Aging Eyelid Research Articles

Infrabrow excision with septo-myocutaneous flap repositioning in aged eyelids in Asians

Asian eyelids are characteristically puffy, with a fold, and have bulging of the orbital fat and septum. Moreover, with the aging process, the orbital septum and skin lose elasticity and orbital fat atrophy proceeds, thus resulting in dermatochalasis and a sunken eyelid. We introduce a modified technique of infrabrow excision with septo-myocutaneous flap repositioning. An upper incision was made along the lower margin of the eyebrow and the placement of the lower incision was decided according to the amount of skin excision needed. After skin removal, the orbicularis oculi muscle (OOM) was incised 2 mm above the lower margin and dissected to expose the orbital septum. Additional dissection was performed along the preseptal plane to the supraorbital rim periosteum. Then, the lower flap (septo-myocutaneous flap) was anchored to the supraorbital rim periosteum. The overlapping OOM and subcutaneous layers were sutured separately. This technique makes it possible to correct the cause of an aging eyelid appearance. Additionally, an overlapping OOM aids in correcting sunken eyelids, and by tensioning the orbital septum, a puffy eyelid is corrected. As an advantage over the conventional infrabrow excision, our method prevents recurrence and corrects orbital septum laxity. Therefore, it can achieve more natural outcomes and lower recurrence rates.

Quantitative 3-dimensional Geometry of the Aging Eyelids.

Background:Although facial aging is a well-known phenomenon, it has not been comprehensively characterized in 3 dimensions. This study introduces a novel technique for capturing periorbital structures across age groups using 3-dimensional (3D) imaging and point cloud data collection.Methods:Forty-six white women were divided into 3 age groups: 20–39 years, 40–59 years, and 60+ years. Patients were scanned with the Canfield 3D photogrammetry system, and data files were exported to the point cloud processing software CloudCompare. Manually selected points specifying eyelid margins, creases, and 5 key periorbital features provided the basis for a fitted model and principal component analysis (PCA). Potential statistical significance across age groups was assessed for PCA values corresponding to each subject's eyelid geometry.Results:Three tendencies emerged with respect to increasing age and eyelid anatomy: the width and height of the palpebral fissure decreases, with the width decreasing more rapidly; the depth of the lateral canthus relative to the medial canthus decreases; and the superior crease becomes more variable. Analyses of variance of PCA values across age groups show statistically significant differences between the youngest and oldest groups.Conclusions:Three-dimensional photogrammetry enables rigorous and reliable evaluation of the aging eyelid. Results suggest age-induced changes to eyelid margin, crease, and lateral canthus positions, which have been noted anecdotally but poorly quantified until now.

Three Simple Steps for Refining Transcutaneous Lower Blepharoplasty for Aging Eyelids: The Indispensability of Micro-Autologous Fat Transplantation

BackgroundLower blepharoplasty has been used for rejuvenating lower eyelids, and diverse modifications have been used to treat conjunct deformities at the tear trough/lid-cheek junction. Strategies for recontouring prominent tear trough/lid-cheek junctions, including orbital fat manipulation, have been reported with good results in the literature. Micro-autologous fat transplantation (MAFT) is a previously unevaluated, potentially advantageous approach to blending the prominent tear trough/lid-cheek junction.ObjectivesWe determined the long-term results after 3-step transcutaneous lower blepharoplasty with MAFT for patients with aging eyelids and prominent tear trough/lid-cheek junctions.MethodsWe evaluated 205 patients with aging lower eyelids who underwent transcutaneous lower blepharoplasty with MAFT between October 2010 and September 2016. The 3-step procedure involved a subciliary elliptical skin excision, resection of 3 orbital fat compartments, and MAFT for the tear trough/lid-cheek junction employing a MAFT-GUN under intravenous anesthesia.ResultsThe mean patient age was 52 years (range, 34-78 years). The mean operating time was 61 minutes. The mean fat volumes delivered to the tear trough/lid-cheek junctions were 2.80 mL and 2.76 mL for the left and right sides, respectively. The average weights of the 3 resected orbital fat compartments were 0.58 g for the left side and 0.56 g for the right side. Patients showed significant improvement and maintenance at an average follow-up of 60.2 months (range, 18-90 months).ConclusionsThree-step transcutaneous lower blepharoplasty with MAFT is an effective, reliable, and promising method with high patient satisfaction and minimal risk of complications. Long-term results demonstrated its utility for aging lower eyelid treatment.Level of Evidence: 4

