Blepharoplasty Research Articles

Case report: A rare case of meningoencephalitis caused by Mycobacterium gordonae

Meningoencephalitis, an infectious disease affecting the nervous system, is primarily caused by a variety of pathogens. Non-tuberculous mycobacteria (NTM) have emerged as the leading causative agent of infections worldwide, but central nervous system infections resulting from NTM are infrequent in individuals with functioning immune systems. This case report highlights the diagnosis and treatment of a 26-year-old female patient who developed headaches 2 months post double eyelid surgery and was subsequently diagnosed with NTM meningoencephalitis through metagenomic next-generation sequencing (mNGS) analysis of cerebrospinal fluid. The patient underwent a comprehensive diagnostic and therapeutic protocol, resulting in a positive clinical outcome.

Unsupervised generative model for simulating post-operative double eyelid image.

Simulating the outcome of double eyelid surgery is a challenging task. Many existing approaches rely on complex and time-consuming 3D digital models to reconstruct facial features for simulating facial plastic surgery outcomes. Some recent research performed a simple affine transformation approach based on 2D images to simulate double eyelid surgery outcomes. However, these methods have faced challenges, such as generating unnatural simulation outcomes and requiring manual removal of masks from images. To address these issues, we have pioneered the use of an unsupervised generative model to generate post-operative double eyelid images. Firstly, we created a dataset involving pre- and post-operative 2D images of double eyelid surgery. Secondly, we proposed a novel attention-class activation map module, which was embedded in a generative adversarial model to facilitate translating a single eyelid image to a double eyelid image. This innovative module enables the generator to selectively focus on the eyelid region that differentiates between the source and target domain, while enhancing the discriminator's ability to discern differences between real and generated images. Finally, we have adjusted the adversarial consistency loss to guide the generator in preserving essential features from the source image and eliminating any masks when generating the double eyelid image. Experimental results have demonstrated the superiority of our approach over existing state-of-the-art techniques.

Alpha-1 antagonist treatment for eyelid retraction in patients with thyroid eye disease-a prospective pilot study.

Sympathetic overstimulation of Müller's muscle is a suggested mechanism underlying upper eyelid retraction in thyroid eye disease (TED). We examined the effect of tamsulosin, an alpha-1 antagonist, on eyelid retraction in patients with TED. A single-centre prospective study. Patients with TED and associated eyelid retraction were treated with oral 0.4 mg/day tamsulosin for 3 months. Upper eyelid margins-to-reflex distance (MRD1), vertical palpebral fissure height (PFH), subjective improvement, signs and symptoms of dry eye, and lubricants use were assessed at baseline and at each subsequent visit. Eleven suitable patients (mean age 47.5 ± 9.68, 8 females) enrolled in the study. Three patients discontinued the drug due to mild adverse effects (dizziness, bradycardia, nausea, and gastrointestinal distress), which resolved immediately upon stopping treatment. The other eight patients tolerated the drug well and reported no side effects. Five patients experienced an objective improvement in eyelid position and subjective improvement in eye discomfort. The mean MRD1 decreased by -1.04 ± 0.81 mm (P = 0.015), and mean PFH decreased by -1.46 ± 1.33 mm (P = 0.039). Mean duration of tamsulosin treatment was 84.63 ± 71.9 days. Patients discontinued the drug due to no improvement in MRD1 (n = 3), referral for eyelid surgery with stable inactive TED (n = 2), treatment with intravenous methylprednisolone due to worsening active TED (n = 2), and patient choice after 5 months of treatment with spontaneous resolution of symptoms (n = 1). Tamsulosin is a safe potential treatment for eyelid retraction in TED and can be used as a temporary alternative therapeutic approach for patients unsuitable for surgery.

Implications of Long-Term Double Eyelid Tape Use.

