Objective evaluation of the eyelids and eyebrows after blepharoplasty.

PURPOSE: Surgery of the upper and lower eyelids and eyebrows is primarily designed to enhance the esthetic appearance and provide functional visual field benefits. Paramount to successful surgical results is a carefully executed examination and treatment plan. The preoperative and postoperative evaluation of these individuals has been primarily subjective. This article describes a method for the quantification of periorbital relationships that is of use in the preoperative planning and postoperative evaluation of patients undergoing esthetic surgery of the eyelids and eyebrows. PATIENTS AND METHODS: The photographic records of 15 female patients who had undergone bilateral upper eyelid surgery were examined. None of the patients underwent lower eyelid or eyebrow surgery. Preoperative and postoperative frontal photographs were projected to a standard size, and measurements were made in a standardized fashion. For the comparison of intrapatient and interpatient relationships, objective anthropometric proportions rather than average measurements were used. Therefore, standard periorbital relationships were recorded and expressed as anthropometric ratios. Measurements were recorded for 30 eyes. The preoperative and postoperative relationships were measured and reported as mean values with standard deviation. The relationships studied were: 1) Upper lid height to orbit height, 2) Lower lid height to orbit height, 3) Lid sulcus height to orbit height, 4) Lid sulcus height to upper lid height, 5) Upper iris coverage to iris height, 6) Lower iris coverage to iris height, 7) Orbit height to middle facial height, 8) Medial brow to orbit height, 9) Lateral brow to orbit height, and 10) Eye fissure height to orbit height. Brow heights were measured vertically from a line connecting exocanthion and endocanthion. RESULTS: The postoperative changes in these patients showed the following: Upper lid height, eye fissure height, and brow position were not significantly affected by upper lid blepharoplasty surgery. The sulcus lid height was doubled postoperatively, and upper iris coverage was decreased slightly postoperatively. CONCLUSIONS: The results of the study indicate that the proposed methodology is appropriate for the objective evaluation of periorbital relationships pertinent to esthetic periorbital surgery. Its use is suggested as a diagnostic aid in preoperative planning and postsurgical evaluation.

Cephalometric analysis of profile nasal esthetics. Part III. Postoperative changes after isolated superior repositioning.

In part I of this study, a method for the objective evaluation of profile nasal esthetics was presented and applied to establish normative values for young adult white males and females. Male and female nasal profile esthetics were found to be virtually identical. In part II, the data from the preoperative lateral cephalograms of 13 young adult white female patients with vertical maxillary excess (VME) were compared to the normative data established for females in part I. Results showed a distinct nasal profile in patients with VME. In this part of the study, the postoperative lateral cephalograms of the 13 female patients from part II were analyzed after surgical correction of their vertical maxillary dysplasia to determine if returning the maxilla to a more normal position effected similar changes in nasal profile esthetics. All patients had superior repositioning of the maxilla for which the magnitude of movement was greatest in the superior direction, with the mean movement being 2.3 mm superiorly. The results revealed that surgical correction of VME effected normalization of most of the nasal profile esthetic characteristics.

Cephalometric analysis of profile nasal esthetics. Part II. Patients with vertical maxillary excess.

In part I of this study, a method for the objective evaluation of profile nasal esthetics was detailed, and normative values for males and females were presented. In part II, identical methodology was applied to the preoperative lateral cephalograms of 13 female patients with vertical maxillary excess to determine how the nasal profile esthetics of these patients varies from the norm. This data was compared to the normative data established for females in part I. Results determined that patients with vertical maxillary excess have increased nasal length caused by a more superiorly positioned soft tissue nasion, decreased thickness of soft tissue at rhinion, increased nasal form angle, and increased absolute nasal tip angle related to an increased inclination of the cranial base, increased forward projection of the anterior nasal spine (tip support), and decreased incidence of supratip break. These findings suggest a characteristic appearance similar to the type II nasal characteristic (aquiline form) established in part I.

Cephalometric analysis of profile nasal esthetics. Part I. Method and normative data.

A comprehensive method for the measurement of profile nasal esthetics from standard lateral cephalograms was used for a group of 30 white male and 30 white female patients with skeletal Class I relationships and dental malocclusions only. Linear, horizontal, vertical, and angular hard and soft tissue measurements were made. Results for the two groups were analyzed to determine if there were statistically significant morphologic differences between the sexes. To eliminate differences related to the absolute size differences that characteristically exist between men and women, the results were taken as ratios of a fixed referent (middle third facial height), so that actual intergender differences in shape and form could be determined. The results indicated that male and female noses have essentially identical profile characteristics. The range for both sexes extended from an aquiline nasal type (more classically male) to an upturned type (more classically female). The characteristics of the normative nose for males and females are presented. The proposed methodology provides a standard objective means of evaluating changes in nasal esthetics after maxillary or rhinoplasty surgery.

Failure of osseointegrated dental implants after diphosphonate therapy for osteoporosis: a case report.

Late loss of initially integrated endosseous implants has generally been attributed to implant overload often the result of inappropriate prosthesis design. Implant placement is rarely contraindicated by preexisting systemic diseases, and no instances of medication-induced implant failure have been reported in the literature. This paper reports a case in which a patient lost five endosseous implants that had successfully osseointegrated and had been restored with a lower hybrid prosthesis approximately 6 months after diphosphonate therapy for osteoporosis was started.