Blefaroplastia y rejuvenecimiento de los ojos / Blepharoplasty and rejuvenation of the eyes

Los ojos son el foco principal de la cara y se les atribuye la expresión de la personalidad del individuo. La configuración anatómica de los párpados y de la región periorbitaria conforma una de las áreas más importantes de la expresión humana. Existen alteraciones aparentemente estéticas que llevan a trastornos visuales, como la dermatocalasis y blefarochalasis, que limitan el campo visual o provocar fatiga ocular por la presión de la piel redundante sobre los párpados, la laxitud de los tendones cantales origina un síndrome de exposición escleral y a la vez lagrimeo. La blefaroplastia produce resultados clínicos y estéticos favorables en los pacientes aquejados por esta patología.

The eyes are the main focus of the face and the expression of the individual's personality is attributed to them. The anatomical configuration of the eyelids and the periorbital region constitutes one of the most important areas of human expression. There are apparently aesthetic alterations that lead to visual disorders, such as dermatochalasis and blepharochalasis, which can limit the visual field or cause eye fatigue due to the redundant pressure of the skin on the eyelashes, the laxity of the canthal tendons causes a scleral exposure syndrome and at the same time tearing. Blepharoplasty produces favorable clinical and aesthetic results in patients suffering from dermatochalasis.

Patología oculoplástica: experiencia de 7 años en Hospital del Sistema de Salud Público de Chile / Oculoplastic Pathology: experience of 7 years in Hospital of the Public Health System of Chile

INTRODUCCIÓN: La cirugía oculoplástica estudia y trata los trastornos de párpados, órbita y vías lagrimales. Entre las patologías más importantes por frecuencia e impacto tenemos: ptosis palpebral, blefarochalasis, ectropión y entropión. OBJETIVO: Analizar la experiencia del Hospital El Pino en cuanto al manejo de patología oculoplástica en manos de un cirujano plástico. MATERIALES Y MÉTODO: Estudio descriptivo y retrospectivo. Se revisaron fichas de pacientes operados con diagnóstico de blefarochalasis, ptosis palpebral, ectropión y entropión entre los años 2010 y 2017. Se analizaron datos como edad, sexo, comorbilidades, causa del defecto, cirugía oculoplástica, tipo de anestesia, complicación posoperatoria, tiempo de seguimiento y resultados. RESULTADOS: Entre los años 2010 y 2017 se operaron 79 pacientes con patología oculoplástica, 17 por ptosis palpebral, 42 por blefarochalasis, 14 por ectropión y 6 por entropión, siendo la principal causa senil (93,7%). Las cirugías realizadas fueron: pexia del elevador para Ptosis palpebral, blefaroplastía para blefarochalasis y para ectropión-entropión tarsal strip. La principal técnica anestésica utilizada fue anestesia local + sedación (54,4%). Entre el total de complicaciones posoperatorias tenemos: lagoftalmo (2 casos), ectropión residual (3 casos), conjuntivitis (3 casos), dehiscencia de herida (2 casos) y hematoma palpebral (1 caso). Se reintervinieron 6 pacientes por complicaciones. Los resultados obtenidos según la evaluación subjetiva del cirujano plástico y pacientes fueron regular (5 casos), bueno (20 casos) y muy bueno (54 casos). CONCLUSIÓN: El manejo de la patología oculoplástica requiere en su mayoría de cirugías ambulatorias con buenos resultados y poca morbilidad, lo cual es factible de realizar en un hospital público. Creemos necesario el uso de algún instrumento objetivo para evaluar de mejor manera los defectos palpebrales y su corrección.