The widespread adoption of double eyelid tapes (DET) to achieve thedesired double eyelid aesthetic has prompted investigations into their long-term effects. Given the delicate and complex anatomy of the eyelid, concerns have emerged about the impact of DETs on eyelid structure and the outcomes of subsequent surgical procedures. A cohort of 267 outpatients from our department was recruited between January 2022 and January 2024 to participate in a survey assessing the usage of double eyelid tape (DET). Eyelid laxity was subsequently tested in all outpatients using the Vertical Lid Pull and Parallel Lid Pull methods. Among all participants, 33 underwent double eyelid surgery, with 22 having a history of excessive DET usage and 11 with no DET usage. Post-operative outcomes, including operation duration, satisfaction levels, and complications were recorded. Additionally excised eyelid skin tissues during surgery underwent Masson's staining and EVG staining to analyze collagen and elastic fibers. Among surveyed outpatients (mean age: 23.79 ± 3.71years, 99.63% female, mean BMI: 21.56 ± 1.75kg/m2), 56.55% had oculopathy with ametropia being predominant (53.93%). Hooded eyelids were the most prevalent congenital condition (62.54%). Nearly half (49.44%) used Double Eyelid Tapes (DET) for 1-2years, with 70.04% experiencing discomfort and 70.79% reporting permanent eyelid shape change. Lid pull measurements showed no significant difference in vertical pulls between DET users and non-users, but parallel pulls varied significantly (p<0.05). Complications like asymmetry, numbness, and hypertrophic scars were exclusive to DET users. Physician evaluations favored non-DET users significantly (p<0.05). Histological analysis revealed an interesting finding that individuals using DET have higher collagen levels and notable changes in skin structure when compared to non-users. Prolonged use of double eyelid tape (DET) may result in eyelid laxity, impacting ocular health and complicating blepharoplasty procedures. 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 .

Correction of Infraorbital Dark Circles Using Autologous Adipose-Derived Collagen Filler: A Novel Regenerative Option.

Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles. Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant. Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery. Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation. 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 .

Direct Excision of Malar Bags: Back to the Basics.

The pursuit of periorbital rejuvenation to counteract signs of aging is a focal point in cosmetic surgery, with eyelid surgery being a prominent choice among patients. Addressing inferior blepharoplasty, especially in cases involving chronic malar edema, malar mounds, and festoons, presents unique challenges. The terminology and classification of these conditions vary, hindering effective management. In this study, we use the term "malar bags" to encompass the spectrum of fluid-associated mounds over the malar eminence. This study aims to demonstrate the effectiveness of direct excision as a surgical choice for treating the aesthetic concerns associated with malar bags. A retrospective study was conducted on 53 patients who underwent direct excision of malar bags between 2013 and 2023 at our clinic. No major complications were encountered, overall high level of satisfaction for both patients and surgeons. Direct excision of malar bags proved to be a safe and effective technique, yielding satisfactory results in terms of both aesthetic outcomes and patient satisfaction. 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 .

Enhancing aesthetic outcomes: The role of biomechanics in periorbital and eyelid cosmetic surgery.

Cosmetic periorbital and eyelid surgery is a commonly performed procedure in facial plastic surgery. Understanding the biomechanics of periorbital anatomy and its role in aesthetic surgery is essential for achieving optimal outcomes. This review explores the biomechanical processes involved in periorbital age changes and analyzes the impact of cosmetic surgery approaches on these processes. By maintaining the initial mechanical equilibrium of the brows, eyelids, septal fat, and blepharoplasty folds, periorbital and eyelid cosmetic surgery can effectively rejuvenate the appearance. Disruption of this equilibrium can lead to the migration of anatomic components, resulting in signs of aging. Surgeons, by applying biomechanical concepts, can tailor the forces exerted upon the different structures to manifest the patient's aesthetic aspirations. The key to success in periorbital and eyelid cosmetic surgery lies in re-establishing a dynamic mechanical equilibrium within the periorbital framework.

Full-Incision Double-Eyelid Blepharoplasty with Selective Sensory Nerve Preservation.

Full-incision double-eyelid blepharoplasty can result in upper eyelid skin numbness postoperatively. However, few studies have examined sensory loss after eyelid surgery. We propose a novel surgical approach with selective sensory nerve preservation to prevent postoperative upper eyelid numbness. We enrolled 90 patients who underwent full-incision double-eyelid blepharoplasty with selective sensory nerve preservation from March 2021 to February 2022. Major longitudinal nerves that spread vertically to the palpebral margin under the orbicularis oculi muscle in the medial portion of the upper eyelid were dissected and carefully preserved. Eyelid sensation was measured using a Cochet-Bonnet filament-type esthesiometer at four predetermined anatomical locations in the upper eyelid. The mean esthesiometry reading was calculated at the preoperative and 2-week and final postoperative visits. The follow-up duration was 2-4 months (mean, 3 months). The mean esthesiometry readings at the inferonasal location were 5.22 cm (n=170, SD=0.28) preoperatively, 5.21 cm (n=170, SD=0.31) at 2 weeks postoperatively, and 5.22 cm (n=170, SD=0.29) at the final postoperative visits. Sensation was not significantly different between the second visit and the baseline (P=0.014) or between the final visit and the baseline (P=0.158). None of the patients reported a reduction in their subjective eyelid sensation. Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation can prevent postoperative upper eyelid numbness while producing reliable and dynamic palpebral creases. The vital nerve branches of the upper eyelid can be preserved, thereby retaining skin sensation near the margin of the eyelid. We propose a novel full-incision double-eyelid blepharoplasty technique that incorporates selective sensory nerve preservation to prevent postoperative upper eyelid numbness. Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation can prevent postoperative upper eyelid numbness while producing reliable and dynamic palpebral creases. The vital nerve branches of the upper eyelid can be preserved, thereby retaining skin sensation near the margin of the eyelid. 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 .