Eye damage due to cosmetic ultrasound treatment: a case report

BackgroundRejuvenation of aging eyelids is one of cosmetic changes to the individual to create the appearance of youth. Tightening treatment of eyelid by ultrasonic heat could possibly develop acute eye injury, including acute increase of IOP, cataract and rarely myopia.Case presentationA case report of rejuvenation tightening treatment caused eye injury with 6 months’ follow-up. All examinations were performed at a university teaching hospital. A healthy 32-year-old Asian woman had pain, photophobia and blurred vision in the right eye after rejuvenation tightening eye brow treatment. Intraocular pressure (IOP) was 31 mmHg in the right eye. Tyndall phenomena were observed. Visual acuity of the right eye dropped to 20/200 (from 20/20), with best-corrected visual acuities (BCVAs) 20/20. An iris pigment detachment was found. Neuro-ophthalmic examination was relative afferent pupillary defect (RAPD) positive with pericentral scotoma in the right eye, indicating optic nerve damage. In the optical quality analysis system (OQAS) exam, the objective scatter index (OSI) was 1.0 in the right eye and 0.7 in the left. Clearing additional plus lens power was difficult for this patient, indicating accommodation spasm in the right eye.ConclusionsRejuvenation with intense-focused ultrasound (IFUS) could cause heat injury, leads to acute increase of IOP. Heat damage in zonular fibers could cause accommodation spasm and myopia. Eye injuries caused by IFUS has been seldom reported. We recommend that cosmetic treatment in the eye area should be highly aware of side effect.

Lateral Canthal Surgery

The lateral canthus is a delicate and complicated three-dimensional structure with function relevant to the health of the ocular surface. Dysfunction of the lateral canthus, due to aging changes or iatrogenic trauma, results in ocular morbidity ranging from chronic irritation to tearing to recalcitrant keratopathy. From an aesthetic standpoint, symmetric, normally positioned lateral canthi are cornerstones of youthful periorbital appearance, disruption of which leads to cosmetically significant deformity or asymmetry. Reconstruction of the lateral canthus is important in the rehabilitation of the aging eyelid and an unfortunate necessity after failed lateral canthal surgery. The common methods for improving or maintaining position, tone, and shape of the lower eyelid and lateral canthus use tightening or shortening the lower eyelid horizontally, keeping the canthal angle in an appropriate vertical level, and hugging the ocular surface. Many techniques have been described for the reconstruction of the lateral canthus in functional conditions or for aesthetic purposes. These methods have met with varying success. In this article, we begin with a discussion of the anatomy and physiology of the lateral canthus, followed by clinical examples of lateral canthal abnormalities and underlying pathophysiologies. A review of surgical options for the lateral canthus is presented with concluding remarks on postoperative complications.

Das alternde Lid

Surgery of the aging eyelid makes great demands on the oculoplastic surgeon regarding preoperative diagnostics as well as choosing the ideal surgical method. This is not only important regarding reconstructive anatomic function but also for aesthetic aspects. This paper gives a résumé of modern diagnostics and therapy of the involutional syndrome of the eyelid. Treating ptosis of the eyebrow, blepharoplasty, blepharoptosis as well as malposition of the lower lid such as ectropion and entropion not only has an impact on the visual system but also on the individual facial features. Considering and treating this makes the highest demands on the oculoplastic surgeon to consider and treat the above problens in order to achieve ideal results.

Surgical Improvement of the Aging Forehead and Eyelids

Periocular reconstruction is limited to the upper lid, lower lid, and brow. Although many of the same principles apply as in other facial rejuvenation procedures, special techniques are involved frequently using microsurgical procedures. Although the majority of oculoplastic procedures are done for cosmetic purposes, occasionally patients with extreme distortion in periorbital anatomy may benefit from this procedure. These include patients with profound ptosis and severe cases of lower lid distortion who have visual compromise.

Rejuvenation of the Aging Eyelid

Rejuvenation of the aging eyelid subunit provides a youthful appearance to one of the focal points of the face. As the age of our population increases, these procedures are likely to become increasingly more common. Accurate preoperative examination, assessment, and counseling are imperative to achieve an excellent result. As well, careful selection from the spectrum of available techniques, combined with meticulous surgical precision, will assist the surgeon in rejuvenating the individual patient. Although no one ideal surgical procedure exists, many safe and effective strategies have been developed as we have learned more about the effects of aging. This article aims to provide a history of techniques used in eyelid rejuvenation, as well as an overview of the evaluation process.