INTRODUCTION: The oculoplastic surgery studies and treats disorders of the eyelids, orbit and lacrimal ways. Among the most important pathologies by frequency and impact are: palpebral ptosis, blepharochalasis, ectropion and entropion. AIM: Analyze the experience of El Pino Hospital regarding the management of oculoplastic pathology in the hands of a plastic surgeon. MATERIALS AND METHOD: Descriptive and retrospective study. We reviewed files of patients operated with diagnosis of blepharochalasis, palpebral ptosis, ectropion and entropion between the years 2010 and 2017. Data were analyzed as age, sex, comorbidities, cause of the defect, oculoplastic surgery, type of anesthesia, postoperative complication, follow-up time and results. RESULTS: Between the years 2010 and 2017, 79 patients with oculoplastic pathology operated, 17 for palpebral ptosis, 42 for blefarochalasis, 14 for ectropion and 6 for entropion, being the main senile cause (93,7%). The surgeries performed were: elevator pexis for palpebral ptosis, blepharoplasty for blefarochalasis and for ectropion-entropion tarsal strip. The main anesthetic technique used was local anesthesia + sedation (54,4%). Among the total postoperative complications, we have: lagophthalmos (2 cases), residual ectropion (3 cases), conjunctivitis (3 cases), wound dehiscence (2 cases) and palpebral hematoma (1 case). Six patients were reoperated due to complications. The results obtained according to the subjective evaluation of the plastic surgeon were regular (5 cases), good (20 cases) and very good (54 cases). CONCLUSION: Management of oculoplastic pathology requires mostly ambulatory surgeries with good results and low morbidity, which is feasible to perform in a public hospital. We believe it is necessary to use some objective instrument to better evaluate the palpebral defects and their correction.

Clinical application of ultra-pulsed fractional CO2 laser with lower energy in treatment of periocular rejuvenation / 吉林大学学报(医学版)

Objective: To compare the scores of periocular wrinkle and blepharochalasis of the patients before and after the treatment of ultra-pulsed fractional CO2laser with low energy,and to illuminate the efficacy of ultra-pulsed fractional CO2laser with lower energy in eyelid rejuvenation including periocular wrinkle and blepharochalasis.Methods:Thirty patients with periocular wrinkles and blepharochalasis who met the inclusion criteria were selected. The patients were treated with ultra-pulsed fractional CO2laser; the laser parameters were 10 mm spot size, pulse energy 5 mJ and repetition rate 600 Hz and the wrinkle walking areas were treated with 2 mm spot size and the same energy again. Two senior dermatologists scored according to the eyelid laxity scale before treatment and 7 d, 1 month, 3 months and 6 months after treatment, and statistical analysis was performed.Results: Compared with before treatment,there was no significant difference in the scores of eyelid laxity scale 7 d after treatment(P>0.05); the score of eyelid laxity scale was significantly decreased 1 month after treatment (P<0.05);the scores of eyelid laxity scale were significantly decreased 3-6 months after treatment (P<0.01),and the curative effect was more obvious.In this group of 30 patients, there were usually transient erythema, swelling and mild burning pain after treatment. But no serious complications occurred. Conclusion: Ultra-pulsed fractional CO2laser with lower energy(5 mJ) can improve the periocular wrinkles and blepharochalasis effectively with high security and without severe side effects.

Diagnosis and treatment of the blepharochalasis / 国际眼科杂志(Guoji Yanke Zazhi)

@#Blepharochalasis is a rare disease that often onsets in childhood or adolescence. It is characterized by non-painful, non-erythemaous eyelid angioedema with intermittent recurrent episodes, resulting in relaxation, atrophy and thinned of eyelid structures. The late complications, attributing to continuous underlying structural destruction, including ptosis, orbital fat prolapse, lacrimal glands prolapse and blepharophimosis <i> etc</i>. The pathogenesis is not clear yet, researchers have indicated that it might be associated with inheritance and endocrine factors. Nevertheless, histopathology examination showed elastic fibers breakdown, IgA deposits and inflammatory cell infiltration. Based on this, it is assumed that the immunologic mechanism and inflammatory reaction play a significant role in the development of the disease. According to the clinical stage, there are two treatment patterns: oral medicine and surgery at present.

Blefaroplastia: resultados del empleo de dos técnicas en el Centro Oftalmológico de Santiago de Cuba / Blepharoplasty: results of using two techniques in the Ophthalmologic Center from Santiago de Cuba