Modified blepharoplasty combined with autologous fat transplantation into the orbital septum for the correction of dermatochalasis and sunken eyelids

BackgroundPeriorbital aging typically manifests with dermatochalasis and depression of the upper eyelid. Blepharoplasty is a popular choice for addressing upper eyelid skin laxity but is not suitable for sunken eyelids. This study introduces an innovative approach for periorbital rejuvenation by addressing dermatochalasis and sunken upper eyelids concurrently in aging Asian women. MethodThe study involved 45 patients with upper eyelid dermatochalasis accompanied by moderate to severe depression. Subbrow blepharoplasty was performed in conjunction with upper eyelid granular fat grafting in the orbital septum for these patients. Preoperative measurements of the depth and volume of the upper eyelid depression were taken and the surgical outcomes were assessed at 3 and 6 months postoperatively using the GAIS score and the Antera 3D camera. ResultThe average depth of the upper eyelid depression before surgery was 6.501±1.473mm, and the average volume was 0.579±0.144 cm3. There were significant improvements in the depth and volume of the depression at 3 and 6 months after surgery compared to the preoperative measurements. The GAIS scores were also improved and postoperative outcomes were deemed satisfactory. ConclusionFor patients with dermatochalasis accompanied by moderate to severe upper eyelid depression, a standard blepharoplasty was unable to improve the sunken eyelid. This novel technique combines autologous granular fat injection into the orbital septum and blepharoplasty to effectively address periorbital aging, thereby promoting facial rejuvenation.

Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration.

Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed. This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis. Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses. Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24 months, none of the patients in the surgery group presented synkinesis. Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed. https://clinicaltrials.gov/study/NCT06538103, NCT06538103.

Clinical Efficacy of Bionic Blepharoplasty Using the Flexible Suspension and Semiflexible Suspension Double-Insurance Methods.

To investigate the clinical effect of the double insurance method of flexible suspension and semiflexible suspension in bionic blepharoplasty. Between January 2020 and January 2022, a total of 115 patients (230 eyes) underwent double eyelid plastic surgery with flexible suspension and semiflexible suspension. Herein, we present a new type of double eyelid surgery that preserves the orbicular muscle of the anterior tarsus without removing the tissue. First, the loose fatty fascia layer between the anterior tarsus and the orbicularis oculi muscle was completely removed to a distance of 2mm from the base of the eyelashes, leaving the compact pretarsal levator aponeurosis. Then, the anterior tarsus orbicularis oculi muscle and the upper levator aponeurosis were sutured and fixed (flexible suspension). Finally, the skin and the upper levator aponeurosis were sutured in the flexible suspension space (semiflexible suspension). Six months after surgery, the patient's double eyelid shape had recovered well, and the satisfaction rate reached 97.3%. Among the unsatisfied patients, 1 patient had a single-focused shallow eyelid line which was associated with postoperative hematoma, and 2 patients felt that the double eyelid line was narrow. All 3 patients achieved satisfactory results after reoperation. The bionic double eyelid method with flexible suspension and semiflexible suspension can restore the natural double eyelid anatomy very well by reconstructing the connection between the orbicularis oculi muscle or skin and the upper palpebral levator aponeurosis. After the operation, the incisions healed quickly and smoothly. The eyelid depression and fleshy feeling were not obvious when the eyes were closed. Consequently, the patient's satisfaction was very high.

Do Botulinum Toxin Injections for Upper Face Rejuvenation and Lateral Canthal Rhytids Have Unintended Effects on Tear Production?

