Clinical application of botulinum toxin type A in the treatment of thyroid-associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

Thyroid-associated ophthalmopathy(TAO)is an autoimmune inflammatory disease involving multiple orbital tissues with a variety of clinical manifestations, which has serious effects on the life quality of patients.Interventions of TAO mainly include medical treatment to stabilize thyroid function, reduce inflammation and regulate immune function, as well as surgical treatment to relieve ocular symptoms. Botulinum toxin type A can paralyze muscles by blocking nerve impulse conduction at the neuromuscular junction, which is of certain therapeutic value for restrictive strabismus due to extraocular muscle involvement and upper eyelid retraction due to involvements of levator palpebrae superioris and Müller's muscle in TAO patients, especially when they have surgical contraindications, lack surgical opportunity, or refuse surgery. This paper reviews the application of botulinum toxin type A in the treatment of TAO, focusing on its pharmacological mechanism, dosage, effectiveness, and possible complications when treating restrictive strabismus and upper eyelid retraction, and discussing potential therapeutic values of botulinum toxin type A for intraocular pressure elevation, glabellar frown lines and dry eye caused by extraocular muscle compression in TAO patients, in order to provide a reference for clinical intervention.

Correction of the first and second degree of upper eyelid depression with orbital septal fat anatomic reduction in blepharoplasty / 中华医学美学美容杂志

Objective:To investigate the method and effect of anatomic reduction of orbital septum fat in blepharoplasty to correct the first and second degree of upper eyelid depression.Methods:From January 2019 to January 2021, the data of patients with first and second degree upper eyelid depression admitted to Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Orbital septum was fully exposed and cut in blepharoplasty, the orbital fat of upper eyelid central group and the medial group were dissected and seperated to form the fat flap pedicled on the medial side. The fat flap was rotated 180° to the medial side and fixed with the orbital fat of the medial group to correct the upper eyelid depression. Complications such as infection, hematoma, fat liquefaction, nodules and orthers were observed after surgery. Questionnaire was used to investigate the satisfaction of patients, with 1-4 points indicating dissatisfaction, general satisfaction, satisfaction and very satisfaction, respectively.Results:A total of 62 patients were included, all patients were female, aged 18-44 years, wit mean 27 years. All patients were bilateral upper eyelid depression. After 6 months of follow-up, the curvature of the double eyelid line was smooth, the width and narrowness of double eyelid were natural, and the upper eyelid depression was significantly improved. Satisfaction survey showed that 60 cases were very satisfied and 2 cases were satisfied. Wound infection was occurred in 1 case, and was cured after dressing change. Scar hyperplasia was observed in 2 cases, which was obviously alleviated after external treatment with anti-scar hyperplasia drugs. No fat liquefaction, nodule and other complications occured.Conclusions:For the first and second degree of upper eyelid depression, it can be corrected by anatomic reduction of orbital septal fat in blepharoplasty. The operation is simple, with fewer complication and high satisfaction.

Clinical effects of lateral orbital septum fat release medial transfer on upper face depression / 中华医学美学美容杂志

Objective:To investigate the method and effect of correcting upper eyelid depression with released orbital diaphragmatic fat.Methods:From January 2017 to June 2020, there were 26 female patients with upper eyelid depression in this department of Hebei Chengde Stomatological Hospital. The patients aged 22-54 years, with average 43 years. An external mass orbital diaphragm fat release reverse folding repositioning with fat placement in the upper lid depression was performed in 26 patients. An incision about 4 mm long was made in the middle and lateral of the orbital diaphragm to ensure the integrity of the orbital diaphragm as far as possible. The photos of beauty seekers before and 6 months after operation were compared to observe the correction effect of upper eyelid depression and the shape of upper eyelid.Results:All 26 patients had one-stage healing of the surgical incision without infection, with inconspicuous incisional scarring. At 6 months postoperatively, 18 patients had satisfactory results; 1 patient had improved results due to insufficient fat; and 1 patient had poor results due to too little fat and poor filler placement, which was later improved by autologous fat grafting.Conclusions:External mass orbital fat release reverse folding repositioning for correction of upper eyelid depressions is a surgical procedure with obvious results, little trauma, and following the principle of anatomical recovery, which is worthy of clinical application.

