Resultados funcionales de la blefaroplastia superior / Functional results of upper blepharoplasty

Objetivo: Describir los resultados funcionales de la blefaroplastia superior. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo de 99 pacientes (198 párpados) con diagnóstico de dermatochalasis de párpado superior, algunos asociados a ptosis palpebral y de la ceja, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período comprendido de febrero del año 2019 a enero de 2020. Resultados: El 85,8 por ciento fueron del sexo femenino y el 43,5 por ciento eran mayores de 62 años. Predominó la dermatochalasis del párpado superior y la ptosis palpebral en el 68,4 por ciento, así como la dermatochalasis y la ptosis palpebral severa, las cuales representaron el 47,5 y el 50 por ciento respectivamente. En el grupo de 56 a 61 años sobresalió la dermatochalasis del párpado superior y la ptosis de la ceja, con el 61 por ciento. En el 98 por ciento de los casos intervenidos se obtuvo la corrección total de la dermatochalasis del párpado superior, la corrección de la ptosis en el 86 por ciento y de la ceja en el 88 por ciento. No se presentaron complicaciones en el 94 por ciento de los párpados intervenidos. La complicación más frecuente fue el sangramiento, con el 2,5 por ciento. Conclusiones: El abordaje de la ptosis palpebral y de las cejas transblefaroplastia superior logra en la mayoría de los pacientes la corrección total de estas afecciones y de la dermatochalasis. Este procedimiento constituye una herramienta importante para el rejuvenecimiento facial(AU)

Objective: Describe the functional results of upper blepharoplasty. Methods: A prospective longitudinal descriptive study was conducted of 99 patients (198 eyelids) diagnosed with upper eyelid dermatochalasis, in some cases associated to eyelid and eyebrow ptosis. The study was carried out at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2019 to January 2020. Results: Of the total patients studied, 85.8 percent were female and 43.5 percent were aged over 62 years. Upper eyelid dermatochalasis and palpebral ptosis prevailed with 68.4 percent, whereas severe dermatochalasis and palpebral ptosis represented 47.5 percent and 50 percent, respectively. A predominance was found of upper eyelid dermatochalasis and eyebrow ptosis in the 56-61 age group (61 percent). Total correction of upper eyelid dermatochalasis was achieved in 98 percent of the cases intervened, eyelid ptosis correction in 86 percent and eyebrow ptosis correction in 88 percent. No complications appeared in 94 percent of the eyelids intervened. The most common complication was bleeding with 2.5 percent. Conclusions: In most cases, management of palpebral ptosis and upper eyebrow transblepharoplasty achieves total correction of these disorders and dermatochalasis. The procedure is an important tool for facial rejuvenation(AU)

Correction of sunken upper eyelids with central orbital fat transposition during upper blepharoplasty / 中华医学美学美容杂志

Objective:To evaluate the effectiveness of correction of sunken upper eyelid with central orbital fat transposition during upper blepharoplasty.Methods:We performed 58 cases of upper blepharoplasty with sunken upper eyelids during January 2016 and June 2020. The lateral portion of the central orbital fat was dissected and reversed 180 degrees, and then fixed to the medial fat pad. Photographs before and 6 months post-operatively were measured to determine the degree of the upper eyelid depression. The results were compared statistically. At the consultation 6 months postoperatively, the patients were asked to evaluate the results of the operation using the Clients Satisfying Questionnaire, with the grade between 4 (very satisfactory) and 0 (very dissatisfactory).Results:Sunken eyelids were effectively corrected in 41 of the 52 patients, but 11 patients had minimal effect because of the lack of sufficient central fat volume mostly due to the prior blepharoplasty. At 6 months post-operatively, 52 of the 58 patients finished the satisfaction questionnaire. Forty one of the 52 patients were satisfying with the results. The mean score was 3.3+ 0.73. The degree of the upper eyelid depression was (4.9+ 1.1) mm preoperatively and (2.4+ 0.7) mm postoperatively. There was a statistically significant difference ( P<0.05). Conclusions:The central orbital fat transposition is an effective way to correct the sunken upper eyelids during the upper blepharoplasty. The results are satisfactory with full upper eyelids and smooth double eyelids.

