Eyelid Rejuvenation Research Articles

The Experience in Lower Eyelid Blepharoplasty: Improvement of Surgical Procedures Based on Anatomical Basis.

This study characterizes the appearance changes associated with aging of the human lower eyelid, grounded in its anatomical basis. Tailored approaches to lower eyelid bag are performed by these anatomical manifestations. From January 2017 to January 2023, lower eyelid blepharoplasty was performed on 137 patients, aged 20 to 60 years. These patients were divided into 3 groups according to the periorbital aging appearance, primarily characterized by the presence and location of the "bag" bulge of the lower eyelid. We analyzed the corresponding changes in anatomical structures for each type, which included a weakened fibrous orbital support system, reduced muscle tone, and increased orbital fat. Patients were treated with tailored blepharoplasty techniques according to their classification. All patients in this study ranged in follow-up from 1 to 12 months. With patients' permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome. Our study identified 3 morphologies of the lower eyelid. Type 1 presents a "bubble bag" in the medial and inferior aspect of the lower eyelid. Type 2 features a double convexity contour, with separate fat pad herniations demarcated by fibrous connective tissue. Type 3 exhibits a single convexity with a uniform herniation of fat pads across the entire lower eyelid. We have delineated the anatomical changes associated with each morphology type. With an approach grounded in "remodeling" and "recovery," the surgical treatment targets the fibrous support tissue to improve the outcomes of lower eyelid rejuvenation. No complications occurred. All postoperative results reached both surgeon's and patient's expectations. Surgeons must recognize the pivotal role of fibrous connective tissues-including the arcuate expansion, fascia of the inferior oblique muscle, and the orbicularis retaining ligament-and endeavor to preserve or reinforce these structures during surgical procedures. An anatomically based surgical approach would more effectively and safely to resist the facial aging process.

Fat or fillers: The dilemma in eyelid surgery

The aging of the periocular region has always aroused great interest. A fresh, young, and attractive sight determined an ever-greater attention to surgical and non-surgical techniques to obtain this result. In particular, the change in the concept of a young look, considered then “full”, led to the increasing use of surgical (fat grafting) or medical (hyaluronic acid) filling techniques. Eyelid rejuvenation became increasingly popular in the field of cosmetic treatments, with a focus on achieving a youthful and refreshed appearance. Among the various techniques available, the choice between using fat grafting or fillers presented a clinical dilemma. In particular, what surgery considered of fundamental importance was a long-lasting result over time. On the other hand, aesthetic medicine considered it fundamental not to have to resort to invasive treatments. But what was the reality? Was there one path better than the other, and above all, was there a better path for patients? The minireview aims to explore the physiopathology, diagnosis, treatment options, prognosis, and future studies regarding this dilemma. We analyzed the literature produced in the last 20 years comparing the two techniques. Current literature reveals advancements in biomaterials, stem cell research and tissue engineering held promise for further enhancing the field of eyelid rejuvenation. The choice between fat grafting and fillers in eyelid cosmetic treatments presented a clinical dilemma. Understanding physiopathology, accurately diagnosing eyelid aging, exploring treatment options, assessing prognosis, and conducting future studies were essential for providing optimal care to patients seeking eyelid rejuvenation.

Eyebrow Lift: Open-Book ROOF Transposition and Orbicularis-Frontalis Sliding Maneuver.

This article delves into innovative surgical techniques, the open-book ROOF (retro-orbicularis oculi fat) transposition technique (OBRoof) and the orbicularis-frontalis sliding maneuver (OFS), designed for eyebrow and upper eyelid rejuvenation in the aging process. Emphasis is placed on understanding the dynamic changes occurring within the forehead and eyebrow envelope's five layers and their intrinsic relationships as well as the impact of the ROOF ptosis causing upper eyelid hooding. The OBRoof technique is highlighted for its effectiveness in addressing ptotic volume, offering a rejuvenated appearance by relocating volume to the supraciliary region.In the OFS, we explore the concept of extensive dissection above the upper border of the eyebrow to allow for free repositioning of the eyebrow. The stabilization is based on deep-plane facelift concepts, as the orbicularis oculi muscle corresponds to the superficial muscular aponeurotic system, and it is anchored to the deep layers (periosteum) by passing through the frontal muscle.In summary, this article provides a comprehensive exploration of innovative and minimally invasive techniques for eyebrow and upper eyelid rejuvenation, shedding light on their anatomical foundations, procedural intricacies, and the potential for achieving natural and lasting outcomes.

