Double Eyelid Research Articles

PtosisDiffusion: a training-free workflow for precisely predicting post-operative appearance in blepharoptosis patients based on diffusion models

PurposeThis study aims to develop a diffusion-based workflow to precisely predict postoperative appearance in blepharoptosis patients.MethodsWe developed PtosisDiffusion, a training-free workflow that combines face mesh with ControlNet for accurate post-operative predictions, and evaluated it using 39 preoperative photos from blepharoptosis patients. The performance of PtosisDiffusion was compared against three other diffusion-based methods: Conditional Diffusion, Repaint, and Dragon Diffusion.ResultsPtosisDiffusion demonstrated superior performance in subjective evaluations, including overall rating, correction, and double eyelid formation. Statistical analyses confirmed that PtosisDiffusion achieved the highest overlap ratio (0.87 ± 0.07) and an MPLPD ratio close to 1 (1.01 ± 0.10). The model also showed robustness in extreme cases, and ablation studies confirmed the necessity of each model component.ConclusionPtosisDiffusion generates accurate postoperative appearance predictions for ptosis patients using only preoperative photographs. Among the four models tested, PtosisDiffusion consistently outperformed the others in both subjective and statistical evaluation.

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.

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 .

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.

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.

Standards of Femininity in Traditional and Contemporary China: Stereotypes and Beliefs on Women’s Appearance, Roles and their Cultural Influences

Technological advancements have advanced patriarchal society. Modern society is bombarded with media, which introduces new styles and trends daily. These new fashion standards often have negative effects and reinforce social norms and stereotypes. Female roles and fashion trends are stereotyped worldwide, but they are rarely rigid. However, many in Eastern Asia, especially China, are concerned about this issue because cultural and media influences shape many stereotypes and perceptions about women’s physical appearances and social roles. People used to embrace their own beauty standards. However, modern society has adopted a standardised ideal, leading many to undergo extensive plastic surgery procedures like nose bridge enhancement, V-shaped face, skin lightening, and double eyelids. It seems like everyone is identical and can be easily replicated. Without inner beauty and values, outer beauty is just a decorative vase. Beauty, like anything else, is harmful in excess. Self-improvement and personal values should be prioritised before cosmetic enhancement. Through impact of social media, Chinese people set beauty standards and keep them for female generations .

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.

Personalized preoperative design reducing complications after upper blepharoplasty

BackgroundUpper eyelid blepharoplasty is a common cosmetic surgery among Asians, and is associated with several complications that are possibly related to the anatomical characteristics of the eyes. MethodsA total of 364 upper eyelid blepharoplasties were performed at the Department of Plastic and Reconstructive Surgery between January 2018 and December 2019. The post-surgery complications and the related eyelid types were classified as follows: upper eyelid crease too high (too high crease, THC), upper eyelid crease too low (too low crease, TLC), medial upper eyelid crease too high (too high medial crease, THMC), bloated upper eyelid (bloated crease, BC), and upper eyelid crease asymmetry (asymmetric crease, AC). The correlation between the anatomical characteristics of the upper eyelid and the complications was analyzed. The patients seeking upper eyelid blepharoplasty were preoperatively categorized into five types according to their anatomical characteristics, and the modified surgical strategies were applied to 117 new blepharoplasties performed between January 2020 and December 2020. Five senior plastic surgeons evaluated the pre- and post-operative photographs of the previous (2018-2019) and modified (2020-2021) blepharoplasties and scored the results on the basis of specific criteria. ResultsThe postoperative scores in modified group increased significantly after the modifications compared to that of the previous surgeries (p≤0.01). ConclusionPreoperative classification based on the anatomical characteristics of the eyelid and surgical modifications can reduce the occurrence of the five common complications of double eyelid blepharoplasty. Level of EvidenceIV

Factors Affecting Patient Satisfaction with Double-Eyelid Blepharoplasty.

Blepharoplasty is a common surgical technique performed in individuals seeking aesthetic enhancement. Thus, it is essential to investigate the factors influencing postoperative satisfaction from the patient's perspective. In this study, patient-rated outcome measure questionnaires were used to identify the factors affecting patient satisfaction after full-incision upper blepharoplasty. This retrospective study analyzed patients who underwent full-incision upper blepharoplasty at an outpatient clinic in China. The questionnaire responses were collected by telephone, text messaging, or email at 6 and 12 months postoperatively. In total, 149 questionnaires were collected. After a mean follow-up of 23.23 months, the patients' overall satisfaction rate was 89.43%. The factors that significantly affected postoperative satisfaction were the patient's education level, the source of referral to the surgeon, the patient's understanding of the surgical risks, application of a cold compress after surgery as recommended, unsatisfactory postoperative double-eyelid width, postoperative bilateral asymmetry, apparent postoperative cicatrices, and postoperative caterpillar-like appearance of the double eyelids. Education level, apparent postoperative cicatrices, and postoperative bilateral asymmetry influenced the patient's satisfaction with the surgical outcome. The patient's understanding of the surgical risks, unsatisfactory postoperative double-eyelid width, postoperative bilateral asymmetry, apparent postoperative cicatrices, and postoperative caterpillar-like appearance influenced the satisfaction of the patient's family and friends. Postoperative bilateral asymmetry, apparent postoperative cicatrices, and a low education level of the patient are independent factors that negatively affect patient satisfaction with the outcome of double-eyelid blepharoplasty. 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 .