Blefaroplastía superior con técnica de realce de volumen: descripción de la técnica quirúrgica y sus beneficios / Upper blepharoplasty with volume enhancement technique: surgical technique description and its benefits

Resumen Introducción: La región periorbitaria es la primera en exhibir los efectos del envejecimiento, siendo el exceso de piel del párpado superior el signo más frecuente. Actualmente las técnicas quirúrgicas de blefaroplastia superior son más conservadoras, logrando resultados estéticos satisfactorios y naturales. La técnica con realce de volumen es una técnica poco agresiva en la cual se respeta el músculo y grasa periorbitaria. Objetivo: Describir la técnica de blefaroplastia superior con realce de volumen, sus beneficios y resultados estéticos. Material y Método: Estudio descriptivo retrospectivo. Se analizaron pacientes sometidos al procedimiento entre agosto de 2016 y octubre de 2017. Resultados: Se describe la técnica quirúrgica. Se operaron 56 pacientes con un promedio de edad de 57 años. 75% correspondían a sexo femenino. Se utilizó anestesia local en 59% pacientes. Se complementó con otras cirugías en un 57%. De éstas 19% corresponden a rinoplastías, 31% a frontoplastías, 47% a blefaroplastias inferiores, entre otras. No se presentaron complicaciones intraoperatorias ni postoperatorias mayores. Conclusión: La técnica de blefaroplastia superior con realce de volumen es una técnica conservadora con excelentes resultados estéticos y funcionales. Al conservar el músculo orbicular y los tejidos blandos subyacentes se genera un aumento de volumen en la zona del supratarso, realzando la belleza de la región periorbitaria.

Abstract Introduction: The periorbital region is the first to exhibit the effects of aging. The excess of skin on the upper eyelid is the most frequent sign. Nowadays upper blepharoplasty techniques are more conservative, achieving satisfactory aesthetic results. The volume enhancement technique is a non-aggressive technique in which muscle and periorbital fat are preserved. Aim: Describe the upper blepharoplasty with volume enhancement technique, its benefits and aesthetic results. Material and Method: The surgical technique is described. Retrospective descriptive study. Patients studied were between august 2016 and october 2017. Results: 56 patients underwent surgery with an average age of 57 years. 75% were female. 59% were performed under local anesthesia. 57% had complementary surgeries. These were rhinoplasties (19%), frontoplasty (31%), lower blepharoplasty (47%) among others. There were no mayor intraoperative or postoperative complications. Conclusion: The upper blepharoplasty with volume enhancement technique is a conservative technique with excellent aesthetic and functional outcomes. By preserving the orbicularis muscle and the underlying soft tissues, a volume increase is achieved in supra tarsal area, enhancing the beauty in the periorbital region.

Value of levator shortening for correction of high supratarsal fold after cosmetic upper blepharoplasty / 中华医学美学美容杂志

Objective To correct the high supratarsal fold after cosmetic upper blepharoplasty is a challenge because of the shortage of both upper eyelid skin and fat.Levator shortening has been a procedure of choice selected by the surgeons to correct this condition.Methods Under local anesthesia, the desired crease was marked according to the characteristics of eyelid anatomy and aesthetic consideration for Asian women.The incision was made through the marked new skin crease and the old incision with surrounding scar tissue was incised.The adhesion between the skin and the levator aponeurosis was completely released.The levator aponeurosis was then divided above the tarsal plate.It could be shortened and then reattached to the tarsal plate depending on the amount of the upper eyelid skin and the degree of the ptosis.The skin incision was then closed to form new but lowered fold.Results Between 2003 to 2015, a total of 34 Chinese women underwent bilateral levator shortening for correction of high supratarsal fold after previous unsatisfactory upper blepharoplasty by other surgeons.There were no surgical complications postoperatively in this series and 32 patients (94.1%) were satisfactory for the outcome of the proper height of the supratarsal fold with at least 1 month follow-up.Only one patient (2.9%) required surgical revision for asymmetry of supratarsal folds and one patient (2.9%) for correction of deepened supratarsal fold.Conclusions The levator shortening can be an effective procedure to correct high supratarsal fold after unsatisfactory upper blepharoplasty in Asian women.It is especially useful to correct such a condition where there is shortage of the eyelid skin combined with the eyelid ptosis.

