A new digital image analysis system for measuring blepharoptosis patients' upper eyelid and eyebrow positions.

PURPOSE: To accurately assess eyelid and eyebrow position, we have developed a new measurement method using a digital image analysis system. MATERIALS AND METHODS: (1) Plotting the corneal limbus by transferring to the software digital images of the patient's eyes in the primary gaze position; (2) determining the corneal ring, center, and longitudinal diameter; and (3) measuring the upper eyelid and eyebrow position. The method was tested on 24 patients with senile blepharoptosis and 45 young healthy eyelids without ptosis. RESULTS: The upper eyelid position of patients with blepharoptosis was significantly lower, and their eyebrow position is significantly higher than those of healthy subjects. The upper eyelid and eyebrow position of the patients with blepharoptosis corelated, but no correlation was observed in the healthy subjects. CONCLUSION: Our measuring system is a simpler, easier, and more accurate way of measuring both upper eyelid and eyebrow position than are currently used techniques.

Bilayer reconstruction for parry-romberg syndrome: using a free circumflex scapular artery-based adipofascial flap for both the buccal fat pad and subcutaneous fat.

PURPOSE: When using a free flap to reconstruct a facial deformity caused by Romberg's disease, it is important to prevent the flap from sagging after the operation. We report a new method of reconstructive surgery using a free subscapular adipofascial flap to prevent this problem. PATIENTS AND METHODS: Three female patients (ages 27, 28, and 34 years) with Parry-Romberg syndrome underwent microsurgical free scapular flap transfer for buccal defects. This operation requires making a gingivobuccal sulcus incision and forming a pocket for buccal fat reconstruction by dissecting over the periosteum of the maxillary bone. Preauricular and submandibular incisions are made to create a subcutaneous pocket for flap transfer. After the subscapular flap is elevated, we use its angiogram to observe its vascular pattern. The flap is separated to preserve the main blood vessels horizontal lower branches. The subcutaneous adipose tissue layer uses the horizontal branch, and the buccal fat pad layer the lower branch. METHODS: After the operations, the adipofascial flaps were in good condition and without postoperative complications. A half year after the first operation, revisional surgery was performed for one patient. No cases showed no sagging of the cheek, and in every case the overall appearance of the buccal region improved significantly. DISCUSSION AND CONCLUSION: Reconstruction of the buccal fat pad and subcutaneous adipose tissue using a free bilobed adipofascial flap nourished by the circumflex scapular artery, returned the adiposal tissue to its normal position, assuring more natural facial contours.