To report the influence of botulinum toxin A (BoNTA) injections on basal tear production, as measured by Schirmer's test with anesthesia in patients seeking eyelid surgery. A retrospective cohort of patients requesting esthetic eyelid surgery reviewed by a single clinician between January 2021 to April 2024, assessed with Schirmer's test with anesthesia. Demographic data, history of BoNTA treatment in the periocular region, ocular surface disease index dry eye symptom frequency, and requirement for ocular lubricants were recorded. Patients with no history of BoNTA were designated as group 1. Patients with a positive recent history of periocular BoNTA were designated as group 2. The proportions of eyes with Schirmer's test with anesthesia (basal tear production) test result <5 mm ("low"), 5 to 9 mm ("borderline"), and ≥10 mm ("normal") were compared between groups. Seven hundred twenty-two eyes (361 patients) were assessed, of which 670 eyes (335 patients) met the inclusion criteria. Mean age was 55.1 (range, 17-93) years, with 71.3% female. Schirmer's data in group 1 were "low" at 32.9%, "borderline" at 26.4%, and "normal" at 40.7%. In contrast, group 2 had significantly lower results (P ≤ 0.05), with readings "low" at 48.3%, "borderline" at 26.7%, and "normal" at 25.0%. However, there were no significant differences between groups in ocular surface disease index symptom frequency scores or ocular lubricant requirements. Patients who had received BoNTA injections had significantly lower basal tear production compared with patients who had never received BoNTA. Esthetic BoNTA treatment may be associated with an unintended effect of decreased basal tear production and subsequent risk of dry eye.

Men’s use of cosmetic surgery and the role of traditional masculinity ideologies

In western countries, men are increasingly using cosmetic surgery. However, despite this trend, there remains a dearth of information on the prevalence, acceptance, and motivations behind men’s use of cosmetic surgery. Furthermore, the potential association between men’s use of cosmetic surgery and in particular male-specific cosmetic surgery procedures such as head hair transplant or penis enlargement and traditional masculinity ideologies (TMI) has not been investigated so far. For this purpose, a cross-sectional anonymous online survey was conducted among 241 self-identifying men aged 18 years or older from the German-speaking part of Europe. Participants responded to questions about cosmetic surgery use and experiences, and completed the Conformity to Masculine Norms Inventory—Short Form (CMNI-SF) and the Male Role Norms Inventory—Short Form (MRNI-SF) questionnaires to assess conformity with and endorsement of TMI. Of the 241 men investigated, 47 (19.5%) had undergone cosmetic surgery. The most common types of cosmetic surgeries reported were wrinkle treatment, eyelid correction, and head-hair transplant. Penis enlargement procedures were reported by three (6.4%) of the 47 men who had undergone cosmetic surgery. The main reasons for undergoing surgery were to feel better (72.3%) and look better (55.3%), while to increase sexual success (17.0%) and to increase manliness (14.9%) were also reported. Logistic regression models showed that higher conformity to TMI (CMNI-SF) was associated with higher odds of having undergone cosmetic surgery. The results highlight the overall increase in men’s cosmetic surgery use and its specific characteristics. The significant positive association between conformity to TMI and men’s use of cosmetic surgery suggests that men increasingly use cosmetic surgery as a means to assert power, success, dominance, and sexual success.

Strategy of Out-Fold Double Eyelid Corrected Into In-Fold: Low Position Design, Direction Control Suture, and Fat Transfer.

Double eyelid surgery is a common but delicate cosmetic procedure in Asia. Because of the precise requirements and technical reasons, patients who received blepharoplasty may not satisfied with their out-fold crease. Some patients are born with unsatisfied out-fold double eyelids. The medial creases of double eyelid were higher than should be. In this study, the authors developed a strategy to correct out-fold crease of double eyelid to in-fold to satisfy patients' requirements. From January 2022 to May 2024, 102 patients (96 females and 6 males) were included in this retrospective analysis. Patients with out-fold double-eyelid inborn or obtained. The patients were divided into 3 groups: inborn out-fold double-eyelid, obtained double-eyelid with epicanthus, and obtained double-eyelid without epicanthus. The surgical strategy contained low position design, direction control suture, and fat transfer. Preoperative and postoperative images were collected, and patients' satisfaction and complications were evaluated. In total, 102 consecutive patients were included in this study, with an average follow-up of 11.9 months. Eleven patients had inborn out-fold creases, and 83 patients had out-fold creases with epicanthus after primitive blepharoplasty, and 8 patients had out-fold creases without epicanthus after primitive blepharoplasty. Ninety-six (94.12%) patients were satisfied with their results. Complications included narrow double eyelid width (n =1, 0.98%), asymmetric creases (n=2, 1.96%), incompletely in-fold creases (n=3, 2.94%), and subtle fork in medial creases (n=4, 3.92%). The surgical strategy, which contained low-position design, direction control suture, and fat transfer, could correct out-fold creases of double-eyelid into in-fold effectively.