Sub-brow Resection via Relocation of Retro-orbicularis Oculi Fat and Preseptal Fat Unit

PURPOSE: Retro-orbicularis oculi fat (ROOF) and preseptal fat pad (PSF) are deep fat structures of frontal and supraorbital area, that encounter galeal fat pad (GFP). If galeal wall is weakened by aging process, GFP loses its anchoring structure, moved downward pushing ROOF and PSF. This especially occur in lateral brow area. As a result of drooping, eyebrow affects the eyelid covering PSF as a sac descended to a lateral hooding and ptotic eyelid simultaneously. Consequently, in the case of lateral hooding and brow ptosis, besides the skin, deep fat structures (ROOF and PSF) should be corrected as well. METHODS: ROOF-PSF repositioning technique in subbrow resection were performed. 21 cases of patients from April, 2007 to January, 2008. Before surgery, all patients were examined carefully to evaluate the degrees of dermatochalasia, drooping of the eyebrow, marginal reflex distance 1 (MRD1), eyelid crease height. Surgery was performed under local anesthesia, then excised the drooped eyelid skin by lateral subbrow resection, removed proper amount of ROOF, repositioned ROOF-PSF at the supraorbital rim, and fix it on periosteum. During follow up periods, the patients were surveyed of the satisfaction of surgery, and postoperative MRD1 was evaluated. RESULTS: One patient had a hematoma on left eyebrow, and another one patient had a numbness on left forehead for two months. Except for these two patients, all patients had good results without any significant complications. The mean follow up period was about 5 months, and the position of lateral eyebrow maintained above the supraorbital rim in all cases. Postoperatively, MRD1 increased by 0.8 mm in 5-months mean follow up period. CONCLUSION: In patient with lateral brow ptosis and lateral hooding, the ROOF-PSF repositioning technique in sub-brow resection could be a good operative option.

Septal Approach on Upper Blepharoplasty in Elderly Person

PURPOSE: Blepharoplasty plays a vital role in facial rejuvenation. Aging eyelids are the result of relaxation of lid structures as the skin, the orbicularis muscle, and mainly the septum, with subsequent protrusion or pseudoherniation of intraorbital fat contents. Traditional blepharoplasty has often involved the excision of excessive lax skin and muscle and removal of fat, leaving the eyelid unnatural and even causing the brow ptosis. The authors propose the septal approach through which the amount of skin excision can be decreased and solid fixation can be achieved in the upper blepharoplasty. METHODS: From November 2007 to February 2010, total of 15 patients underwent upper blepharoplasty with septal approach. In 9 patients, orbital septum anchored into the orbital periosteum only. But in 6 patients, the attenuated septum was strengthened through shortening and fixing into orbital periosteum with non-absorbable suture. RESULTS: Pleasing results were obtained from most of the patients. But one patient who had septum anchoring procedure complained of slight undercorrection, therefore secondary operation with septum shortening procedure was followed. CONCLUSION: We found that the method using orbital septum fixation into orbital periosteum has several advantages: less amount of skin excision, less recurrence rate, and more natural appearance. And the results were reliable and satisfactory.

Correction of Crow's Feet by the Expansion of Orbicularis Oculi Muscle Flap

As people grow older, many aging phenomena occur in the facial skin and soft tissues, including crow's feet, glabellar frown lines, jowls, depression of malar fat pads, brow ptosis, Marionette lines, and more. Among these results, the authors focused on crow's feet(Lateral. periorbital wrinkles), which are one of the major causes of facial rejuvenation in the periorbital area. Upper & lower blepharoplasty do not always improve crow's feet to one's satisfaction, and above that, surgery sometimes accentuates rather than improves these wrinkles. Consequently, the authors proposed a new operative method for lateral. periorbital wrinkle correction, which could be summarized as dissection of the orbicularis oculi muscle, below the subcutaneous tissue above the temporal fascia, elevation of the muscle flap, advancement of the flap to the upper-lateral direction, and excision of redundant skin. After laying the patient down on the operation table and exposing both ears, the whole face was cleansed with an antiseptic solution. Incision lines were designed as temporal W-shaped. After dissecting through the subcutaneous fat layer and elevating the flap from the temporal fascia, the orbicularis oculi muscle was incised at the lateral margin of orbicularis muscle. The orbicularis oculi muscle flap was then elevated, and pulled into the upper- lateral direction with smooth forceps to find the point which would make the patient's eyes look the most natural. The lateral margin of orbicularis muscle was fixed to the deep temporal fascia of temporal hairline. with 4-0 Nylon suture. Redundant skin was excised and wound was closed with 6-0 Black silk by W- plasty technique. Between 2001 and 2006, 63 patients were operated on using the technique mentioned above, with favorable aesthetic and functional results. Several patients complained about the W-plasty scar but those were aesthetically accepted. Crow's feet are not always corrected with satisfactory results, and sometimes are accentuated, by upper & lower blepharoplasty. In order to solve these problems, an operative technique was conceived that dissects the orbicularis oculi muscle, elevates and advances the muscle flap, and then excises the redundant skin. This technique showed favorable patient satisfaction scores in both functional and aesthetic aspects, with satisfactory results even in long-term follow up, and also had the effect of a central- facial face lift.

