A Six-Year Review of the Latest Oculoplastic Surgical Development.

PURPOSE: The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral canthoplasty, and upper and lower blepharoplasty. DESIGN: Systematic review of epicanthoplasty, lateral canthoplasty, upper and lower blepharoplasty in the period of 6 years. METHODS: A systematic MEDLINE search by 2 independent reviewers was performed on PubMed using the search terms (blepharoplasty) OR double eyelid) OR lateral canthopexy) OR fat repositioning) OR epicanthoplasty) OR love band) AND (From January 2012 to January 2018). RESULTS: After screening 1456 abstracts from search results, 1377 were eliminated due to irrelevant content. Full text of the remaining 79 articles and relevant cross-references were reviewed and summarized. Studies on cosmetic epicanthoplasty reported Z-plasty or modifications (n=8), advancement flap (n=4) or skin redraping procedures (n=1), removal or release of the orbicularis muscle (n = 14), with (n = 6) or without (n = 11) tightening medial canthal tendon. In lateral canthoplasty, approaches to preserve continuity of eyelid margin prevent lateral canthal deformity with inconspicuous incision via gray line (n = 2) or upper eyelid (n = 2) were described. Techniques of upper blepharoplasties described included open incision method (n = 9) with (n = 5) or without (n = 3) orbicularis resection, subbrow approach (n = 1), nonincisional suture blepharoplasty (n = 2), or partial incision blepharoplasty (n = 1). For lower blepharoplasties, techniques described included blepharoplasty with fat transposition (n = 7), transconjunctival blepharoplasty (n = 3), transcutaneous blepharoplasty and canthopexy (n = 1) or orbicularis flap (n = 2), minimally invasive or laser-assisted blepharoplasty (n = 2). CONCLUSIONS: The recent trend of periocular surgical rejuvenation focuses on preserving soft tissue volume, avoiding skin or use hidden incision, taking the eyebrow and midface position into account, and measures to minimize iatrogenic eyelid malposition.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong.

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.

Lower Eyelid Blepharoplasty: Does the Literature Support the Longevity of this Procedure?

BACKGROUND: Lower eyelid blepharoplasty has continued to evolve with ongoing debate regarding optimal techniques. Despite large case series publishing excellent results and minimal complications, the true longevity of these procedures remains unclear. OBJECTIVES: The aim of this study was to determine how thoroughly the aesthetic surgery literature assesses the longevity of lower blepharoplasty. METHODS: A 20-year comprehensive literature review from 1997 to 2017 was conducted. The titles and abstracts of 180 articles were reviewed, yielding 86 potential publications; 49 studies met inclusion criteria and were analyzed. RESULTS: A total of 10,698 patients were included for analysis. Reported follow-up ranged between 1 week and 192 months. Mean follow-up was 14.8 months for the 29 studies (59.2%) that reported these data. Pooled analysis of complication rates demonstrated 0.77% (n = 82) reoperation, 0.37% (n = 39) scleral show, 0.25% (n = 27) lid malposition, and 0.24% (n = 25) ectropion rates, among others. Forty-four studies (89.8%) published postoperative photographs with a total of 141 unique postoperative time points that were supported with photographic evidence (mean: 15.3 months; range: 1 week-192 months). In this series, for only 10 patients (0.094%) were postoperative photographs available at time points beyond 24 months. CONCLUSIONS: Lower eyelid blepharoplasty is a powerful procedure with seemingly minimal morbidity despite its technical demands. The longevity of this procedure is poorly supported with photographic evidence in the literature. Studies do not adequately report or represent their follow-up to capture long-lasting results. Standardized reporting of results is needed to ensure that anyone seeking this treatment can be adequately counseled.

Current Trends in Upper and Lower Eyelid Blepharoplasty Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members.

PURPOSE: To assess current practice patterns for management of upper and lower eyelid blepharoplasty by active American Society of Ophthalmic Plastic and Reconstructive Surgery members. METHODS: An invitation to participate in a web-based anonymous survey was sent to the active American Society of Ophthalmic Plastic and Reconstructive Surgery membership via email. The survey consists of 34 questions, both multiple choice and free response, regarding upper and lower eyelid blepharoplasty surgery. Practice patterns for both aesthetic and functional blepharoplasty are assessed. RESULTS: Thirty-four percent (161/472) of American Society of Ophthalmic Plastic and Reconstructive Surgery members polled responded to the survey. Members perform an average of 196 upper eyelid, 46 lower eyelid, and 53 four-eyelid blepharoplasty procedures per year, with 70% of cases being functional and 30% purely aesthetic. Most members prefer monitored care (71%) to local (21%) or general (8%) anesthesia. Eighty-nine percent of surgeons use topical antibiotics after surgery, erythromycin being the most common (51%). Fourteen percent of members use postoperative oral antibiotics, with cephalexin (81%) being most common. In upper eyelid blepharoplasty, orbicularis muscle is excised by 86% of respondents. Orbital fat is excised, when deemed appropriate, in 97% of cases, with nasal fat excised most commonly (88%). Less commonly, fat repositioning (36%) and adjunctive fat grafting (33%) are performed. In lower eyelid blepharoplasty, surgeons report using one or more of the following approaches: transconjunctival (96%), transcutaneous (82%), and both transconjunctival and transcutaneous (51%). Common adjunctive procedures include orbital fat excision (99%), fat repositioning (80%), and lateral canthal suspension (96%). Less common adjunctive procedures include laser skin resurfacing (36%) and chemical peels (29%). CONCLUSIONS: This report outlines contemporary practice patterns among active American Society of Ophthalmic Plastic and Reconstructive Surgery members in the management of upper and lower eyelid blepharoplasty. It is important to quantify such data periodically to update the membership as to how this common surgical procedure is approached. This also allows eyelid surgeons to compare their practice patterns with a national group specializing in such surgery.