Clinical Treatment Efficacy and Incidence of Complications in Asymmetric Double Eyelid Repair Surgery

Objective: It’s to analyze the clinical treatment efficacy and incidence of complications in asymmetric double eyelid repair surgery. Methods: Fifty patients who underwent asymmetric double eyelid repair surgery at our hospital from March 2022 to March 2023 were selected. Using a random number table, the patients were divided into two groups of equal size. The observation group (n=25) underwent small incision fat removal and continuous buried suture repair, while the control group (n=25) underwent traditional incision surgery. The treatment efficacy (excellent, effective, ineffective) and one-year postoperative complication incidence (conjunctival blockage, eye swelling, bruising) were compared between the two groups, as well as clinical data (operation time, healing time, incision length). Results: The total effective rate in the observation group (96%) was higher than that in the control group (64%); the one-year postoperative complication incidence in the observation group was lower than that in the control group (P&lt;0.05); the operation time, healing time, and incision length in the observation group were all less than those in the control group (P&lt;0.05). Conclusion: Double eyelid repair surgery demonstrates significant clinical efficacy and a low incidence of complications in treating asymmetric double eyelids, warranting further promotion.

Preferences for the ocular region aesthetics and elective double eyelid surgery in Chinese: A nationwide discrete choice experiment

ObjectiveThis study aimed to investigate preferences for elective double eyelid surgery and explore the psycho-social underpinnings influencing ocular aesthetics and attitudes towards aesthetic surgery. MethodThis nationwide online experiment was conducted throughout four tiers of cities in China using quota sampling, which included self-administered Likert scales for general self-efficacy and modified body image, and a set of discrete choice experiments (DCE) that measured the relative value and odds ratio of elective double eyelid surgery surgical options and marginal willingness to pay for procedure attributes. ResultsA total of 554 respondents were included in the final analysis (41.9% males, 57.9% females). Totally 47.1% of the respondents perceive double eyelid surgery as acceptable, with surgeon proficiency being the most important attribute (25.88%) followed by healthcare facilities (17.90%), maintenance time of double eyelid (18.62%), and others. Respondents held a Juste-milieu and moderate mind for ocular aesthetics. Those who accepted the surgery had higher ratings on all items of the modified body-image measures than their counterparts, with the sum of the 5-point Likert values being 27.5 (SD 11.2) versus 21.2 (SD 10.0) (P<0.001 for all), whereas there are no differences in the general self-efficacy scale. ConclusionChinese respondents prioritized improving their physical appearance and preferred undergoing aesthetic double eyelid surgery with a skilled surgeon at a higher-tier hospital. Understanding patients' stated preferences, training new surgeons, and improving Chinese medical system facilities are vital and urgent to better balance patient expectations and improve aesthetic surgical satisfaction.

Selection of Optimal Double-Lid Blepharoplasty Based on Asian Upper Eyelid Tissue Structure.

To investigate the postoperative effect of double-lid blepharoplasty based on the histological difference in the upper eyelid of Asian patients. A total of 76 patients with poor bilateral upper eyelid morphology or a single eyelid were included in this study. Different techniques of double-eyelid blepharoplasty were performed based on the thickness of the palpebral tissue. The improved PARK method (group A: 15 participants) was employed for patients with orbicularis oculi muscle being thinner, and the fat bulge of orbital septum was less. The improved traditional method (group B: 52 participants) was employed for patients with hypertrophy of the eyelid skin, orbicularis oculi muscle, and fat bulge in the orbital septum. All 76 patients achieved satisfactory outcomes in a single surgical procedure. Postoperative follow-up ranged from 3 to 6 months. In group A, there was no obvious swelling of flap near the palpebral margin and the double blepharon line becomes shallow. Although some patients in group B experienced varying degrees of bruising in the early postoperative period, all patients returned to a more natural shape 1-3months after surgery. Furthermore, after 3-6months postoperatively, there were no obvious scar adhesion and ladder sensation in the both sides of the incision. Preoperative analysis of the thickness of the upper eyelid tissue is essential to determine the appropriate surgical technique for double-eyelid blepharoplasty. The improved traditional method is recommended for patients with hypertrophy of the upper eyelid tissue (group A), as it minimizes scar adhesion and reduces the stair-step sensation in the lower eyelid tissue during long-term follow-up. For patients with thin upper eyelid tissue, the improved PARK method should be employed to avoid issues such as tissue accumulation, double eyelid crease became shallower, or disappearance. In order to obtain natural and long-term surgical results, different surgical methods should be provided according to the patient's eye tissue condition. 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 .

Aesthetic Asian double eyelid surgery: Exploring a novel indication for microsurgery

Asian double eyelid blepharoplasty and medial canthoplasty aim to enhance eye appearance in individuals of Asian descent. Traditional methods have limitations and may cause complications. This study introduces a microsurgical approach, offering improved precision and reduced scarring, applied to 37 patients over six years. While promising, this method requires specialized equipment and training, increasing complexity and cost. Further studies are needed to compare its efficacy with conventional techniques.

Creating Double Eyelids in the Japanese Colonial Era of Korea (1910-1945).

The aim of this study was to analyze the origins of the double-eyelid procedure in Korea during the Japanese colonial era. Through Google (www.google.com) and Naver (www.naver.com), the archives of newspapers and magazines were searched. The following topics were identified: ideal eyes in the Japanese colonial era, creating double eyelids using a non-surgical method, the first case of a double-eyelid operation in a Korean woman, and the presumed first case of a double-eyelid operation in Korea. By 1935, possessing double eyelids had come to be recognized as a symbol of modern beauty. An article suggested that women with small eyes consider surgery to transform their "single eyelid" into a "double-eyelid." It endorsed plastic surgery as a marker of "worldly progress." In 1939, a magazine featured an advertisement for Aihon tape, which was promoted to create "double eyelids." Oh Yeop-ju, the first Korean hairdresser, underwent double-eyelid surgery at an Ophthalmology Clinic in Japan, sometime between 1927 and 1932. She is celebrated as a beauty icon who broadened the beauty horizons of Korean women. After returning in 1933 with a "very beautiful" appearance resulting from successful double-eyelid surgery, she received a special invitation to the Kong Eye Center in Seoul, which opened in 1937. Upon hearing her detailed account and examining her eyelids, the clinic began offering double-eyelid surgery. The technique for double-eyelid surgery was introduced from Japan and disseminated through a medical journal and to patients who had undergone the procedure in Japan.

Clinical Results of Asymmetric Blepharoplasty Plastic Repair.

To investigate plastic surgery repair's effects and adverse reactions in the clinical therapy of asymmetric double eyelids. All 126 sufferers who came to the hospital for asymmetric double eyelid plastic repair from January 2022 to October 2022 were selected as the research objects, and they were divided into a control group and an observation group using the random number method, with 63 cases in each group, in which sufferers in the control group underwent full incision blepharoplasty and sufferers in the observation group underwent small incision liposuction with submerged sutures. The general data, treatment results, treatment satisfaction, related surgical indicators, and frequency of adverse reactions of the 2 groups of sufferers with asymmetric double eyelid plastic repair were compared. It had no statistically obvious distinction between the control group and the observation group of sufferers in terms of general data such as sex, age, weight, and height ( P> 0.05); the total therapy efficiency of the sufferers in the observation group (95.24%) was greater than the control group (74.60%), with P value <0.05; the total treatment satisfaction of the patients in the observation group (96.83%) was significantly higher than that in the control group (76.19%), with P value <0.05; compared with the control group, patients in the observation group had shorter operative time and healing time and less intraoperative bleeding, with P value < 0.05; the total frequency of adverse reactions of sufferers in the observation group (4.76%) was less than the control group (17.46%), with P value < 0.05. Small incision liposuction with submerged sutures for plastic repair has significant efficacy, relatively high patient satisfaction, and low incidence of adverse reactions, in line with patient esthetic review, which has a broad clinical application prospect.

Thin-Film Buckling Theory and Clinical Application of the Mechanism of Double Eyelid Formation.

The mechanism underlying the formation of upper eyelid creases has been the subject of extensive study and ongoing debate. This research aims to elucidate the principles of upper eyelid creases formation, leveraging the membrane bending theory from engineering mechanics. We developed an anatomical model of the eyelid and implemented the finite element analysis. Preprocessing and mesh division were conducted using HyperMesh, followed by computational analysis with Abaqus. This approach enabled the observation of dynamic changes in the upper eyelid during eye opening and closing. The study reveals that natural upper eyelid crease formation is influenced by multiple factors. These include the softer texture of the upper eyelid skin and the suborbicularis oculi fat, reduced rigidity at the eyelid crease, optimal contraction force of the upper eyelid, and the strategic placement of the pre-tarsal fat pad just above the eyelid crease. Ultimately, our findings demonstrate the effectiveness of finite element analysis, grounded in membrane bending theory, in elucidating the dynamics of upper eyelid crease formation. 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 severe upper-eyelid sunken deformity in Asians by double-eyelid procedure and combination of orbital fat pad repositioning and autologous fat transplantation: a one-year follow-up study of 79 cases.

Nowadays, people's pace of life continues to rapid up, and many bad habits will accelerate the aging of the eye periphery, and patients with sunken upper eyelids are to be found in younger people. In young Asians, single eyelids are often accompanied by upper eyelid depression, so correcting the upper eyelid depression during blepharoplasty becomes a higher challenge for plastic surgeons. Current surgical methods for upper eyelid depression include three major categories: tissue repositioning, injection and filling, and combined use. According to grades 1 and 2 are mild or moderate upper eyelid sunken. The sunken can be well corrected only by repositioning the orbital fat pad, while the correction effect for severe upper eyelid sunken in grades 3 and 4 is Poor, need to be used in combination to achieve the desired effect. The authors sought to determine whether, for patients with single eyelids and severe upper eyelid depression of grades 3 and 4, combined with orbital fat pad repositioning and autologous fat transplantation during blepharoplasty, an aesthetic and youthful blepharoplasty can be achieved. This study included 79 patients with single eyelids and severe upper eyelid depression of grades 3 and 4 who received treatment between June 2020 and July 2022. All patients underwent double eyelid surgery plus orbital fat repositioning and autologous fat grafting. After a minimum follow-up period of 1 year, overall patient satisfaction was 92%. The recurrence rate within the first year was 6% and the complication rate was 5%. This combined surgery may be an option for young Asians with single eyelids and severe upper eyelid depression. In this study, the surgery resulted in natural-looking double eyelids and younger-looking eye sockets in most patients. A combination of different surgical methods based on the patient's preoperative condition is critical to achieving long-term correction.

The Clinical Experience in Temporal Branch of Facial Nerve Transient Injury After Reduction Malarplasty

Purpose: During reduction malarplasty using both intraoral and preauricular incisions, the operative exposure of the preauricular incision can result in injury of the temporal branch of the facial nerve, a potentially serious complication. The purpose of this study was to determine the relative frequency of this injury and investigate potential methods of prevention by analyzing the related anatomic and functional details of the patients that sustained temporal branch injury. Methods: The study comprised a retrospective review of 93 patients who underwent L-shaped reduction malarplasty with osteotomy using intraoral and preauricular incisions between December 2018 and February 2021. Specifically, this included all patients with transient dysfunction of the temporal branch of the facial nerve 1 week postoperatively, which recovered with conservative treatment. Results: In 4 of the 93 operated cases, the postoperative evaluation revealed that the forehead lines disappeared, there was a failure of eyebrow lifting, double eyelids remained unchanged in 3 cases and narrowed in 1, but eye closure was not affected. However, using only conservative treatment, the symptoms of all patients improved and recovered. Conclusions: To avoid the temporal branch of facial nerve injury during reduction malarplasty with intraoral and preauricular incisions, surgeons need to be especially familiar with the anatomy of the temporal branch of the facial nerve and proceed with precise, atraumatic dissection. However, if facial paralysis is diagnosed postoperatively, active treatment should be undertaken as soon as possible. Level of Evidence: Level IV

Skin-Tarsus-Skin Combined with Orbicularis-Tarsus-Orbicularis Fixation Technique Creates a Double Eyelid: A Case Series.

The skin-tarsus-skin and orbicularis-tarsus-orbicularis fixation methods are widely used in double-eyelid surgery. Both methods have limitations. In this study, the two surgical methods were integrated and applied to form a stable double eyelid that mimics the natural physiological structure with minimal visible scarring. At the inner, middle, and outer sites of the double-eyelid line, 7-0 silk sutures were passed successively through the orbicularis oculi muscle at the lower edge of the incision, the tarsus/anterior tarsus tissue, and the orbicularis oculi muscle at the upper edge of the incision, and the skin was sutured with 8-0 thread. The remaining parts were fixed with 8-0 silk sutures successively passed through the skin at the lower edge of the incision, tarsus/anterior tarsus tissue, and skin at the upper edge of the incision. Scar formation, incidence of complications, and patient satisfaction were observed and recorded during follow-up. Fifty-eight patients were included. The follow-up ranged from 3 to 24 months (mean, 8 months) with 47 patients undergoing primary and 11 secondary/revision surgery. Twelve cases showed slight linear scars and in 46 cases, surgical marks were almost invisible, and there were no dynamic depressed scars. Evaluation of patient satisfaction showed high satisfaction scores (VAS score, 8.56 ± 0.51). The main reason for dissatisfaction was asymmetry of the double eyelid. There were no significant complications. A skin-tarsus-skin combined with orbicularis-tarsus-orbicularis fixation technique can produce a long-lasting, natural-looking double eyelid.