Importance of managing retro-orbicularis oculi fat in double-fold eyelid surgery for patients with swollen upper-eyelid / 中华医学美学美容杂志

Objective:To explore the importance of managing retro-orbicularis oculi fat (ROOF) in double-fold eyelid operation for patients with swollen upper-eyelid.Methods:From January 2018 to December 2020, 76 cases of swollen upper-eyelid were treated with double-fold eyelid operation by PARK method. In operation, an oval shape ROOF was removed from the outside-to the inside, and then appropriate lateral intraorbital fat was also removed. If fleshy orbicularis oculi muscle and anterior tarsus fat affected appearance of double-fold eyelid, both of them might be removed properly.Results:All patients were followed up from seven days to two years, two cases presented with shallowed double-fold eyelid, 5 cases of lacrimal gland prolapse had good lacrimal gland reduction and no recurrence; 4 cases of ptosis had normal corneal exposure and natural appearance after correction; the swollen upper-eyelid was obviously improved in 74 cases, and restoration stage was short, the apperaence and radian of doule-fold eyelid were beautiful, local scar was slight, satisfactory operative effect was achieved.Conclusions:In double-fold eyelid operation by PARK method for patients with swollen upper-eyelid, an ideal effect would be achieved, if transconjunctival route and fleshy orbicularis oculi muscle are appropriately removed in turn according to the reasons to give rise to swollen upper-eyelid.

Effect of SVF-gel transplantation combined with double eyelid operation for upper eyelid depression / 中华医学美学美容杂志

Objective:To explore the clinical effect of SVF-gel transplantation combined with double eyelid operation for upper eyelid depression.Methods:From January 2018 to October 2019, the Cosmetic Surgery Department of Henan Plastic Surgery Hospital treated 58 famale patients with sunken single eyelid and double eyelid, they aged 24-53, and the average age was (35±7) years old. A total of 58 patients with sunken upper eyelid were divided into two groups: SVF-gel group (study group) and traditional autologous fat (Coleman fat) group (control group), 29 cases in each group. Before the operation, patients in the study group were injected with SVF-gel, while those in the control group were injected with Coleman fat. After filling the fat, the traditional double eyelid line was designed in both groups.Results:Three months after operation, the patients in the study group and the patients in the control group had same survival rate of fat filling: the satisfactory rate of fat filling and the effect of double eyelid were 93.10% and 89.66% in the study group, respectively, while 82.76% and 82.76% in the control group.In the control group, there were 4, 1 and 3 cases of gross appearance, tubercle and unevenness respectively, while in the study group, there were no postoperative complications.Conclusions:SVF-gel is superior to traditional structural fat in the double eyelid surgery of upper eyelid sunken type. The patients are satisfied with the surgery and the clinical effect is good.

Clinical application of orbital fat fascia flap in upper eyelid depression correction / 中华医学美学美容杂志

Objective:To investigate the clinical application of orbital fat fascia flap in upper eyelid depression correction.Methods:From January 2015 to December 2020, 38 female patients (aged 25-55 years, average 37.5 years) with mild to moderate upper eyelid depression were treated with orbital fat fascia flap at plastic surgery department of Friendship Plastic Surgery Hospital affiliated to Nanjing Medical University. During the operation, the lateral part of the central orbital septal fat was transferred to the upper eyelid depression, and then the upper eyelid depression was corrected.Results:35 cases of upper eyelid depression were significantly improved postoperatively, 2 cases of double eyelid line became shallow after operation, and adjustment was performed again; 1 case had partial depression on one side and received autologous granular fat supplement transplantation. Postoperative effect was satisfied.Conclusions:The method of longitudinal separation and preservation of the capsule below the orbital septal for orbital septal fat transposition can better correct the upper eyelid depression while reducing fat absorption.