Lower lid blepharoplasty: panel discussion, controversies, and techniques.

UNLABELLED: What is the most frequent displeasing effect you see when performing lower eyelid blepharoplasty? What surgical approach do you most frequently use when performing lower eyelid blepharoplasty? How much skin removal of the lower eyelids? When performing lower lid blepharoplasty, what is your preferred method of managing pseudoherniated fat? If you perform midface lifting during blepharoplasty, what approach do you use? ANALYSIS: Over the past 5 years, how has your technique or approach evolved or what is the most important thing you have learned in doing blepharoplasty?

[Ptosis surgery. Current aspects]. / Ptosischirurgie. Aktuelle Aspekte.

Ptosis can be congenital but is more commonly an acquired condition occurring in particular as involutional forms. In addition to the aesthetic aspects ptosis mostly also leads to functional problems. Congenital ptosis in particular carries a high risk of amblyopia in childhood, therefore competent and close-knit pediatric ophthalmological treatment is important. Correction of ptosis is surgical and direct or indirect procedures are available depending on the conditions. Transcutaneous levator surgery has proven to be the universally applicable method for ptosis of all degrees of severity and can be combined with other corrective measures, such as temporal canthopexy or blepharoplasty, particularly for eyelids of elderly patients. In cases of severely impaired levator function and poor Bell phenomenon the indirect frontalis suspension method can be used. Congenital ptosis in childhood should be surgically treated at an early stage because of a substantial risk of amblyopia even if the central visual axis is still clear. The results of ptosis surgery are generally good and serious complications are rare.

[Blepharoplasty of the upper and lower eyelid. Strategic considerations for incisions]. / Blepharoplastik des Ober- und Unterlids. Strategische Betrachtung der Schnittführung.

Blepharoplasty of the upper and the lower eyelid is a very common aesthetic procedure of the face and is carried out by different types of surgeons. Before starting the procedure it is very important to analyze all pathogenetic factors. The position of the skin incision is dependent on the extent and position of the element to be corrected and age, sex and racial characteristics should be taken into consideration.

[Lower lid entropion and ectropion. Indication, technique and key points of "classical" surgical methods]. / Ektropium und Entropium des Unterlids. Indikation, Technik und Schlüsselpunkte "klassischer" Operationsmethoden.

Lower lid malposition is common, increases with age and leads to impaired optical function of the ocular surface through chronic irritation of the conjunctiva and cornea. Numerous techniques have been described to reposition the lid margin to the globe and secure this position while maintaining intact motility. Some of these techniques have passed the test of time and have reached the status of "classic" standard procedures that need to be in the armamentarium of every oculoplastic surgeon. The aim of this article is to consider the merits of a selection of standard methods for the correction of lower lid entropion and ectropion by describing their indication, technique and key points.

[Management of eyelid burns]. / Particularités de la prise en charge des paupières brûlées.

Burns are devastating injuries scarring patients, both physically and psychologically, for life. This remains particularly true for facial burns. Eyelid burns occur in about 10% of thermal injuries and is a considerable challenge for the reconstructive surgeon given the particular anatomy of the eyelids. Reconstruction of the eyelids following burn injuries has been performed by plastic surgeons since the earliest days of reconstructive surgery, yet a consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. Controversies exist regarding the excision and debridement of eschar, temporary suture and surgical tarsorrhaphy, timing of surgery for eyelid contraction, and the role of full and split-thickness skin grafts in eyelid reconstruction. This paper describes the particularities of the treatment of burned eyelids in our Burn Center.

The current state of ptosis repair: a comparison of internal and external approaches.

PURPOSE OF REVIEW: Posterior approach ptosis repair has made a resurgence over the last decade. The purpose of this review is to examine the history of posterior approach ptosis repair and the events that have led to its current favorable status. RECENT FINDINGS: The evolution of the posterior and anterior approach ptosis surgeries has resulted in two favored techniques for involutional ptosis repair: the Müller muscle-conjunctiva resection (MMCR) and the external levator advancement. Each procedure has strong and prominent proponents in the oculoplastic surgery community. Recently, the MMCR has converted surgeons who have previously favored the external levator advancement. A number of factors have influenced this recent elevation of the MMCR including differing opinions on the cause of involutional ptosis, the mechanism by which the MMCR works, the predictability and speed of the MMCR, and the current reimbursements for ptosis repair by insurance companies. SUMMARY: The recent preference for posterior approach ptosis surgery, in particular the MMCR, is multifactorial. In order to understand the evolution of opinions about the procedure, a historical knowledge of involutional ptosis and ptosis repair is necessary.