Ultrasound-based histological differences in thickness between puffy eyelids and normal eyelids in Asian monolid women

BackgroundUpper eyelid tissue swelling is a common characteristic among Asian monolid individuals and is associated with a high incidence of complications following eyelid surgery. Currently, there is no precise definition for upper eyelid tissue swelling, necessitating further research to elucidate the specific causes contributing to upper eyelid puffiness. MethodBetween June 2023 and February 2024, we recruited 84 Asian monolid women categorized into groups based on the severity of upper eyelid tissue swelling: the puffy eyelid group and the normal eyelid group. High-frequency ultrasound was employed to capture images of the upper eyelids and measure the thickness of various tissue layers. This study aims to conduct a comparative analysis to identify the factors contributing to upper eyelid fullness, focusing on elucidating the underlying causes of this condition. ResultAll volunteers underwent bilateral upper eyelid ultrasound imaging. Significant differences were observed in the thickness of subcutaneous fat, pre-tarsal fat, retro-orbicularis oculi fat（ROOF）, and composite fat(ROOF and pre-aponeurotic fat) layer between the puffy eyelid group and the normal eyelid group. However, no significant differences were found in skin thickness or orbicularis oculi muscle thickness. Additionally, no significant differences were observed in the thickness of various layers of the upper eyelid tissue between the left and right eyes in all participants. ConclusionThickening of the upper eyelid fat layer is a primary cause of upper eyelid puffiness. In upper blepharoplasty, targeted removal of pre-aponeurotic fat, ROOF, and pre-tarsal fat can achieve precise reduction to correct upper eyelid puffiness effectively.

Effects of Upper Eyelid Blepharoplasty on Perceived Attractiveness, Success, and Health.

This study aims to evaluate the impact of upper eyelid blepharoplasty on perceived age, attractiveness, success, and overall health as rated by observers. A web-based survey was conducted with 203 observers who were unaware of the study's purpose. They assessed pre- and post-operative images of 12 female patients using the Delphi method to ensure appropriate image selection and unbiased ratings. Observers rated the images on a visual analog scale from 0 to 10, where higher scores indicated more favorable perceptions. The observer group consisted of 108 females (53.2%) and 95 males (46.8%), with an age range of 18 to 61 years. The mean age perceived by observers decreased from 51.75 before surgery to 42.10 after surgery, indicating a significant reduction in perceived age (p=0.01). Additionally, post-surgical assessments showed significant increases in perceived attractiveness, success, and overall health. Upper eyelid blepharoplasty significantly enhances how patients are perceived in terms of youthfulness, attractiveness, and success. These findings underscore the positive impact of cosmetic eyelid surgery on public perception.

CADS as a Decision-making Tool: Developing an Oculoplastic Management Algorithm for Facial Nerve Palsy.

The Cornea, Asymmetry, Dynamic, Synkinesis (CADS) score is a validated grading score for periocular involvement in facial nerve palsy (FNP). We conducted a retrospective review of FNP cases, including initial CADS scores and subsequent ophthalmic interventions. The results were used to inform the development of an oculoplastic management algorithm for FNP. Single-center retrospective cohort study of patients with FNP referred to a tertiary unit between 2016 and 2022. Data collected included demographic data, etiology of FNP, treatment initiated, and CADS grading at each visit. Adult patients with ≥6 months of follow-up were included, and cases were excluded if ocular surface or oculoplastic procedures were performed elsewhere prior to the initial review by the unit. Of 408 consecutive new patients with FNP, 80 fulfilled inclusion criteria (mean age 57 years, range 21-83 years). Presentations of FNP were unilateral in 98.8% (79/80), with an underlying preganglionic etiology in 75.0% (60/80). At the initial review, surgery was recommended for 61.3% (49/80) of cases. Subgroup analysis of surgical cases for each CADS domain showed 46.9% (23/49) had C-score ≥2, which was predictive of upper lid surgery requirement (e.g., upper lid platinum segment chain; levator recession). About 63.2% (31/49) had an A-score ≥1 which predicted for lower lid surgery requirement (e.g., retractor recession, lower lid sling, medial canthal tendon plication, and lower lid full thickness skin graft) as well as a brow lift. Almost 79.6% (39/49) had a D-score ≥2, which was associated with both upper lid and lower lid surgery requirements. Also, 59.2% (29/49) had an S-score of ≥1 however, this was not associated with the surgical requirement, highlighting a different approach compared with the other CADS domains. This study represents a large cohort of patients followed up with a validated ophthalmic-specific FNP grading scale. This was utilized to develop a CADS-based management algorithm to help guide decision-making for surgical intervention versus medical management in FNP.

