Correction of paralytic lagophthalmos.

INTRODUCTION: Bell's palsy causes lagophthalmos of the involved eyelids. Secondary to the atonicity of the eyelids, xerophthalmia, conjunctivitis and epiphora develops. There are dynamic (muscle transfers) and static (gold weights, tarsorrhaphy) approaches to alleviate these problems. The GOALS of this study are to present a technical note for a surgical method for lengthening the retracted upper eyelid with autogenous temporalis fascia and elevation of the lower eyelid with transplantation of autogenous morselized conchal cartilage graft via standard blepharoplasty incisions. MATERIAL AND METHODS: The proposed technique is illustrated in details with an example of a patient with paralytic lagophtalmos. The 4 years follow up of the case operated by this technique shows a stable occlusion of the eyelids with a lowering of the upper eyelid and elevation of the lower eyelid margin. CONCLUSION: If the paralysis is complete this technique will not accomplish adequate relieve of symptoms. In this cases re-animation of the eyelids with either temporalis muscle transfers or free micro neurovascular muscle transfers are indicated.

Autologous fat transplantation in the facial region--clinical and morphological studies of 30 cases.

OBJECTIVE: This study presents the results of a clinicomorphological study of autologous fat transplantation in the face region. The aim was to investigate and compare adipose tissue morphology after it was purified by two methods--centrifugation and serum lavage, and to find a correlation between the histological outcomes and the postoperative results. PATIENTS AND METHODS: The evaluation was performed on a series of 30 patients assigned into two groups of 15 patients. Centrifuged adipose tissue was transplanted in one of the groups, and noncentrifuged (saline solution washed) in the other group. In all cases fat was obtained by syringe liposuction of subgluteal zones, processed by one of the two methods and then transplanted. Part of the material was fixed between vitaline membranes and embedded in paraffin. Histological analysis was performed after hematoxylin eosin staining of the slides. Post-operative effect was assessed by comparison of the pre- and postoperative photos on a 4-grade scale. RESULTS: The morphological analysis revealed that adipose tissue was damaged by neither of the purification methods but the serum lavage preserved greater number of non-differentiated fat cells and connective tissue fragments. Furthermore, our clinical results suggested clearly that the noncentrifuged adipose tissue transplantation was more advantageous than the other type of transplantation. CONCLUSION: The present study is an attempt to make a contribution towards a better understanding of the mechanisms involved in fat graft preservation.