Intralesional Tetracycline Injection, Pinch Technique, and Canthopexy for the Treatment of Severe Festoons: Preliminary Results.

BACKGROUND: Many techniques have been presented for the treatment of lower eyelid festoons, but no singular technique has become dominant. OBJECTIVES: The authors describe the safety and efficacy of intralesional tetracycline injection, the pinch technique, and canthopexy for the treatment of severe festoons. METHODS: Institutional board review approval was obtained, and a retrospective chart review was performed on 15 consecutive patients who had received 2% tetracycline injections to treat lower eyelid large festoons between February 2017 and February 2020. Three months after the last injection, a series of patients underwent the surgical procedure: pinch technique and canthopexy bilaterally. RESULTS: Clinical and photographic records were reviewed, and 12 patients were included in the analysis. Three patients did not return for follow-up after the injection series. Of the 12 patients, there were 3 male patients and 9 female patients, with an average age of 66.6 years. The mean volume injected in each festoon was 0.43 mL, and the mean follow-up was 313 days. A series of injections with a 3-month time interval were performed for patients with a partial response to the initial injection. There was no evidence of complications at the site of the injection. Three months after the last injection, these 12 patients underwent complementary surgical treatment, which included pinch resection and canthopexy. CONCLUSIONS: These preliminary results suggest that intralesional injections of tetracycline 2% may offer a safe option to treat lower eyelid festoons. This noninvasive procedure represents adjunct benefits to complementary surgical therapy.

Relation Between Post-Augmentation Parenchymal Atrophy and Local Tissue Pressure.

BACKGROUND: Breast parenchyma interacts dynamically with an inserted implant, which may lead to local atrophy and sensory involvement, changes in vascular tissue and lactation, and volume reduction over time. The inversely proportional relationship between pressure and volume cannot be stated with certainty; that is, the larger implants having more local pressure would lead to compression, thus leading to atrophy of parenchyma more intensely compared with smaller implants. The objective of this study was to assess and list breast parenchyma volume changes with different pressure levels due to silicone implants of several sizes. OBJECTIVES: The authors sought to list the pressure exerted by silicone implants and the atrophy caused in the breast tissue. METHODS: Thirty-six women were placed in 3 groups (n = 12) and subjected to augmentation mammoplasty in the subglandular plane. The measurement of pressure in millimeters of mercury was conducted with help of molds with the same base and projection of implants introduced posteriorly. MRI was conducted in all participants in the preoperative period and at 6 and 12 months after surgery. RESULTS: Twelve months after breast implant insertion, the groups had a significant glandular volume reduction (mean, 12.97% in the right breast and 12.42% in the left breast). There was a statistically significant difference in the proportions of volume reduction and the pressure levels measured. CONCLUSIONS: A reduction in breast volume was verified. This reduction was also related to the level of pressure exerted on the implant.

Lateral Canthal Clefts of the Eyelid.

PURPOSE: Facial clefts are congenital anomalies classified by Tessier based on their anatomical position. Tessier 8 craniofacial clefts extend from the lateral canthus to the temporal region, including bone cleft at the frontozygomatic suture, and it is characterized by the interposition of a strip of skin at the lateral canthus that disrupts the continuity of the orbicularis muscle, preventing its normal functioning. METHODS: This is a retrospective study of 6 patients with congenital eyelid coloboma, of whom 5 underwent surgery for the removal of dermolipoma and reconstruction of the lateral canthus. After surgery, the shape and symmetry of the lid fissure was restored, and motility was maintained. Vertical and horizontal measurements of the palpebral fissure were carried out before and after surgery. RESULTS: Five cases of lateral colobomas were evaluated after surgical treatment up to a year post operatively. The surgical correction with limited resection of the tumor was very effective, and the resulting small horizontal scar almost disappeared over time. In all cases, motility was maintained, and there were no cases of symblepharon. After surgery, there was improvement in the shape and symmetry of the eyelid fissures. CONCLUSIONS: Tessier' Number 8 facial cleft coloboma is characterized by the interposition of a skin strip, constituting a dermolipoma between the upper and lower eyelids that disrupts the continuity of the orbicularis muscle, and lateral bone alteration. The surgical correction of dermolipoma should be performed conservatively with limited resection of the tumor. A simple canthoplasty was very effective, and the small scar practically disappears over time. The absences of bone alteration in the cases presented suggest a unusual variation of lateral canthal cleft.