Upper blepharoplasty in Asian population: A novel technique based on functional zoning and dynamic reconstruction with anatomical structure.

Double eyelid blepharoplasty is the most popular cosmetic operation in Asian population. Various surgical techniques have been developed in order to create dynamic eyelid folds with natural-looking in recent years, but postoperative complications like so-called sausage-like appearance have not been resolved completely. To create natural-looking dynamic folds, we propose a new method imitating the original anatomical structure of congenital double-eyelid. Eighty-six patients who underwent the double-eyelid surgery from June 1st, 2018 to October 31st, 2020 were included in this retrospective study, including 10 males and 76 females, aged 18-39 years (mean 27.4 ± 5.6 years). All the included patients received double eyelid surgery performed by the same senior doctor, using the pretarsal orbicularis oculi muscle-releasing technique. Patient Reported Outcome Measures questionnaires were administrated to assess the severity of scarring, pain, and asymmetry, as well as functional and appearance issues. Surgical outcome was assessed through objective and subjective evaluation forms (PROM and patient satisfaction rate). Among the 86 patients, 5 were lost during the follow-up period. The absolute number of enrolled patients is 81. 91.36% of the enrolled patients reported minimal or non-visible scarring at the double eyelid incision. As to functional and appearance issues, the main problem were asymmetry (12.35%) and the narrowing of the supratarsal crease width (8.64%). No supratarsal depression and "sausage-like" appearance occurred in this study. 95.1% of patients reported either good or excellent outcome (mean score: 108 of 120) based on analysis of PROM results, and 96.3% of patients reported either high or very high satisfaction (mean score: 96 of 120) for the patient satisfaction assessment. This new surgical method of double-eyelid blepharoplasty provides comparatively safe and effective results.

Intratarsal Keratinous Cyst at the Eyelid Margin: A Case Report.

An uncommon case of an intratarsal keratinous cyst at the lid margin is described in a 73-year-old Asian man using long-term antiglaucoma eye drops. There was no history of trauma or surgery of the upper eyelid. A yellow solid mass attached to the tarsal plate had been located there for about 3 years. It imitated a sebaceous gland carcinoma or steatocystoma simplex. Excision biopsy showed cystic formation and leaked yellow creamy substance without hair. Histopathological and immunological findings helped make the diagnosis of an intratarsal keratinous cyst. To the best of our knowledge, this is the first case report of an intratarsal keratinous cyst at the lid margin.

Thyroid Eye Disease: Advancements in Orbital and Ocular Pathology Management.

Thyroid Eye Disease (TED) is a debilitating autoimmune condition often associated with thyroid dysfunction, leading to significant ocular and orbital morbidity. This review explores recent advancements in the management of TED, focusing on both medical and surgical innovations. The introduction of Teprotumumab, the first FDA-approved drug specifically for TED, marks a pivotal development in medical therapy. Teprotumumab targets the insulin-like growth factor-1 receptor (IGF-1R), effectively reducing inflammation and tissue remodeling. Clinical trials demonstrate its efficacy in reducing proptosis and improving quality of life, making it a cornerstone in the treatment of active, moderate-to-severe TED. Surgical management remains critical for patients with chronic TED or those unresponsive to medical therapy. Advancements in orbital decompression surgery, including image-guided and minimally invasive techniques, offer improved outcomes and reduced complications. Innovations in eyelid and strabismus surgery enhance functional and cosmetic results, further improving patient satisfaction. The management of TED necessitates a multidisciplinary approach involving endocrinologists, ophthalmologists, oculoplastic surgeons, radiologists, and other specialists. This collaborative strategy ensures comprehensive care, addressing the diverse aspects of TED from thyroid dysfunction to ocular health and psychological well-being. Future directions in TED treatment include emerging pharmacological therapies targeting different aspects of the disease's pathophysiology and advanced surgical techniques aimed at enhancing precision and safety. This review underscores the importance of a personalized, multidisciplinary approach in managing TED, highlighting current advancements, and exploring potential future innovations to improve patient outcomes and quality of life.