Clinilal effects of a modified double-eyelid blepharoplasty: tarsus-orbicularis oculi muscle-septum fixation / 中华医学美学美容杂志

Objective:To observe the effect of a new modified double-eyelid operation.Methods:From February 2018 to January 2021, modified tarsal plate-orbicularis oculi muscle-orbital septum (TMS) suture was performed in 193 double-eyelid operation in the plastic surgery department of Peking Union Medical College Hospital, including 14 males and 179 females. The patients aged from 18 to 45 years with an average of (22.3±4.2) years. The patients were followed up for 6-24 months to observe the morphology of the double eyelid fold and complications.Results:The 193 patients were included. The double eyelid lines of 173 patients were smooth, natural, durable and the scar was shallow; both doctors and patients were satisfied. There were no obvious complications after the operation. The double eyelid line became shallow or disappeared in 11 patients, and the double eyelid asymmetry occurred in 7 patients after the operation. However, the folds were symmetrical and natural after secondary operation, and both doctors and patients were satisfied.Conclusions:TMS suture not only establishes a firm adhesion, but also effectively transmits the force of the levator aponeurosis with significant advantages. After the operation, the double eyelid line is smooth, natural and stable. Both doctors and patients are highly satisfied. It is an improved double eyelid procedure worthy of clinical promotion.

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)

Soft tissue composition and tailor-made blepharoplasty for upper eyelid puffiness / 中华医学美学美容杂志

Objective:To explore the soft tissue composition underlying upper eyelid puffiness and the experience in treating it with tailor-made procedure during upper blepharoplasty.Methods:In a retrospective study from January 2017 to December 2018, 165 patients with upper eyelid puffiness underwent full-incision upper blepharoplasty. During the procedure, the anterior wall of orbital septum was exposed, and the volume of the retro-orbicularis oculus fat (ROOF) and preaponeurotic fat was observed. The orbital septum would be opened if lacrimal gland prolapse was suspected. The puffy upper eyelid would be targeted with tailor-made procedure such as partial ROOF resection, removal or transposition of the preaponeurotic fat, as well as lacrimal gland refixation.Results:All 165 cases were healed by first intention. No relapse was found after a 6 to 24 months follow-up. Persistent mild pain and local skin tightness epiphora chemosis were presented in isolated cases with self-resolution within a short time. There were no severe adverse reaction or complications occurred during the operation and follow-up.Conclusions:The tailor-made procedure during upper blepharoplasty targets the soft tissue anatomy underlying upper eyelid puffiness. It is safe and effective in maintaining a natural look of upper eyelids while retaining the appropriate amount of adipose tissue in the upper eyelid.

Clinical effect of modified autogenous fat grafting for sunken upper eyelid / 中华医学美学美容杂志

Objective:To study the clinical effect of modified autogenous fat grafting for sunken upper eyelid in order to simplify surgical methods and to reduce complications.Methods:From January 2014 to May 2018, fifty-five patients with sunken upper eyelid were enrolled in this study. The traditional autologous fat filling injection was modified in present study, and the previous injecting method of large columnar fat mass in the deep subcutaneous layer of upper eyelid was modified; instead, small fat particles were injected into the superficial layer of subcutaneous tissue. After treatment the clinical efficacy and complications were evaluated.Results:Fifty-five patients were followed up for more than eight months, among which forty-seven patients were satisfied with the results and the depression of upper eyelid was significantly improved. However, postoperative complications were found in seven patients, including three patients encountered asymmetry, three patients presented upper-eyelid swelling, one patient had a nodule in the eyelid, and one patient suffered both swelling and asymmetry. The complications rate was 14.5%.Conclusions:Modified autologous fat transplantation is an ideal method for cosmetic repair of sunken upper eyelid, which is easy to operate and can effectively reduce the incidence of complications. However, some complications such as swelling, asymmetry and nodule in the upper eyelid still occur occasionally.