Introducción: La blefaroplastia produce resultados clínicos y estéticos favorables en los pacientes aquejados por dermatocalasis. Objetivo: Evaluar los resultados de los procedimientos quirúrgicos convencional y con láser de CO2 en estos afectados. Métodos: Se realizó un estudio descriptivo, prospectivo y trasversal de 300 pacientes con dermatocalasis, atendidos en el Servicio de Oculoplastia del Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2015 hasta diciembre de 2016. Resultados: Predominaron el grupo etario de 40 a 59 años, el sexo femenino y la afectación en los párpados superiores, sin diferencias significativas en cuanto a las técnicas quirúrgicas empleadas; se observó un mayor número de complicaciones en los pacientes operados de manera convencional, con más frecuencia del sangrado. En general los pacientes evolucionaron satisfactoriamente y los que presentaron limitaciones del campo visual superior se recuperaron sin dificultad luego de la intervención quirúrgica. Conclusiones: La blefaroplastia con láser de CO2 constituye una mejor y más calificada opción terapéutica para la corrección de la dermatocalasis

Introduction: Blepharoplasty produces favorable clinical and cosmetic results in the patients that are suffering from dermatochalasis. Objective: To evaluate the results of the conventional and CO2 laser surgical procedures in these affected patients. Methods: A descriptive, prospective and cross-sectional study of 300 patients with dermatochalasis, assisted in the Oculoplasty Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital Ophthalmologic Center was carried out in Santiago de Cuba, from January, 2015 to December, 2016. Results: There was a prevalence of the 40 to 59 age group, female sex and upper lids disorder, without significant differences concerning the surgical techniques that were used; a higher number of complications in patients operated with a conventional way was observed, with more frequency of bleeding. In general the patients had a favorable clinical course and those that presented limitations of the upper visual field recovered without difficulty after the surgical intervention. Conclusions: Blepharoplasty with CO2 laser constitutes a better and more qualified therapeutic option for the correction of dermatochalasis

Ascher’s syndrome: A rare case report.

An 18‑year‑old Indian girl with upper lip deformity presented with on and off painless swelling of her both upper eyelids for 3 years. Clinical evaluation revealed bilateral blepharochalasis narrowing of horizontal palpebral fissure, decreased outer intercanthal distance, iris coloboma, cleft soft palate, bifid uvula, sensorineural deafness and double upper lip. Clinical examination of the thyroid, thyroid hormone assay and ultrasonography revealed normal thyroid gland structure and function. Ascher’s syndrome was diagnosed. To our knowledge, this is the first reported case of Ascher’s syndrome associated with iris coloboma, heterochromia iridum, and narrowing of horizontal palpebral fissure and decreased outer intercanthal distance secondary to lengthening of lateral canthal ligament.

Combined Subbrow Excision with Upper Blepharoplasty Using a Tadpole Shaped Excision for Blepharochalasis

BACKGROUND: In efforts to solve blepharochalasis, induced by aging process, various surgical methods have been developed over the years. Among them, classical upper blepharoplasty has a problem that severe lateral hooding may be restricted in making correction, cause of difference in thickness between the pretarsal skin and subbrow skin. And also subbrow excision (SE) blepharoplasty cannot be easily corrected in severe drooping of the medial skin. In an effort to make up for the disadvantages of these methods, we attempted SE-tadpole shaped excision blepharoplasty (TSEB). METHODS: Fifteen patients underwent SE-TSEB from January 2013 to November 2014. SE-TSEB was performed the following cases: 1) patients who showed moderate to severe blepharochasis with severe lateral wrinkles; 2) patients with a history of pre-existent SE blepharoplasty; 3) patients with a tattoo on the eyebrows, who want to make revision; and 4) patients with eyelid skins that are thick or have overly protuberant fat pads of the retro-orbicularis oculi fat (ROOF), and have a plan to extirpate them. RESULTS: During the follow-up observation period, most patients showed amicable correction of visibility difficulty and were aesthetically satisfied with the postoperative results with respect to correction of the lateral wrinkles. Scars formed in the subbrow incision line were within the scope of management. CONCLUSIONS: SE-TSEB is a treatment modality that overcomes the disadvantages and limitations of classical upper blepharoplasty and SE blepharoplasty. Furthermore, maximizing the advantage of each surgical approach is another innovative approach for correction of changes in the upper eyelid, induced by aging.

