Correction of Sunken Upper Eyelid in Asian Blepharoplasty Based on Anatomical and Histological Study of Orbital Fat Fascia Flap.

OBJECTIVES: To explore the clinical application of orbital fat fascia flap in the correction of sunken upper eyelid in Asian blepharoplasty based on anatomical and histological research. METHODS: Observe the histological structure of the orbital fat and its fascia vascularity through cadaver anatomy and histological sections of 10 cadavers. Based on the anatomical and histological characteristics of orbital fat, 36 patients with mild to moderate sunken upper eyelids were corrected by transposition of orbital fat fascia flap with preservation of fascia vascular pedicle. During the operation, the lateral part of the central cellulite of orbital fat was separated longitudinally and transferred to the sunken place to correct the sunken upper eyelid. RESULTS: Anatomy and histology show that the orbital fat was located between the anterior layer of the levator aponeurosis and the posterior layer of the orbital septum and was separated into fat lobules by many fibrous septa. The blood vessels move forward from back to front along the orbital fat interlobular septum, and the blood vessels in the capsule below the orbital fat are abundant. Clinical results showed that the shape of the sunken upper eyelid was significantly improved in 35 cases after correction with this method during the postoperative follow-up from 9 months to 18 months. The mean sunken depth improved from 6.2mm (±1.0 mm) preoperatively to 2.2mm (±0.9 mm) at the last follow-up with a statistical significance. And only 1 case had partial depression in the unilateral eyelid and received autologous granular fat transplantation with satisfactory postoperative results. CONCLUSION: The transposition of orbital fat fascia flap with longitudinal separation and preservation of fascia vascular pedicle can better correct the sunken upper eyelid during blepharoplasty, and the long-term effect is stable, which is worthy of clinical promotion. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of Surgery Combined With Platelet-Rich Plasma in the Correction of Mild to Moderate Blepharoptosis.

OBJECTIVES: To explore the effect of surgery combined with platelet-rich plasma (PRP) in the correction of mild to moderate blepharoptosis. METHODS: A retrospective study was conducted on 36 patients with bilateral mild to moderate blepharoptosis from January 2021 to January 2023, which were corrected by surgery combined with local multi-point injection of PRP. The postoperative effect was observed, and the incidence of postoperative complications and patient satisfaction were calculated. RESULTS: Postoperative follow-up was 3 months to 2 years. Thirty-five cases of blepharoptosis were well corrected; 1 case (2.8%) had insufficient correction and was corrected by reoperation. There were no obvious complications such as incomplete closure, conjunctival prolapse, and exposed keratitis in 36 patients. All patients were satisfied. CONCLUSION: Surgery combined with PRP is effective in the correction of mild to moderate blepharoptosis with few complications and high satisfaction. As far as we know, this is the first time to apply PRP in the correction of blepharoptosis, which may provide a new idea for the clinical treatment of blepharoptosis and is worth popularizing.

Anatomical and Histological Study of the Upper Tarsus in Asian.

OBJECTIVE: The aim of this study was to observe and analyze the anatomical and histological characteristics of the upper tarsus in Asian. METHODS: A total of 15 Asians (14 adults, 1 child) were used. The sagittal sections with thickness of 3 µm in the middle of the upper eyelid were prepared and stained with hematoxylin-eosin, Masson trichrome and anti-smooth muscle actin antibody staining, and then were observed and photographed under light microscopy. RESULTS: On the sagittal section, the upper end of the tarsus was connected with the Müller muscle and the part of the posterior layer of the levator aponeurosis; the lower end was the inflated part of the palpebral margin; the superficial surface was connected with the pretarsal fascia; and the deep surface was connected with Müller muscle aponeurosis and palpebral conjunctiva. Histologically, the tarsus was similar to the structure between dense fibrous connective tissue and cartilage, and its main structures include meibomian glands and its ducts, accessory lacrimal glands, glands of Moll, glands of Zeis, eyelash hair follicles, Riolan muscle, blood vessels, and collagen fibers. Through the observation of the tarsus of a child, compared with the adult specimen, the meibomian gland tissue was more abundant; the collagen fibers density was significantly lower and arranged orderly; the blood vessel density was significantly higher; α-SMA positive smooth muscle cells could be seen in the upper end of the tarsus and its superficial and deep surfaces. CONCLUSIONS: In this study, the internal and adjacent anatomical structures of the upper tarsus in Asians were observed under a microscope, and according to the histological characteristics, the tarsus was divided into 3 parts and 3 types. Through the preliminary analysis, the tarsus was likely to show different histological characteristics in different individuals and age groups of Asians. There was a certain correlation between the degree of meibomian gland atrophy, the degree of collagen fibrosis and the density of blood vessel in the tarsus.

Research progress of mechanisms of fat necrosis after autologous fat grafting: A review.

Currently, autologous fat grafting is the common surgery employed in the department of plastic and cosmetic surgery. Complications after fat grafting (such as fat necrosis, calcification, and fat embolism) are the difficulties and hotspots of the current research. Fat necrosis is one of the most common complications after fat grafting, which directly affects the survival rate and surgical effect. In recent years, researchers in various countries have achieved great results on the mechanism of fat necrosis through further clinical and basic studies. We summarize recent research progress on fat necrosis in order to provide theoretical basis for diminishing it.

A Novel Strategy to Achieve Stable and Lasting Double Eyelids in Upper Blepharoplasty.

BACKGROUND: Incision blepharoplasty is very common among aesthetic surgery, but the effect of it varies considerably. The quality of incision blepharoplasty is mainly defined by operator's ability, which will result in the uncertainty of operation result. We are committed to seeking a principle to guide every operator to achieve optimum success. MATERIALS AND METHODS: A retrospective study of 150 patients experienced the new method from January 2020 to May 2022. This method was mainly divided into 4 steps. Firstly, released adhesion between the orbital septum and the levator aponeurosis and the connection between the orbital septum and the pretarsal fascia. Then, dealt with the epicanthus to reduce the resistance. Third, improve the lifting force of opening eyes or decrease the resistance of opening eyes to keep the balance of biomechanics in the upper eyelid. Last, sutured and closed the incision. The postoperative outcomes were assessed by "Global Aesthetic Improvement Scale." RESULT: The follow-up period at last for 3 months.-The results showed that the rate of "Very much improve" was 88% (132 patients); that of "Much improve" was 9.3% (14 patients); that of "Not change" was 0.6% (1 patient); and that of "Worse" was 2% (3 patients). The recovery time of patients varied from 2 weeks to 1 month. And the complications of the narrowing and lightening of the double-eyelid line decreased. CONCLUSION: Applying the biomechanical balance principle to incision blepharoplasty can generate a more beautiful double-eyelid line and is less likely to trigger off complications.