Efficacy of two surgical approaches in correction of severe upper eyelid cicatricial entropion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the efficacy of two surgical approaches that microscopical Hotz combined with eyelid margin incision and flap translocation and pure Hotz method in correction of severe upper eyelid cicatricial entropion. <p>METHODS: Totally 84 eyes of 60 patients who underwent corrective surgery for upper eyelid trichiasis between July 2017 to July 2019 were retrospectively assessed. The patients in trial group(32 cases, 42 eyes)underwent the surgical procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope, the other group(28 cases, 42 eyes)were treated with Hotz method. The follow-up time was 12mo. Subjective symptoms, eyelid marginal position, eyelash eversion and patient satisfaction were recorded.<p>RESULTS: The surgery time of one eye in trial group was longer than that in control group(40.8±2.57min <i>vs</i> 28.5±2.64min, <i>P</i><0.01). The cure rates of 1 and 12mo in trial group were 100% and 95%, respectively. And those in control group were 95% and 76%, respectively. The cure rate of 12mo in trial group was higher than that of the control group(<i>P</i>=0.013). There was no significant difference in patient satisfaction between the two groups at 1mo after surgery(<i>Z</i>=1.1825, <i>P</i>=0.2371). 12mo after surgery, patient satisfaction in the trial group was higher than that in the control group(<i>Z</i>=3.7346, <i>P</i><0.01).<p>CONCLUSION: While it spents longer time, the procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope is reasonably successful and satisfactory in rectifying severe upper eyelid cicatricial entropion. It offers more higher cure rate than Hotz alone at long time after operation.

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.

Reconstrução total de pálpebra superior no tratamento do carcinoma de glândula sebácea / Total upper eyelid reconstruction in the treatment of sebaceous gland carcinoma

Resumo O carcinoma de glândulas sebáceas (CGS) é a terceira neoplasia maligna mais frequente nas pálpebras. Acomete geralmente mulheres idosas e pode simular blefarite ou calázio. A reconstrução da pálpebra superior é sempre desafiadora. O objetivo deste é relatar um caso inusitado de CGS na pálpebra superior de indivíduo jovem e do sexo masculino. Foi realizada a ressecção total da pálpebra superior direita e o exame histológico revelou margens livres. A reconstrução foi feita com dois procedimentos cirúrgicos em tempos diferentes. Devido ao fato do CGS apresentar alto potencial de metástases, o paciente continua em acompanhamento para reavaliação funcional e estética.

Abstract Sebaceous gland carcinoma (SGC) is the third most frequent malignant neoplasm in the eyelids. It usually affects elderly women and can simulate blepharitis or chalazion. Upper eyelid reconstruction is always challenging. The purpose of this is to report an unusual case of SGC in the upper eyelid of a young and male patient. Total resection of the right upper eyelid was performed and histological examination revealed free margins. The reconstruction was done with two surgical procedures at different times. Due to the fact that SGC presents a high potential for metastasis, the patient continues to be followed for functional and aesthetic reevaluation.

