na comunicação, e a "olheira" dificilmente passa despercebida, proporcionando à face aspecto de cansaço, causando importante impacto na qualidade de vida. Há poucas publicações na literatura sobre hiperpigmentação periorbital e, embora as opções de tratamento sejam muito vastas, a maioria carece de embasamento científico que comprove sua eficácia e duração. Este artigo aborda a anatomia da região palpebral, a epidemiologia, a etiopatogenia e os tratamentos propostos na literatura para a hipercromia periorbital.

Estudo comparativo entre blefaropeeling e laser fracionado de CO2 no tratamento do rejuvenescimento periorbital / Comparative study between blepharopeeling and fractional CO2 laser in the treatment of periorbital rejuvenation

Introdução: A queixa de rugas e flacidez na região periocular é freqüente.O blefaropeeling utilizando a fórmula de Baker-Gordon e a aplicação de laser fracionado ablativo de CO2 fracionado são consideradas opções efetivas para o tratamento dessa região. Objetivo: Comparar as técnicas, a recuperação e os resultados finais das duas modalidades terapêuticas. Material e Métodos: Estudo comparativo de hemi-faces em pacientes com dermatocálase e rítides moderadas. Realizou-se no lado direito blefaropeeling e, no esquerdo, laser fracionado de CO2, cujos resultados foram avaliados por fotografia, medidas do sulco palpebral superior e melhora clínica. Resultados: Foram incluídas 11 pacientes no protocolo.Verificou-se melhora clínica e fotográfica com ambos os métodos. O tempo de recuperação foi maior com o peeling de fenol. As medidas do sulco palpebral superior não mostraram diferenças significativas. Conclusões: Ambas as modalidades terapêuticas são efetivas no tratamento do envelhecimento periorbital. O processo de recuperação o blefaropeeling foi mais demorado. Clinicamente a melhora da flacidez palpebral foi superior com o blefaropeeling.

Introduction: Complaints about wrinkles and flaccidity in the periocular region are frequent. Blepharopeeling, associated with the Baker-Gordon formula, and the application of ablative fractional CO2 lasers are considered effective options in the treatment of the periocular region. Objective:To compare the techniques, recovery process and results of blepharopeeling and fractional CO2 lasers in the periorbital region. Methods: Comparative split-face study of patients with dermatochalasis and moderate rhytids. Blepharopeeling was applied on the right side of the face, and the fractional CO2 laser was used on the left side of the face. Results were assessed through photographic analysis, measurements of the superior palpebral fold and clinical improvement. Results: Patients (n=11) demonstrated clinical and photographic improvement using both methods. The recovery time was longer for the phenol peeling. No significant differences were observed in the measurements of the superior palpebral fold. Conclusion: While both therapeutic modalities were found to be effective in the treatment of periorbital aging, blepharopeeling produced greater clinical improvement of palpebral flaccidity.