Blefaroplastia: ¿suturar o usar cianocrilato? / Blepharoplasty: to suture or to use cyanoacrylate?

Objetivo: Estudiar la seguridad y el tiempo quirúrgico requerido al usar el adhesivo tisularetil-2-cianocrilato comparado con la sutura convencional en la blefaroplastia superior.Métodos: Se realizó un estudio retrospectivo en 40 ojos de 20 pacientes intervenidos deblefaroplastia superior bilateral. En 7 pacientes para el cierre de la incisión se utilizaronpuntos continuos de sutura no reabsorbible (monofilamento nailon (6-0 Ethilon®, EthiconInc., Somerville, NJ) y en 13 pacientes se usó etil-2-cianocrilato (Epiglue®,Meyer-Haake, Alemania).Las variables estudiadas fueron el tiempo intraoperatorio requerido para el cierrede la incisión, el coste del material utilizado y la incidencia de infecciones y/o dehiscenciade sutura.Resultados: El promedio del tiempo empleado para el cierre de la incisión con el cianocrilatofue de 6.069 minutos y de 11.914 minutos con la sutura convencional (p < 0,05). El precio delmaterial quirúrgico utilizado fue prácticamente similar.No hubo ningún caso de infeccioneso dehiscencia de herida.Conclusiones: El cierre de la incisión de la blefaroplastia superior con cianocrilato es un procedimientoefectivo, seguro, más rápido pero no menos costoso que la sutura convencional(AU)

Objective: To study the safety and surgical time required when using the tissue adhesive2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty.Method: A retrospective study was performed on 40 eyes of 20 patients who underwentbilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylonmonofilament Ethilon®, Ethicon Inc., Somerville, NJ) was used for closure of the incisionand in 13 patients 2-ethyl-cyanoacrylate (Epiglue®, Meyer -Haake, Germany) was used. Thevariables studied were intraoperative time required to close the incision, the cost of thematerial used and the incidence of infections and suture dehiscence. Results: The average time taken to close the incision was 6.069 minutes with cyanoacrylateand 11.914 minutes with conventional suture (P < .05). The price of surgical material usedwas practically similar. No cases of infection or wound dehiscence were found.Conclusion: The closure of the incision in upper lid blepharoplasty using 2-ethylcyanoacrylateis a safe, effective, and faster, but not less expensive method thanconventional suture(AU)

New technologies in aesthetic blepharoplasty and brow-lift surgery.

New technologies are important in the advancement of any field. Two such advancements in blepharoplasty and brow lifting include use of the PlasmaBlade and fractionated CO (2) laser resurfacing. The PlasmaBlade uses pulsed radiofrequency energy with a highly insulated blade to assist with incision and dissection during eyelid surgery, resulting in minimal bruising and edema. This article describes specifically how the PlasmaBlade can be used and its typical settings. Fractionated CO (2) laser resurfacing is also a powerful tool that can significantly enhance eyelid rejuvenation. This resurfacing can address fine lines in the periocular region with limited downtime. Use of these technologies can help to improve results and shorten the recovery time traditionally associated with blepharoplasty and periocular resurfacing.

Use of the orbicularis retaining ligament in lower eyelid reconstruction.

INTRODUCTION: The orbicularis retaining ligament (ORL) is a distinct anatomical structure that has only been recently characterised. A variety of techniques, based on Hamra's concepts, now divide this ligament during lower lid blepharoplasty. This often produces a substantial skin excess which is discarded. We set out to investigate the validity of this surgical manoeuvre as a means of recruiting anterior lamella for the purposes of lower lid reconstruction. MATERIALS AND METHODS: Between September 2002 and August 2004, 23 patients underwent reconstruction of the anterior lamella of their lower eyelid using this technique. The mean age of the patients was 56 years (range 26-86 years). The mean follow-up time was 20 months (range 12-36 months). Clinical evaluation was carried out preoperatively and postoperatively to assess the presence of palpebral non occlusion, epiphora, the sensation of a dry eye, ectropion, conjunctivitis and keratitis. Assessment of the tissue deficit was made clinically and with standardised digital photographs. RESULTS: Satisfactory reconstruction of the anterior lamella of the lower eyelid was achieved in 19/23 patients. Preoperative symptoms of epiphora and lower lid position were improved. The visual analogue scale of appearance was improved postoperatively. In some cases, particularly in the atrophic lower lid, the results were short lived and further surgery was required to achieve optimal results. CONCLUSION: In cases of isolated cutaneous deficit where the lid support mechanisms are intact, the procedure is both successful and aesthetically favourable for resurfacing this challenging area.