Clinical effect and prognosis of glucocorticoid combined with surgical method for TAO-related upper eyelid retraction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical efficacy and prognosis of glucocorticoid combined with surgical method for TAO-related upper eyelid retraction. <p>METHODS: A total of 96 patients(146 eyes)with upper eyelid retraction who were admitted to the plastic surgery clinic and ward of our hospital from February 2014 to July 2018 were selected. According to different treatment methods, the patients were divided into GI group: 72 patients with TAO-related upper eyelid retraction treated with glucocorticoids; 72 patients with GS group: 48 patients with TAO-related upper eyelid retraction treated with glucocorticoid combined with conjunctival approach. After treatment, the upper eyelid muscle strength, the treatment effect, the height of the eyelid fissure, and the actual double eyelid width were compared between the two groups of patients.<p>RESULTS: After treatment, the patients in GI group had significant treatment effects in 32 people and 47 eyes, and the patients in the GS group had significant treatment effects in 16 and 25 eyes. The patients in the GS group had significant treatment effects in 46 cases and 71 eyes, and there were no significant treatment effects in 2 people and 3 eyes. Compared with the GS group, the treatment effect of the GS group was significantly higher than that of the GI group(<i>P</i><0.05). There was no significant difference between GS group and GI group(<i>P</i>>0.05). According to the table, before treatment, the height of the eyelid fissures in the GI group and the GS group were 11.25±1.85 and 11.31±1.46mm, and the data in the two groups were similar(<i>P</i>>0.05). The height of the eyelid fissures was 10.14±1.23mm, 3mo after treatment was 8.52±1.01mm. Compared with the GI group, the recovery of blepharoplasty was better in the GS group than in the GI group(<i>P</i><0.05). According to the table, before treatment, the upper eyelid muscle strength of the patients in the GI group and the GS group were 15.34±2.13 and 15.26±1.78mm, the data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the upper eyelid muscle strength was 15.64±1.34, 14.36±1.56mm. There was no significant difference in upper eyelid muscle between the GI group and the GS group(<i>P</i>>0.05). The results showed that before treatment, the patients with GI group and GS group actually had a double eyelid width of 5.12±1.64 and 5.16±1.48mm. The data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the double eyelid was actually The widths were 7.67±2.95 and 8.49±2.39mm, respectively. Compared with the GI group, the GI group had a better change in the double eyelid width than the GI group(<i>P</i><0.05). <p>CONCLUSION: Glucocorticoid combined with conjunctival approach Müller myectomy is better for patients with upper eyelid retraction, which can significantly improve the height of the eyelid fissure and the width of the double eyelid.

Resultados quirúrgicos de la técnica de elevación de la ceja transblefaroplastia / Clinical outcomes of the eyebrow lift technique of transblepharoplasty

RESUMEN Objetivo: Evaluar los resultados quirúrgicos de la técnica de elevación de la ceja transblefaroplastia y las complicaciones presentadas. Métodos: Se realizó un estudio descriptivo, retrospectivo, de corte longitudinal, de 12 pacientes (24 párpados) con ptosis de la ceja asociada a dermatochalasis del párpado superior desde mayo a septiembre del año 2018, en la consulta de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Fueron excluidos los que ya tenían una cirugía anterior del tercio facial superior. Resultados: El 83,3 por ciento de los pacientes fueron del sexo femenino. En cuanto a los grupos de edades resultó más frecuente el grupo de mayores de 62 años de edad. Hubo un predominio de la raza blanca, para un 58,3 por ciento. En el 60 por ciento de los casos del sexo femenino (6 pacientes), la dermatochalasis del párpado superior, asociada a la ptosis de la ceja, fue moderada. La ptosis de la ceja resultó corregida en 18 párpados, para el 75 por ciento. Se presentó el 25 por ciento de complicaciones (3 pacientes). Conclusiones: La técnica de elevación de la ceja transblefaroplastia logra la corrección de la ceja en el mayor número de pacientes con un bajo porcentaje de complicaciones, y constituye una buena opción quirúrgica para este tipo de afección palpebral(AU)

ABSTRACT Objective: To assess the surgical outcomes of the eyebrow lift technique of transblepharoplasty and the complications presented. Methods: A descriptive, retrospective, longitudinal study was carried out with 12 patients (24 eyelids) with eyebrow ptosis associated with upper eyelid dermatochalasis, from May to September 2018, in the Ocular Plastic Surgery office of Ramón Pando Ferrer Cuban Institute of Ophthalmology. Those who already had a previous surgery of the upper facial third were excluded. Results: 83.3 percent of the patients were female. Regarding the age groups, the group of people over 62 years of age was more frequent. There was a predominance of the white race, accounting for 58.3 percent. In 60 percent of female cases (6 patients), dermatochalasis of the upper eyelid, associated with eyebrow ptosis, was moderate. Eyebrow ptosis was corrected in 18 eyelids, for 75 percent. 25 percent of complications were presented (3 patients). Conclusions: The eyebrow lift technique of transblepharoplasty achieves eyebrow correction in the greatest number of patients with a low percentage of complications, and constitutes a good surgical option for this type of eyelid condition(AU)