Effect of plastic surgery of double-palpebra with prolapse of lacrimal gland for blepharochalasis / 中华医学美学美容杂志

Objective To investigate the clinical effect of plastic surgery of double-palpebra with reposition of lacrimal gland for blepharochalasis.Methods We operated on 10 cases (20 eyes) with dermatolysis palpebrarum which stopped attack and was static for more than one year.A double eyelid fold incision was made.Then redundant skin and sphincter palpebrarum as well as protrusion of intraorbital fat were removed.In the operation of dislocation of lacrmial gland we sewed up lacrmial gland in full thickness and fixed it to the periosteum of lacrmial fossa,and the levator muscle of upper eye lid aponeurosis prothesis or plication was choosed when the levator muscle of upper eye lid aponeurosis was broken or not.And for the shorted transverse diameter of coloboma of eye lid we sewed up the external palpebral ligament and fixed it to the periosteum of lateral orbital margin.Results All the 10 patients got satisfactory therapeutic effect,the cutis laxa had been amended obviously,the good upper double eyelid shape could be achieved,the reposition of lacrimal gland was finished,lapsus palpebrae superioris and shorted transverse diameter of coloboma of eye lid had been rectified satisfactorily.All cases we followed up for three monthes to one year,and dislocation of lacrmial gland had been amended in one case,others had been reposited well,without recurrence.Conclusions Blepharochalasis can be effectively treated by surgery,and it is convenient and effective to treat dislocation of lacrimal gland and blepharochalasis through a double eyelid fold incision.This multiple surgical treatment is not only a curative operation but also a cosmetic surgery.

Therapeutic analysis of young blepharochalasis / 中华医学美学美容杂志

Objective To evaluate the surgical procedures and clinical results to treat the bleph arochalasis.Methods A series of 43 blepharochalasis in 23 patients were surgically treated.A double eyelid fold incision was made.Surgeon clippd redundant skin of upper eyelid with forceps,so that would be excised was marked out.Then redundant skin and muscles as well as hernia septal fat were removed.The lacrimal glands were found and repositioned into lacrimal glands fossa behind superolateral orbital rim.We choose different methods to perform plastic operation in 23 cases of blepharochala sis according to different topographic anatomic characteristics.Results Postoperatively,not only the patients recovered in a followed-up period of 1-3 years,but all lacrimal glands were normally rep soitioned.Conclusions These methods are effective in patients with blepharochalasis and meet the cosmetic demands.Good clinical results in both function and appearance are achieved.

Surgical treatment of patients with blepharochalasis and its associated abnormalities / 眼科

Objective To assess the effects of surgical treatment for patients with blepharochalasis and its associated abnormali- ties. Design Retrospective case series, Participants 35 cases (52 eyes) with blepharochalasis in stable phase. Methods The correction of the abnormalities in upper eyelids: after designing the lid crease incision, the redundant eyelid skin and prolapsed fat were excised, and prolapsed lacrimal glands were sutured back into position in 18 cases (36 eyes) and ptosis was treated in 10 cases (16 eyes). The correction of abnormalities in lower eyelids: lower eyelid retraction was corrected in 4 cases (6 eyes). The correction of lateral canthus malformation: lateral canthus rounding was treated in 7 cases (14 eyes), accompanied with or followed by correction of baggy eyelid or ptosis. Main Outcome Measures The shape, location and movement of bilateral eyelids, the location of lacrimal glands and the cir- cumstance of tear secretion. Results During the follow-up of 6～60 months, the appearance and location of bilateral eyelids and can- thuses were satisfying, the function of eyelids were normal, and no dry eye symptoms were found. Two cases (3 eyes) appeared recurrent lacrimal gland prolapse 29 and 36 months postoperation and received surgeries for correction again. There was no recurrence after the second prolapse correction surgery in the follow-up of 18 and 24 months respectively. Conclusions Surgical treatment for patients with blepharochalasis and its associated abnormalities is safe and effective. Its recurrence rate is low.

Cosmetic surgical treatment of blepharochalasis with lacrimal glands prolapse / 中华医学美学美容杂志

Objective To study the pathologenesis and to evaluate an operative method of blepharochalasis. Methods A double eyelid-fold incision was made. The lacrimal glands were found and repositioned into lacrimal glands fossa behind superolateral orbital rim. Then redundant skin and muscles as well as hernia septal fat were removed. Results Twenty-three patients were successfully treated by the mentioned methods from 1998 to 2002. A good clinical results in both function and appearance were achieved. Conclusion It is convenient and effective to treat blepharochalasis through a double eyelid fold incision.