Zespół wiotkiej powieki z perspektywy lekarza okulisty – wybrane aspekty

Aging changes in the periorbital region may include the development of excess eyelid skin, hernation of orbital fat, descent of the eyebrows. These changes affect the limitation of the field of vision and the aesthetics of this area. Blepharoplasty is a popular technique for eyelid rejuvenation. Autor discus blepharoplasty role in periorbital rejuvenation, restoring the function of the eyelids, provide some information about patient selection, surgical technique and complication of surgery. Autor present methods of skin removal, treatment of the orbicularis oculi muscle and palpebral fat in order to obtain a good functional and aesthetic effect.

Plastyka powiek górnych. Wskazania i technika

Aging changes in the periorbital region may include the development of excess eyelid skin, hernation of orbital fat, descent of the eyebrows. These changes affect the limitation of the field of vision and the aesthetics of this area. Blepharoplasty is a popular technique for eyelid rejuvenation. Autor discus blepharoplasty role in periorbital rejuvenation, restoring the function of the eyelids, provide some information about patient selection, surgical technique and complication of surgery. Autor present methods of skin removal, treatment of the orbicularis oculi muscle and palpebral fat in order to obtain a good functional and aesthetic effect.

Anatomical Foundations of Lower Eyelid Revitalization: Letter on Anatomical Basis for the Lower Eyelid Rejuvenation

Anatomical Foundations of Lower Eyelid Revitalization: Letter on Anatomical Basis for the Lower Eyelid Rejuvenation

Long-Term Effects of Extended Upper Blepharoplasty Combined With Subbrow Skin Removal for Correction of Lateral Hooding in Asian Women.

Upper eyelid aging with lateral hooding is common among Asian women older than 40 years. Since Asians tend to develop more visible scars than White people, we used an extended upper blepharoplasty technique to correct lateral hooding and conceal the scar, combined with the removal of the thick subbrow skin for women over 60 years of age, to achieve a stable, improved outcome. An extended cutaneous scalpel-shaped excision was designed and hid the extended part of the excision in the patient's upward crow's feet to address the redundant skin of lateral hooding. For patients older than 60 years, we used a crescent-shaped excision and simultaneously removed the thick skin under the eyebrow to reduce the likelihood of long-term postoperative pseudoexcess. A retrospective study was conducted on 40 Asian women who underwent upper eyelid rejuvenation surgery with the above methods from July 2020 to March 2021 (follow-up, 12-15mo). Extended blepharoplasty notably corrected the lateral hooding and achieved a natural double eyelid. The postoperative scar was inconspicuous. For patients older than 60 years, the long-term rejuvenation outcome was stable when associated with subbrow skin removal. However, two patients older than 60 years in whom the subbrow skin was not removed developed pseudoexcess of the upper eyelid 1 year postoperatively. Extended blepharoplasty is a simple and effective technique for improving periorbital aging in Asian women, and the postoperative scarring was inconspicuous. For patients older than 60 years, we recommend removal of the thick subbrow skin to avoid long-term postoperative pseudoexcess.

Combined Blepharoplasty and Brow Fat Pad Transfer for the Correction of Dermatochalasis and Sunken Upper Eyelids.

Women commonly experience upper eyelid dermatochalasis and upper eyelid depression with advancing age. Blepharoplasty is a suitable method for treating dermatochalasis, but not sunken eyelid. This study proposed a novel technique for eyelid rejuvenation by simultaneously correcting dermatochalasis and sunken upper eyelids in middle-aged women. Forty patients underwent subbrow blepharoplasty combined with brow fat pad transfer. Ellipse-shaped skin and subcutaneous tissue underneath the eyebrow were measured, demarcated, and excised. The orbicularis oculi muscle beneath the subcutaneous tissue was exposed and dissected in the upper-third area. The brow fat pad was turned downward using the lower edge as the pedicle and was fixed in the layer of retro-orbicularis oculi fat to fill the depressed area in the upper eyelid. The lower muscle flap was fixed to the supraorbital rim periosteum and upper musculocutaneous flaps, thereby forming a cross flap for interlocking fixation. The surgical outcomes were evaluated using a three-dimensional imaging device and the Global Aesthetic Improvement Scale. The depth and volume of upper eyelid depression decreased significantly 3 months after the surgery and stabilized within 6 months. Global Aesthetic Improvement Scale scores significantly improved after the surgery, and the postoperative outcomes were acceptable. The novel technique is simple and effective for simultaneously correcting dermatochalasis and sunken upper eyelids in middle-aged women. The surgical outcomes are predictable and acceptable to most patients. Therapeutic, IV.

Anatomical Basis for the Lower Eyelid Rejuvenation.

The tear trough, hollow concavity of the lower eyelid, is one of the recognizable signs of facial aging. Anatomical description is essential in improving tear through deformity for facial rejuvenation. Fifty cadaver were microdissected. Fat pad types, fat herniation and the fibrous support system of lower lid were investigated. The areas of the fat compartments were compared using photogrammetry method and ImageJ software. Lower lids develop palpebral bags as a result of herniation of orbital fat against a weak orbital septum in all cases (%100). The attachment of the arcus marginalis at the orbital edge is a large contributor to the middle-aged appearance of the midface in all cases (100%). The most common type is Type 1 (36%). In this type, three distinct fat pads were diverged by arcuate expansion at lateral, fascia of the inferior oblique muscle at medial, as central, medial and lateral. Type 2 specimens (20%) were observed with two fat pads. Double convexity contour is in Type 3 cases (%44). It is determined that the medial fat pads are located in larger areas. Also, herniation is particularly evident in the medial and mediocentral fat pads. Analysis of the lower lid morphology enables surgeons to apply safe and effective procedures. The inferior oblique muscle and arcuate expansion structures should be supported and not be damaged during surgical interventions. Surgeons should focus mainly on the anatomical data obtained, and in this sense, surgeons apply them during aesthetic and reconstructive procedures of the lower eyelids. 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 .

Brow and Eyelid Rejuvenation: Trends from the 100 Most Cited Articles over 30 Years.

Background and Objective: Various periorbital rejuvenation techniques have been introduced over the last 3 decades. This study highlights important milestones in the evolution of periorbital rejuvenation surgery by identifying the 100 most-cited articles in this field. Material and Methods: The Web of Science citation index was used to identify the 100 most-cited articles concerning periorbital rejuvenation. Articles published in English from January 1989-April 2020 describing periorbital rejuvenation-related surgical techniques, facial aging, and anatomy were included. The terms "lower blepharoplasty", "upper blepharoplasty", "browlift", "browplasty", "endobrow lift", "endoscopic brow", "Foreheadplasty", "lower eyelid anatomy", "upper eyelid anatomy", "forehead lift", "eyelid rejuvenation", "canthopexy", "canthoplasty", "eyelid fat pad", "orbital fat pad", "tear trough", and "eyelid bags" were entered into the citation search. Web of Science Core Collection was the database used for the search. A manual review of the initial 159 studies was performed. Articles describing reconstructive or non-invasive techniques, injectable fillers, lasers, and neurotoxins were excluded. Of the 100 most-cited articles, the publication year, specialty journal, the corresponding author's primary specialty, the focus of the article, the corresponding author's country of residence, the type of study, and the level of evidence were analyzed. Results: The mean number of citations per article was 75 ± 42. There were more articles published from 1989-1999 (n = 53) than later decades. Most articles originated from the USA (n = 82) and were published in plastic surgery journals (n = 81). Plastic surgery was the primary specialty of the corresponding authors (n = 71), followed by oculoplastic surgery (n = 22). Most articles (n = 69) reported on surgical techniques. Of the clinical studies (n = 69), 45 (79%) provided level IV evidence. Conclusions: Of the 100 most-cited studies on periorbital rejuvenation, studies focusing on periorbital anatomy, aging, and surgical techniques comprised the most-cited publications. An anatomically based approach accounting for age-related changes in the periorbital structures is paramount in the field of contemporary periorbital rejuvenation.

Lower Eyelid Blepharoplasty With Volume Preservation Using the Skin Flap.

Abstract Lower blepharoplasty is one of the most commonly performed facial plastic surgeries and can be approached through many different techniques to improve perceived aging and fatigue due to prominent eyelid fat pads, deep tear troughs, loose eyelid skin, and global periorbital deflation. The technique discussed herein is a personal approach to lower eyelid rejuvenation surgery by the senior author, focusing on volume preservation with conservative resection and transposition of lower eyelid fat pads, muscle preservation, and microfat grafting. The authors discuss a series of 80 patients with case examples and a technique video. Level of Evidence: 5

Nonsurgical lower eyelid rejuvenation using injectable poly-d,l-lactic acid in Asian patients.

Filler injection for lower eyelid rejuvenation remains a difficult subject due to many complicated anatomic changes as the face ages. To propose an alternative, simple, and effective filler injection method in lower eyelids for Asian patients. Any patient who has tear trough deformities, infra-orbital hollows, nasojugal grooves, dark eye circles, as well as mild eyebags is a potential candidate for this method. Our filler choice is injectable poly-d,l-lactic acid (PDLLA; AestheFill; REGEN). PDLLA must be reconstituted with sterile water for injection (SWFI) before administration. When the patient's troughs, grooves, or volume deficit are classes II and III, 3-4ml of SWFI and 1ml of lidocaine are used. When the deficits are class I, 5-7ml of SWFI and 1ml of lidocaine are used. With the fanning injection technique, a wide region that covers all the deficits is evenly injected. The depth is under the dermis layer. The total amount of filler injection is not more than 2ml on each side. Since 2019, we have injected more than 100 patients by following these steps in Taiwan. The level of patient satisfaction is high. Only some mild and transient post-injection complications such as edema, erythema, and ecchymosis were found. We propose an alternative, simple and effective method for non-surgical lower eyelid rejuvenation for Asian patients. However, anyone who wants to perform this procedure should be well-trained and knowledgeable about the anatomy, product, and procedure to prevent adverse events.

A novel preoperative analysis method of upper blepharoplasty: Movable pulley concept.

Up to date, many surgical techniques have been introduced for upper eyelid rejuvenation. Despite those technical advances, little attention has been put on objective preoperative analysis methods. The current study introduces our simplified, versatile, and predictable upper eyelid analysis method for upper blepharoplasty patients. A total of 1509surgeries were performed from March 2017 to May 2021 using our preoperative analysis method. As a result of the operation based on this new analysis method, it was possible to individualize the plan according to the patient's needs and obtain satisfactory outcomes. Using our simplified, versatile, and predictable upper eyelid analysis method, we could counsel the surgical result with high predictability. In addition, it is a highly recommended method for beginners as it is easy to understand the mechanism of double eyelid surgery.

A case study of using cross-linked hyaluronic acid for upper eyelid rejuvenation

Introduction: The aim of study is to rejuvenate upper eyelid by injecting cross-linked hyaluronic acid into it and correct the appearance of the eye whether it is sunken or hollowed. Method: thirty participants divided into 2 groups. Group A: a patient with sunken eye, Group B: a patient with hollowed eye and mild excess skin and. A cross-linked hyaluronic acid 20mg/ml (Hyamira/Italian brand) was injected into upper eyelid via 25gauge blunt cannula. Assessment was done by taking photos and measurements. Follow up was made on basis of 2 weeks and 3 months. Result: cross sectional study of 30 patients have left and right side upper eyelid rejuvenation, mean age of patients is (37.5 ± 8.2) years old, 19 (63.3%) patients have hallowed mild abnormality and 11 (36.67%) of them have sunken eye abnormality. There is significant difference between the mean of period of injection according to group (A&B). group A more have injection time than group A in period 2 weeks and 3 months. Conclusion: obvious upper eyelid rejuvenation, youthful appearance with no more sunken or hollowed eye with more than 1 year.

Acute cataract by a high-intensity focused ultrasound procedure: a case report

BackgroundWe report a case of acute onset of cataract after eyelid rejuvenation tightening with intense focused ultrasound (IFUS) treatment without using a protection device.Case presentationA 47-year-old female patient presented at the outpatient clinic with blurred vision in her left eye immediately after undergoing an eyelid tightening procedure, using IFUS, seven days prior. The patient had decreased vision in her left eye, caused by an acute cataract with several drop-like opacities and a rosette-like posterior subcapsular cataract. One month after her first visit, the patient’s visual acuity in her left eye decreased to 20/630. A Swept-Source Anterior Segment optical coherence tomography confirmed that the posterior capsule was not ruptured. The patient underwent uneventful phacoemulsification cataract surgery with intraocular lens implantation, which resulted in full visual recovery.ConclusionsThis case emphasized the need to evaluate possible ocular side effects, resulting from periocular IFUS without a protection device, including severe cataract requiring surgery.

