Long-term results of autologous periorbital lipotransfer.

OBJECTIVE: To evaluate the long-term aesthetic results in patients treated with autologous periorbital lipotransfer. METHODS: A retrospective review of 114 consecutive patients during 4 years who underwent autologous periorbital lipotransfer. Of these patients, 99 were identified who had complete photographic and medical records and were therefore included in the study. Patients were placed into 5 groups based on their total length of postoperative follow-up. Periorbital volume augmentation was assessed by 3 independent masked evaluators using a standard aesthetic scale from 0 to 2 (with 0 indicating no improvement; 1, mild improvement; and 2, marked improvement). Interobserver correlation was determined by κ correlation, and Mann-Whitney tests were used to assess for statistical significance comparing the same patients in each group. RESULTS: Scores from the 3 independent evaluators correlated well (κ = 0.316); aesthetic improvement was seen in almost all patients (86.4%), who had demonstrated improvement for the first 3 years of follow-up. The degree of improvement decreased each year, and only mild improvement was retained in most patients (68.2%) by the 3-year follow-up point (P = .049). CONCLUSIONS: Results from most patients who underwent autologous periorbital lipotransfer demonstrated improvement that lasted as long as 3 years. Autologous periorbital lipotransfer remains a valid and effective technique for periorbital rejuvenation and demonstrates long-term potential effectiveness.

Midface restoration in the management of the lower eyelid.

Aging of the midface and lower eyelid represents one of the earliest clinically detectable areas of aging on the face. These senile changes include laxity of eyelid skin, pseudoherniation of orbital fat, ptosis of the suborbicularis oculi and malar fat pads, and loss of facial volume. Several approaches, including surgical and nonsurgical procedures, have been developed to counter the effects of aging on the midface and lower eyelid. This article reviews the techniques used by the authors to rejuvenate the midface and lower eyelid, and illustrates a comprehensive approach to management of this complex facial region.

Fat management in lower lid blepharoplasty.

Aging of the lower eyelid involves a complex series of anatomic and physiologic changes that occur over time. Rejuvenation of the lower eyelid complex must systemically address the various contributions of soft tissue laxity, pseudoherniation of orbital fat, and loss of periorbital volume. This article outlines the evolution of our approach to lower eyelid blepharoplasty with a specific focus on the importance of management of fat in the periocular region. A discussion of various surgical approaches with their advantages and disadvantages is presented, and the importance of maintaining a safe lower eyelid is emphasized. A comprehensive and systematic approach to restoration of the lower eyelid is highlighted with specific postoperative results.

Cosmetic and functional effects of cephalic malposition of the lower lateral cartilages: a facial plastic surgical case study.

Certain anatomic variations of the lower lateral cartilages can predispose patients to nasal obstruction. One particular orientation is the cephalic malposition of the lower lateral cartilages which often results in both cosmetic and functional nasal effects. This article will discuss the pertinent surgical anatomy, diagnosis, the process to identify patients at risk with cephalic malposition of the lower lateral cartilages, pitfalls, and poor surgical changes that result in external nasal valve collapse. Appropriate diagnosis, prevention, and surgical maneuvers to address this will be discussed.