The fat transplantation of upper eyelid depression with autologous fat transplantation booster / 中华整形外科杂志

Objective@#To summarize the clinical effects of meticulous fat transplantation with fat grafts in the treatment of sunken upper eyelid.@*Methods@#From September 2016 to January 2019, 58 patients with sunken upper eyelid were treated in the 940th Hospital of the Joint Logistic Support Force of PLA. There were 2 males and 56 females, aged from 20 to 63 years. Among them, 14 cases were congenital, 30 cases were senile, 8 cases were postoperative, and 6 cases were traumatic. The prepared autologous granule fat was extracted with a 1 ml syringe, which matched with a 1.0 mm diameter needle. The 1 ml syringe was packed into the card slot of a fat graft booster, and the needle was inserted into the orbital fat zone of a depressed upper eyelid to homogenously inject the granule fat. For patients with iatrogenic and traumatic upper eyelid depression, the adhesion was released by small needle knife before injection. For those with aging skin, subcutaneous injection of nano-fat was applied.@*Results@#The amount of granule fat transplantation was 0.5 ml to 3.6 ml, with an average of 1.5 ml. The amount of nano-fat injection was 0.5 ml to 1.0 ml, with an average of 0.7 ml. All patients were followed up for 1 month to 2 years. Except 2 patients with severe traumatic upper eyelid depression, the other patients were satisfied with their full and natural upper eyelids after treatments.@*Conclusions@#When the upper eyelid depression was treated with granule fat transplantation by the booster, the small needle knife peeling technique and nano fat transplantation can be combined to correct different types of congenital, aging and surgical derived sunken upper eyelid and traumatic sunken upper eyelid from mild to severe cases. At the same time, the skin of the upper eyelid can be rejuvenated as well.

Efficacy of double-eyelid plasty: a clinical analysis of 162 cases / 中华医学美学美容杂志

Objective@#To discuss one double-eyelid surgery which is conformed to the anatomy characteristics of the asian upper eyelid.@*Methods@#A total of 162 cases were performed blepharoplasty for double eyelids, who aged 19 to 33 years with average 24.22±3.05 years, including 28 men and 134 women. Double eyelid line was designed according to the overall characteristics of eyebrows and eyes of beauty seekers combined with aesthetic standards. The surgery was performed to restore the anatomical characteristics of natural double eyelids as far as possible.@*Results@#The double eyelid surgery was designed and performed in 162 cases based on this method. All the patients underwent suture removal 7 days after operation, none of them had postoperative infection, and 15 patients had the bruising during the first week. After symptomatic treatment, the bruising had gone in 1 month. All the cases were followed up for more than six months postoperatively, and eight cases presented shallow double eyelid and the satisfactory results were achieved after the second operation of small incision.@*Conclusions@#The double-eyelid line should be designed individually before operation and the surgery done according to the natural characteristics of Asian upper eyelid. It will get coherent double eyelid without obvious scar or depression at resection margin, with high satisfactory rate.

Revision upper blepharoplasty: correcting upper eyelid retraction after initial upper blepharoplasty / 中华整形外科杂志

Objective@#To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation.@*Methods@#A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision.@*Results@#All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results.@*Conclusions@#The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty.

Revision upper blepharoplasty: correcting upper eyelid retraction after initial upper blepharoplasty / 中华整形外科杂志

Objective@#To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation.@*Methods@#A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision.@*Results@#All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results.@*Conclusions@#The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty.