Cosmetic Eyelid Surgery Research Articles

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 .

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.

The Dysmorphic Concern Questionnaire: Is It Possible to Predict a Satisfactory Result After Cosmetic Eyelid Surgery?

As oculofacial surgeons performing esthetic surgery, the most valuable result is a satisfied patient. It can be extremely frustrating to have an unhappy patient with, what we believe is, a satisfactory result. Therefore, the ability to predict satisfaction is of extreme importance. We studied our cosmetic eyelid surgery patients to try to find factors that can predict satisfaction. We retrospectively studied 454 consecutive patients, who underwent any combination of 7 cosmetic surgical procedures. Patients answered the Dysmorphic Concern Questionnaire (DCQ) before surgery. We studied age, gender, type and number of procedures performed, DCQ score, presence of complications, and history of previous fillers. At the 3-month follow-up visit, patients were given an outcome report survey to graduate their surgical results on a scale from 1 to 5. Results were evaluated using a model of binary logistic regression in which the outcome variable was divided into 2 groups. Three hundred eighty-six patients (85%) were female and the median age was 54.8 years old. The median for the number of procedures was 2 (range, 1-5). Two hundred two of the 454 patients (44.5%) had a history of fillers. Twenty-five patients had complications. DCQ score was significantly lower in the satisfied group (median score, 3) versus the unsatisfied group (median, 6), p = 0.007. In the multiple binary logistical model, the variables age, male gender, DCQ, presence of complications, and upper eyelid blepharoplasty resulted as significant. We found a significant positive association with upper lid blepharoplasty and a negative association with increasing age, male gender, occurrence of complications, and DCQ score, as predictors of patient satisfaction. We routinely administer the DCQ to all cosmetic patients: It is a brief, sensitive, and specific screening instrument for body dysmorphic disorder.

Результаты реконструктивно-восстановительной хирургии после тяжелой сочетанной травмы глаза, век и глазницы

Purpose. Presentation of the clinical result of complex surgical rehabilitation in a patient with combined traumatic injury of the eye, its adnexa and orbit. Material and methods. A clinical case is presented. Described step by step: surgical reconstruction of orbital walls with «Ekoflon» material (Russia), of lacrimal duct by Taumi method, of medial palpebral ligament, of upper eyelid coloboma with free skin graft, evisceration with plastic surgery of the musculoskeletal stump and ocular prosthetics. Results. Evaluation of the results of the surgical treatment performed at the final examination 14 months after the injury showed that the dimensions of the patient’s palpebral fissure had no obvious differences from the healthy side, the mobility of the upper eyelid was restored, and the lacrimal drainage function was preserved. There was a normal position and good mobility of the ocular prosthesis. Conclusion. Complex specialized rehabilitation of patients after a severe concomitant injury of the organ of vision using the achievements of modern reconstructive ophthalmic surgery makes it possible to restore the anatomy and function of the adnexal apparatus of the eye as much as possible, to carry out cosmetic prosthetics with a satisfactory aesthetic outcome. Key words: combined ocular injury, reconstructive and cosmetic eyelid surgery, lacrimal duct reconstruction; periorbital reconstruction; eye prosthesis

Triangular Resection Epicanthoplasty: A Novel Method of Minimizing Hypertrophic Scar After Medial Epicanthoplasty.

Medial epicanthoplasty is a crucial component in Asian cosmetic eyelid surgery. Conventional surgical methods have mandated wide undermining for the purpose of sufficient release. However, excessive undermining may result in hypertrophic scar or webbing deformities. To minimize undesirable results, the authors are proposing a novel approach. From March 2010 to December 2017, a triangular resection epicanthoplasty was performed in 421 Asian patients. The authors' procedure consists of triangular skin resection, the release of orbicularis oculi muscle and upper half medial epicanthal tendon, and dog ear correction. No complication regarding scarring or webbing was reported. The revision was performed in 18 cases where the patients wanted additional correction. The triangular resection epicanthoplasty offers both optimal results and minimal scar with relative simplicity.

Комплексная хирургическая реконструкция глаза, век, слезоотводящих путей и орбиты после тяжелой сочетанной травмы (клинический случай)

The article presents clinical case of severe combined injury ocular surface, ocular adnexa, lacrimal duct, orbital walls. The article describes a staged complex surgical rehabilitation, performed in the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution: of orbital walls with “Ekoflon” material (Russia), of lacrimal duct by Taumi method, of medial palpebral ligament, of upper eyelid coloboma with free skin graft; locomotory stump and ocular cosmetic prosthesis after evisceration. In the long-term period (14 months), restoration of the eyelids anatomy, the measures of the palpebral fissure, the mobility of the upper eyelid, positive function of lacrimation, normal positioning and good eye prosthesis movement was noted. Keywords: combined ocular injury, reconstructive and cosmetic eyelid surgery, lacrimal duct reconstruction; periorbital reconstruction; eye prosthesis.

Poches palpébrales : pièges en blépharoplastie

Requests for cosmetic eyelid surgery are frequent. The surgeon must carry out a complete clinical examination in order to rule out any orbital pathologies responsible for eyelid pockets. Study of ten patients who have consulted in the oculopalpebral surgery department of La Fondation Ophtalmologique de Rothschild for cosmetic surgery of the eyelid pockets and in whom an underlying pathology was diagnosed. The clinical examination allows to look for signs of alarms, such as medical history, unilateral involvement, pain and the presence of exophthalmos. These should lead to perform orbital imaging and surgical biopsy if an orbital mass has been identified for histological analysis which will make the diagnosis. We identified four cases of orbital lymphoma, one foreign body granuloma, chronic bilateral dacryoadenitis, sarcoidosis involvement, AAPOX syndrom, cavernous hemangioma, and simple fatty hernia. These cases shows the importance of not ignoring an underlying orbital pathology before proposing cosmetic surgery for eyelid pockets.

Blepharoplasty and periorbital surgical rejuvenation

The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist's point of view.

Association between gender, age and palpebral dimensions/exophthalmometric values among Nigerians of Ido local government area of Oyo State, Nigeria

Background: Knowledge of factors that could affect exophthalmometric and palpebral's measurement are important in clinical for the correct interpretation of these parameters. Among these factors are age and sex. Aims and Objectives: The objective of this study is to describe the relationship between gender, age and palpebral dimensions/exophthalmometric values (EV) among Nigerian. Materials and Methods: In a descriptive cross -sectional survey, EV and palpebral dimensions were measured in 1020 eligible and consented adults Nigerians using Hertel's exophthalmometer and non -stretchable plain plastic ruler respectively. Results: The studied population comprised of 1020 subjects including 515 females and 505 males. In the male subjects, the mean (mm) palpebral fissure width, palpebral fissure height, upper eyelid crease, margin reflex distance, lateral canthal distance, medial canthal distance, inter inner canthal distance and inter outer canthal distance were; 32.6 ± 2.8, 8.3 ± 1.4, 6.9 ± 1.6, 3.2 ± 1.2, 12.8 ± 2.0, 10.1 ± 0.9, 39.9 ± 3.2, 99.5 ± 5.6 respectively. Males had a significantly higher EV compared with females (15.5 ± 2.5 mm vs. 15.1 ± 2.4 mm, P = 0.0005). Conclusion: In this study, we described the relationship between gender, age and EV/palpebral dimension in African population. The knowledge of this relationship is valuable in the early diagnosis of the eyelid and orbital diseases, manufacturing of spectacles as well as achieving a satisfactory cosmetic eyelid surgery.

Full-Thickness Eyelid Resection in the Treatment of Secondary Ptosis

To describe horizontal full-thickness eyelid resection for the treatment of ptosis as related to overcorrections after levator recession for eyelid retraction in Graves disease or repeatedly failed external levator advancement. The authors present a retrospective case study of 19 eyelids of 17 patients with refractory ptosis. Patients were selected based on history of horizontal full-thickness eyelid resection to treat ptosis secondary to over-recessed Müller and levator muscles, persistent ptosis after levator advancement/resection, or persistent ptosis after internal levator advancement. Results were graded from eyelid measurements taken before and at least 6 weeks after treatment. All eyelids were measured preoperatively and postoperatively for the following parameters: palpebral fissure in primary gaze nasally (N), centrally (C), and temporally (T); upper eyelid margin to light reflex distance in primary gaze; upper eyelid margin to crease distance; and upper eyelid margin to fold distance. Final postoperative measurements were taken at a minimum of 2 months. Thirteen eyelids had a history of previous Müller muscle excision/levator recession, 3 eyelids had a history of previous levator advancement/resection, 2 eyelids had previous internal levator advancement, and 1 eyelid had previous cosmetic eyelid surgery. All 17 patients were women. Patients ranged in age from 41 to 63 years. All patients had cosmetically and functionally satisfactory results. Horizontal full-thickness eyelid resection is a unique procedure that can provide an excellent result for patients with residual ptosis with no recurrence of ptosis during an average of 2 to 3 months follow-up.

Cosmetic Eyelid and Facial Surgery

The goal of cosmetic surgery is to reverse anatomical changes that occur in the face with aging. It is a rapidly growing subdiscipline of ophthalmic plastic surgery and includes forehead, eyelid, mid-face, lower face, and neck surgery, most performed by ophthalmic plastic surgeons. The current article reviews updates in cosmetic eyelid and facial surgery, including minimally invasive techniques such as cable suspensions, injections, and fillers.

Lessons from “Around the world with Oprah”: Neoliberalism, race, and the (geo)politics of beauty

On 6 October 2004, viewers went “Around the world with Oprah” and received a rare glimpse inside the lives of 30-year-old women from 17 different countries. When Oprah turned her gaze (and that of middle-class American housewives) eastward, she highlighted South Korean women's penchart for plastic surgery. Oprah's “trip” to South Korea is emblematic of Western discourse surrounding South Korean Women's plastic surgery consumption, most of which focuses on cosmetic eyelid surgery or the sangapul procedure as it is called in South Korea. Given its widespread popularity, the sangapul procedure has come to signify South Korean women's acquiescence to not only patriarchal oppression but racial oppression as well. This essay goes beyond the psychologization of South Korean women in order to ask what such psychological musings obscure about the very political nature of beauty itself. Using “Around the world with Oprah” as a starting point, then, this essay examines beauty at the intersection of race, technology, and (geo)politics in order to show that, in an era of neoliberalism, plastic surgery is often rationalized as an investment in the self towards a more normal, if not better future. As this essay suggests, such a framing of plastic surgery is contingent on Oprah's production of neoliberal feminism based on liberal notions of choice. Given her global reach, these neoliberal feminist subjects are not produced equally, however, but are discursively constructed along a First World/Third World divide.

The Influence of Previous Orbital Irradiation on the Outcome of Rehabilitative Decompression Surgery in Graves Orbitopathy

To investigate whether orbital irradiation influences the outcome of decompression surgery in Graves orbitopathy. Retrospective, comparative case series. The medical records of all the patients with Graves orbitopathy treated with a three-wall orbital decompression through a coronal approach at our institution between January 1, 1990 and December 31, 2000 were reviewed. Only patients who underwent bilateral surgery for aesthetic rehabilitation, without preoperative diplopia, and who, in the active phase of the disease, had received orbital radiotherapy alone (20 Grays (Gy) in 10 daily fractions of two Gy over a period of two weeks; group R), systemic glucocorticoids alone (daily administration for more than three months independently from the dosage; group G), or both radiotherapy and glucocorticoids (group RG) were selected. Groups were compared for demographics, smoking habits, preoperative characteristics, and surgical outcome (mean reduction of exophthalmos, reduction of lid retraction, persistence of periorbital swelling requiring cosmetic eyelid surgery, onset of diplopia within 20 degrees of the central position of gaze, and variations in the peripheral field of diplopia). Sixty-one of 376 patients were selected for this study. There were no differences between group R (n=29), group G (n=15), and group RG (n=17) with respect to demographics or predecompression characteristics, whereas the number of smokers was significantly greater in group RG (P=.019). We could not find differences in surgical outcome by comparing the three groups. The total radiation dose, fraction size, and irradiated volume commonly used to treat active Graves orbitopathy do not adversely interfere with the outcome of rehabilitative decompression surgery.

Management of cosmetic eyelid surgery complications.

There is a broad spectrum of complications that can occur following cosmetic eyelid surgery. The experienced eyelid surgeon should be able to avoid most serious complications through proper patient selection, a comprehensive preoperative assessment and surgical plan, meticulous surgical technique, and appropriate postoperative care. The aesthetic eyelid surgeon must counsel a patient contemplating blepharoplasty surgery regarding typical expectations including edema, eyelid numbness, dry eyes, and mild blurred vision. Patients must also be aware of the risks and the signs of serious complications such as infection, hematoma, or severe vision loss. Oculofacial surgeons must be capable of managing these adverse outcomes. The management of these urgent complications as well as other significant postoperative problems including diplopia, lagophthalmos, eyelid malposition, severe chemosis and edema, crease abnormalities, and wound dehiscence is outlined in this review.

Early versus Late Orbital Decompression in Graves’ Orbitopathy: A Retrospective Study in 125 Patients

To determine if early rehabilitative orbital decompression in Graves' orbitopathy (GO) leads to a more effective postoperative outcome than the same intervention performed at a later, more likely, fibrotic stage. Retrospective comparative case series. The medical records of all GO patients treated with a 3-wall orbital decompression at our institution between 1990 and 2000 were reviewed retrospectively. Only patients operated bilaterally for aesthetic rehabilitation, without preoperative diplopia, were included. They were divided into group 1 (duration of GO < 4 years) and group 2 (duration > or = 4 years). The 2 groups were compared for demographics, smoking habits, preoperative characteristics (immunosuppressive treatments, Hertel values, score in NOSPECS [no signs or symptoms, only signs, soft tissue involvement with symptoms and signs, proptosis, extraocular muscle involvement, corneal involvement, sight involvement] class 2, degree of extraocular muscle enlargement), and surgical outcome (mean reduction of exophthalmos, symmetry of exophthalmos reduction, reduction in upper and lower lid retraction, any persistent periorbital swelling requiring cosmetic eyelid surgery, postdecompression diplopia). The medical records of 125 of 376 patients were selected for this study. There were no differences between group 1 (n = 70) mean GO duration (2.2+/-0.8 years) and group 2 (n = 55) mean GO duration (9.0+/-5.4 years) with respect to demographics, smoking habits, and preoperative characteristics except for the degree of extraocular muscle enlargement, which was significantly greater in group 1 (P = 0.039). There was no difference in surgical outcomes between the 2 groups, with the exception of postdecompression diplopia, which was significantly more frequent in group 1 than in group 2 (29% vs. 13%, P = 0.033). In GO, early rehabilitative orbital decompression does not improve surgical outcome and is associated with a higher risk of postdecompression diplopia.

Postoperative Chemosis After Cosmetic Eyelid Surgery

Persistent conjunctival chemosis in patients who have undergone cosmetic eyelid surgery is an uncommon but aesthetically undesirable and potentially debilitating postoperative complication. We attempted to determine if a regional conjunctivoplasty can effectively reduce signs and symptoms of chronic postoperative chemosis in these patients. Three patients with iatrogenic chemosis resistant to conservative management (ie, lubrication, pressure patching, and steroid drops) and persisting for more than 6 months after the initial surgery were included. A limbal peritomy followed by subconjunctival and sub-Tenon's fascia dissection was performed in regions of clinically detectable chemosis. Patients were followed postoperatively for 3 to 9 months to assess clinical response. All patients demonstrated significant objective improvement in clinically observable chemosis as well as symptoms related to ocular surface dryness.

Incidence of Postblepharoplasty Orbital Hemorrhage and Associated Visual Loss

Orbital hemorrhage, especially when associated with visual loss, is a significant complication of cosmetic eyelid surgery. We investigated the incidence of this complication among cases handled by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. We also reviewed the length of time between surgery and the onset of bleeding and sought any factors that may contribute to these cases. A 2-page questionnaire was sent to all American Society of Ophthalmic Plastic and Reconstructive Surgery members. Responses were tabulated as to total numbers of cases performed, the incidence of postoperative orbital hemorrhage, treatments, and incidence of permanent visual loss. Comorbidities were also reviewed. Two hundred thirty-seven responses were received from American Society of Ophthalmic Plastic and Reconstructive Surgery members, collectively representing 269,433 cases. Among these cases, there were 149 orbital hemorrhages, 48 cases associated with temporary visual loss, and 12 cases associated with permanent visual loss. The majority of these cases occurred within the first 3 hours of surgery, and the risk decreased significantly after 24 hours after surgery. Common comorbidities were hypertension, perioperative aspirin use, postoperative vomiting, and increased physical activity. Treatment commonly consisted of wound drainage with cauterization of active bleeders, lateral canthotomy, intravenous steroids, and intraocular pressure-lowering drugs. Orbital decompression was infrequently used; anterior chamber paracentesis was not used. This study is limited by recall biases regarding the number of cases performed by each responding surgeon and the number of relevant cases of orbital hemorrhage. The incidence of orbital hemorrhage associated with cosmetic eyelid surgery is 0.055% (1:2,000), and orbital hemorrhage with permanent visual loss is 0.0045% (1:22,000) [corrected] Development of orbital hemorrhage is most common within the first 24 hours after surgery, especially within the first 0 to 3 hours, but can occur as late as several days after surgery.

Unfavorable Results after Cosmetic Blepharoplasty—A Study of 41 Patients

Introduction: The purpose of this study is to elucidate the various types of unfavorable results after cosmetic blepharoplasty and adjunctive mid–face-lift and their management by an oculoplastic surgeon specializing in cosmetic eyelid surgery. Materials and Methods: The charts of patients who had unfavorable results after cosmetic eyelid surgery in the 3-year period ending October 31, 2002, were retrospectively reviewed. An unfavorable result after cosmetic blepharoplasty was defined by a (a) need for functional revisional surgery or (b) request from the patient for cosmetic revision. Results: Review of over 300 charts from the author revealed 41 patients who met criteria for inclusion in the study. Twenty-one patients had functional problems that required additional surgery and 13 patients sought further corrective surgery for cosmetic problems. Seven patients had complications that did not warrant further surgery, including dry eye, ectropion, or lagophthalmos. In these patients, the problem gradually resolved or required topical lubrication. The most common problem was lower eyelid retraction, which occurred in 10 patients and required functional repair in 9. Discussion: Canthopexy or lower eyelid shortening helps present lower lid retraction after cosmetic lower blepharoplasty and is advisable is virtually all cases. However, canthopexy alone does not present lower lid retraction especially when mid–face-lifts are concomitantly performed. Surgeons should strive for symmetrical results because patients who request cosmetic repair notice asymmetry. Transient dry eye and conjunctival Chemosis due to exposure keratitis with or without accompanying significant malposition often resolves with conservative treatment. Preoperative ophthalmologic consultation may help determine patients who are predisposed to symptoms of dry eye after cosmetic blepharoplasty. An unfavorable result may necessitate early repair when the ocular function is compromised. The author concludes that most patients are satisfied and happy with a more modest improvement after cosmetic blepharoplasty that is achieved without a complication.

Perspective: cosmetic eyelid surgery from the patient's perspective.

Summit, New Jersey, U.S.A. Accepted February 10, 2003. Address correspondence and reprint requests to Dr. Joseph A. Mauriello, Jr., Medical Arts Center of Summit, 33 Overlook Road, Suite 104, Summit, NJ 07901, U.S.A. Presented in part as a Poster Presentation at the 2001 Annual Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery, New Orleans, Louisiana, November 9–10, 2001.

Management of Cosmetic Eyelid Surgery Complications

Purpose: Preoperative evaluation with detailed surgical planning is imperative to avoid potential complications in cosmetic eyelid surgery. Materials and Methods: Before undergoing cosmetic upper eyelid blepharoplasty, patients should be thoroughly evaluated. Patients should be examined for ptosis, dry eye syndrome, prolapsed lacrimal gland, and brow ptosis. In addition to the evaluation for dry eye syndrome, patients interested in cosmetic lower eyelid blepharoplasty should be assessed for ectropion, entropion, lid retraction, scleral show, lid laxity, and lagophthalmos. Preoperatively, risk factors for orbital hemorrhage, including hypertension, anti-platelet or anticoagulant medication, history of abnormal bruising of bleeding, or underlying diseases that may contribute to bleeding, should be assessed. Intraoperative management of cosmetic upper eyelid surgery complications should focus on decreasing the risk of postoperative ptosis, lagophthalmos, lid retraction, and lid asymmetry, with special attention to limiting the risk of visual loss secondary to orbital hemorrhage. Discussion: Management of cosmetic lower eyelid blepharoplasty complications should focus on methods to assess lower lid laxity, limit the risk of diplopia, and manage orbital hemorrhage. Results: Techniques to revise cosmetic eyelid surgery complications during the postoperative period will be described.