Transconjunctival lower lid blepharoplasty with simultaneous chemical peel: predictable results with minimal complications

The most common complication associated with lower lid blepharoplasty is lid malposition/retraction. Clinical postoperative presentation may range from increased scleral show to lateral canthal rounding or ectropion. Any of these complications can exacerbate other ocular problems, such as dry eye syndrome, requiring more extensive oculoplastic correction.Transconjunctival lower lid blepharoplasty has been proven to produce a lower incidence of postoperative lid malposition versus open excision techniques. Coupled with surgical lid tightening and skin resurfacing, transconjunctival blepharoplasty is a safe and effective method for improving lower lid contour and reducing rhytids while producing minimal complications.Keys to predictable clinical success are understanding lower lid anatomy and its relation to structure/support of the lid complex, recognizing changes associated with the aging eyelid complex, assessment and planning for surgery to restore structure, and avoiding operative techniques with a high probability of complications in patients with pre-existing eyelid or ocular problemsReferencesPopp JC: Complications of blepharoplasty and their management. Dermatol Surg Oncol 992:1122, 1992Shorr N, Enzer YR: Considerations in aesthetic eyelid surgery. Dermatol Surg Oncol 992:1081,1992Zarem HA, Resnick JI: Operative techniques for transconjunctival lower lid blepharoplasty. Clin Plast Surg 19:351, 1992 The most common complication associated with lower lid blepharoplasty is lid malposition/retraction. Clinical postoperative presentation may range from increased scleral show to lateral canthal rounding or ectropion. Any of these complications can exacerbate other ocular problems, such as dry eye syndrome, requiring more extensive oculoplastic correction. Transconjunctival lower lid blepharoplasty has been proven to produce a lower incidence of postoperative lid malposition versus open excision techniques. Coupled with surgical lid tightening and skin resurfacing, transconjunctival blepharoplasty is a safe and effective method for improving lower lid contour and reducing rhytids while producing minimal complications. Keys to predictable clinical success are understanding lower lid anatomy and its relation to structure/support of the lid complex, recognizing changes associated with the aging eyelid complex, assessment and planning for surgery to restore structure, and avoiding operative techniques with a high probability of complications in patients with pre-existing eyelid or ocular problems References Popp JC: Complications of blepharoplasty and their management. Dermatol Surg Oncol 992:1122, 1992 Shorr N, Enzer YR: Considerations in aesthetic eyelid surgery. Dermatol Surg Oncol 992:1081,1992 Zarem HA, Resnick JI: Operative techniques for transconjunctival lower lid blepharoplasty. Clin Plast Surg 19:351, 1992

Update on management of oral cancer: diagnostic and therapeutic modalities

rhytids while producing minimal complications. Keys to predictable clinical success are understanding lower lid anatomy and its relation to structure/support of the lid complex, recognizing changes associated with the aging eyelid complex, assessment and planning for surgery to restore structure, and avoiding operative techniques with a high probability of complications in patients with pre-existing eyelid or ocular problems.

Laser blepharoplasty in Asians.

Traditional blepharoplasty removes periorbital wrinkles by cutting and stretching the skin. However, this method has a substantial risk of producing ectropion or scleral show. In addition, fine periocular wrinkles may persist because this method does not change skin texture. The pulsed CO2 laser has recently become a primary surgical tool in treating aging eyelids. Periorbital wrinkles vary in depth not only from person to person, but also among different races. Compared with whites, most Asians have a thicker dermis, so more laser passes and a higher power may be required to remove periorbital wrinkles, but concerns about hyperpigmentation and prolonged erythema have limited its use on Asian skin. In this study, 346 patients underwent laser blepharoplasty at the Korea University Medical Center and at Dr Choi's Aesthetic Clinic. They were followed for 12 months on average from September 1995 to September 1999. The CO2 laser was used in resurfacing periorbital wrinkles, transcutaneous skin excision, and transconjunctival blepharoplasty, including fat removal. The authors assessed the benefit of using the UltraPulse CO2 laser in Asian blepharoplasty. They found that 291 patients (84%) had good to excellent results. The incidence of side effects was very low. Prolonged erythema occurred in 19 patients (5%) and hyperpigmentation occurred in 35 patients (10%), but the erythema disappeared spontaneously within 2 months and the hyperpigmentation could be managed readily by the topical use of retinoids and hydroquinone cream. Therefore, the authors conclude that postoperative hyperpigmentation is no longer a problem limiting laser resurfacing in Asian blepharoplasty. The UltraPulse CO2 laser is a safe and effective rejuvenation method for treating aging eyelids in Asians.

