Transconjunctival Subperiosteal Septal Reset for the Correction of Orbital Fat Bulging and Tear Trough

Transconjunctival lower blepharoplasty has gained interest because of less-invasiveness and fast recovery. This is a study about operative skill, strength, and weakness of transconjunctival lower blepharoplasty and a trial for suggesting the guidelines for patient selection. The authors reviewed the medical records and photographs of 530 patients(M:F=470:60) who underwent transconjunctival lower blepharoplasty with orbital fat reposition and subperiosteal septal reset, retrospectively. Most of the patients were satisfied with results for correction of orbital fat bulging and tear trough deformity. Eighteen patients(3.4%) developed relapse of fat bulging requiring revision with subsequent fat removal(seventeen patients) or fat reposition(one patient). Two patient(0.4%) developed entropion. One case was corrected with revisional surgery and the other case was recovered after an injection of triamcinolone. Delayed hematoma was developed in five patients. Surgical evacuation was required in 3 cases. Minor problems included postoperative swelling, bruise, and transient paresthesia that resolved spontaneously. Transconjunctival lower blepharoplasty is an excellent surgical choice for correction of orbital fat bulging and tear trough in the patients who have proper tension of soft tissue. Invisible scar, fast recovery, and low complication rate are merits of this method.

Strategy for the Treatment of Infraorbital Dark Circles

Infraorbital dark circles refer to the darkness of lower eyelids and can be a significant cosmetic problem for the people of any age and sex. Although the general concern for dark circles is increasing, little has been published about the treatment of dark circles in the scientific literature. Dark circles are not a single disease but combination of causative symptoms. We classified patients to five groups according to patients' symptoms; bulging of infraorbital fat(Ia), sunken lower eyelids(Ib), depression or groove on midface(Ic), thin translucent skin(IIa), and excessive pigmentation(IIb). We reviewed medical records and photographs of patients retrospectively. The classification of patients and the treatment of the groups were evaluated. Problems of shape, especially bulging of infraorbital fat was the main cause of dark circles in most patients(65.2%). The treatment of each group included transconjunctival fat reposition or removal(Ia), single fat cell graft(Ib,IIa), microfat graft(Ic), and various dermatologic therapies(IIb). We obtained better results when we did combination of the treatments according to symptomatic groups.

Corneal Abrasion Occurred during Transconjunctival Blepharoplasty in a Patient with History of LASIK Operation

PURPOSE: LASIK, one of the currently popular ophthalmic procedures, can sometimes result in dry eye symptoms. In the patient who had underwent LASIK operation, the periorbital surgery may be more likely to lead to such a complication as dry eye symptom. We would like to report a case of corneal abrasion occurred after transconjunctival blepharoplasty in post-LASIK state and suggest the method about preventing the complication. METHODS: A 30-year-old female patient underwent transconjunctival blepharoplasty and microfat graft into the face. She had history of LASIK operation 2 years ago. Corneal protector was applied to both eye during transconjunctival operation. After the surgery, she complained of visual blurring at left side. Ophthalmic examination revealed corneal abrasion of left eye. RESULTS: Cornea protecting lens was applied to left eye for 2 weeks. Steroid and antibiotic eye drops were applied for relieving the symptoms and the prevention from progressing of complication. After 1 week, visual power and acuity was recovered to preoperative state. No other specific complications happened. CONCLUSION: Post-LASIK patient may have possibility of decreased corneal sensation and tear production. Preoperative ophthalmic examination is recommended for the prevention of complication. When corneal protector is applied, we suggest Optagel(R) as a useful lubricant.

Malignant Fibrous Histiocytoma Arising in Old Burn Scar on the Anterior Chest

PURPOSE: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. METHODS: We report a 58-year-old male patient who was admitted due to 3.5x5cm chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. RESULTS: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. CONCLUSION: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.