The Objective Change of the Eyelid after Upper Blepharoplasty

PURPOSE: To evaluate the morphological changes in the external eyes after upper blepharoplasty. METHODS: Twenty-six eyes of 13 patients undergoing upper blepharoplasty from May 2002 to May 2003 were selected. All surgeries were performed by one surgeon. MRD1, MRD2, interpalpebral fissure height, and levator function test were each measured twice, and the averages were calculated. Likewise, significant changes were checked before and after the operation. The subjects were divided into two groups. For group A (n=12), a double line suture was stitched at the levator aponeurosis, which was directly superior to the tarsal plate. In group B (n=14) the suture was stitched at a levator aponeurosis 3 mm superior to tarsal plate. The delta levator function (postoperative mean levator function minus preoperative mean levator function) measurements were calculated and compared between the two groups. RESULTS: The MRD1 was 2.04+/-0.75 (mean+/-SD) before the operation, and 2.0+/-0.81 after the operation. MRD2 was 5.23+/-0.75 before the operation, 5.35+/-0.54 after operation. Interpalpebral fissure height was 7.27+/-0.38 before the operation and 7.35+/-0.63 after the operation. There were no statistically significant factors before and after the operation in MRD1, MRD2 and interpalpebral fissure height. The levator function was 14.04+/-1.80 before versus 16.19+/-1.58 after. This increase was statistically significant (p<0.01, Wilcoxon signed ranks test). The delta levator function was 1.58+/-0.90 for group A and 1.96+/-1.36 for group B. CONCLUSIONS: After upper blepharoplasty, the measurement of levator function increased significantly.

Early Revisoion of Unfavorable Upper Blepharoplasty

Double eyelidplasty is one of the most common esthetic surgical procedures in Asia. However the incidence of complications is not rare, even by the hands of much experienced plastic surgeons. The most common serious complication is high fold, deep fold or ectropion, triple fold, ptosis and retraction. These occur single or complexed. The proper time of secondary revision is usually accepted at least 6 months after primary operation. It means that revision should be delayed until wound maturation. However when the complications are too severe for patient to manage his or her normal life, early revision should be taken into consideration. Moreover early revision can get better result in certain cases especially such as ptosis and retraction. A total 23 patients were treated early revisions between December 2004 and June 2006. All of the patients had their initial surgery done at another hospital or clinic. Early revsion was performed differently according to the various problems. Dissection was carried out with two forceps traction each other. Metzem was not used. Previous adhesion was detached also with two forceps and high fixation was lowed. And in ptosis and retracction cases, levator advancement was adjusted according to the eye fissue size. The successful early correction of complicated double eyelidplasty could be accomplished by accurate identification of the problem based on established surgical principles.

Easy Method to Determine Skin Excision Amount in Upper Blepharoplasty

The aging change that occur to the upper eyelid is the obscurity of the position of eyelid crease by the appearance of redundant upper eyelid skin and fold displacement. The solution is to raise the eyelid crease of the affected upper eyelid through the excision of excess soft tissue. Despite of many descriptions of blepharoplasty in the literature, marking the upper lid skin excision has not been well described. Many operators advocate use of a forceps to measure the amount of skin to be excised. But this method is not accurate and may result asymmetric double folds especially in less- experienced operators. Thus we present easy, accurate, and simple method to determine the amount of the skin to be excised as follows: The lower incision is drawn 6-8mm apart from the lid margin in sitting position while gently pulling upward the upper eyelid. While the marking pen is held at the level of the lower incision line, upper lid return to initial natural position, then a mark is made at the same level. After this procedure is repeated at several points, the dots are connected to a continuous line for the upper line of skin excision.