Lower eyelid blepharoplasty: the aging eyelid.

The aging process affects the underlying structural integrity of the eyelids as well as the overlying skin, muscle, and fat. Gravitational descent of the deep supporting soft tissues of the eyelid complex coupled with skin texture changes exemplified by loss of skin elasticity, solar actinic changes, and dynamic and static rhytids result in the aged eyelid. Surgery of the lower eyelid on the youthful face usually involves excisional fat sculpting without skin removal. Lower eyelid blepharoplasty performed on the mature face often requires excision of periorbital fat combined with some treatment of the lower eyelid skin. In the aging eyelid, the surgeon must also be prepared to address lower eyelid laxity to prevent the potential complications of lower eyelid retraction or scleral show.

Fourth-generation subperiosteal approach to the midface: The tridimensional functional cheek lift

The fourth-generation subperiosteal cheek lift preserves full function and integrity of the orbicularis oculi muscle It minimizes the potential for eyelid complications. The addition of the IMP and the BFP suspension provides a truly three-dimensional cheek lift. Repositioning of the aging eyelid, cheek, paracommissural tissue, and jowl gives a pleasing aesthetic result (Figures 3 and 4). See the Table for additional advantages, as well as the disadvantages of the fourth-generation approach.

Septal-myocutaneous flap technique for lower lid blepharoplasty.

Lower lid blepharoplasty can present a significant challenge to the facial plastic surgeon. Routine findings of periorbital fat herniation and dermatochalasia of the lower lid are often associated with the presence of more occult findings, e.g., tarsoligamentous laxity and ectropion. Traditional surgical approaches to the aging lower eyelid utilize the skin flap, the skin-muscle flap, and the transconjunctival technique. The limitation of any one of these procedures alone is that of not addressing the multiple problems of the aging eyelid; this may lead to common postoperative problems of lower lid blepharoplasty, including lid retraction, lagopthalmos, scleral show, rounding of the lateral canthus, and ectropion. We present an integrated surgical solution to the functional and anatomical defects of both the anterior and posterior lamellae, and, when indicated, lateral canthal support. The procedure incorporates a small lateral subciliary and lateral canthal incision with a myocutaneous advancement flap developed in a plane deep to the orbital septum, combined with transconjunctival blepharoplasty for removal of herniated orbital fat. It allows for simultaneous management of the multiple defects of the aging lower eyelid and complete restoration of the relevant anatomy, while avoiding the common pitfalls of lower lid blepharoplasty. We present our experience of 64 patients who underwent bilateral combined septal-myocutaneous advancement flap and transconjunctival blepharoplasty. Indications and postoperative results are reviewed. No complications, including scleral show or ectropion, have been noted over the 4-year postoperative period.

Herniated Fat And The Orbital Septum Of The Lower Lid

The bulging fat of aging eyelids has always been described as a hernia; yet, the treatment has not been that of a true hernia. Rather, the contents (orbital fat) have been excised and the hernia wall left unrepaired. It is possible to treat bulging lower eyelids as a hernia by replacing both the fat and the sac into the original location within the orbital cavity, and then repairing the retaining wall.

Senile ectropion

The author describes a new surgical technique for the cure of senile ectropion based on the anatomical study and physiological and pathological study of aging eyelids. Very good results are obtained if good preoperative examination of the patient and adequately chosen and performed operative technique, are adhered to.

An update on blepharoplasty.

An integral perspective of the aging eyelid is presented. A classification into three different degrees of aging is done, according to gravitation and excess skin present. The surgical techniques for third-degree aging are described, and a ten-year bibliography is presented to show the reader the interest that this anatomical region has had in the medical profession.

A surgical technique for cosmetic blepharoplasty.

A method of blepharoplasty for cosmetic purposes to eliminate superfluous skin and fat from aging eyelids is described in detail. A technique for correct placement of incisions, a method of locating and excising orbital fat, control of bleeding and a safe method of approximating skin flaps are discussed and illustrated.