Measurement Method to Determine the Difference in Tear Trough and Palpebromalar Groove Distribution After Transconjunctival Fat Reposition.

This study designed an efficient measurement method to evaluate the outcome of transconjunctival fat reposition in the tear trough and palpebromalar groove. A total of 41 patients (82 eyes) who underwent transconjunctival fat reposition surgery between January 2016 and March 2019 were retrospectively analyzed. Preoperative and postoperative (at least six months) standardized digital images were taken from the patients. A satisfaction survey was conducted on all patients. Their images were analyzed by using the Adobe Photoshop CS5 software. Ratios of the tear trough and palpebromalar groove were calculated. These data were analyzed by SPSS 20.0. The overall satisfaction rate was 90.2%. With a partition in the infraorbital region, a line graph showed that the location of the tear trough and palpebromalar groove moved to the upper squares postoperatively. The number of patients whose end points of the tear trough and palpebromalar groove located outside the midline of the pupil decreased by 30.5%. When we processed all the parameters of the preoperative and postoperative groups by profile analysis, a significant difference in the tear trough and palpebromalar groove before and after surgery was observed (right: F = 79.844, P = 0.000 < 0.01; left: F = 161.799, P = 0.000 < 0.01). Digital image analysis is feasible and useful in investigating the improvement of the tear trough and palpebromalar groove. The tear trough and palpebromalar groove shifted up and became shortened, which provided a more reliable evidence for lower eyelid rejuvenation.

Transconjunctival lower eyelid blepharoplasty with fat transposition above the orbicularis muscle for improvement of the tear trough deformity.

The tear trough is the hollow concavity of the medial lower eyelid. Surgery can address tear trough deformities and reverse visible signs of periorbital aging. The previous methods of transconjunctival blepharoplasty with fat transposition were first described with subperiosteal placement of fat (Plast Reconstr Surg, 125, 2010,699, Aesthetic Surg J, 32, 2012, 426). This was followed by techniques with submuscular transposition of fat, which overcame certain difficulties associated with the subperiosteal methods (Clin Plast Surg, 20, 1993, 393, Arch Facial Plast Surg, 2, 2000, 16). We present a detailed description, evaluate the efficacy, safety, and advantages of transconjunctival blepharoplasty with fat pedicle transposition above the orbicularis muscle for lower eyelid rejuvenation and improvement of the tear trough deformity. Forty-one patients underwent lower eyelid blepharoplasty with fat transposition above the orbicularis muscle. Clinical and photographic documentation along with patient satisfaction ratings were evaluated for a minimum of 44months postoperatively. Significant improvements of lower eyelid aesthetics and correction of tear trough abnormalities were observed in most patients. At 44months postoperatively, surgical correction was maintained in all patients with a high satisfaction and long-term survival. No contour irregularities or significant long-term complications were detected in any of the patients. Transconjunctival blepharoplasty with the fat pedicle transposition placed above the orbicularis muscle is a safe and effective technique for lower eyelid rejuvenation. Compared to previously described techniques of repositioning fat into the subperiosteal or submuscular plane, this technique of transposing fat above the orbicularis muscle is an alternative technique resulting in long-term improvement of tear trough abnormalities with no major complications.

A Comprehensive Approach to Upper Eyelid Rejuvenation Surgery.

Upper eyelid aging results from comprehensive changes, and studies have failed to comprehensively address these changes. This study proposes a comprehensive approach to the surgical treatment of aging upper eyelids. Data of 116 patients with aging upper eyelids were analyzed. Each eye was scored on upper eyelid laxity, degree of blepharoptosis, and upper eyelid socket depression at preoperation and 6months after surgery. Based on average scores of both eyes, three degrees of aging were considered: mild, moderate, and severe. All patients underwent comprehensive surgical treatments. Depending on its condition, loose skin was appropriately removed, and the levator palpebrae superioris (LPS) was corrected in patients with degenerative ptosis. Meanwhile orbital septum fat was released or periumbilical fat mass was used as a filler to correct upper eyelid socket depression. All cases were summarized based on a classification and grading system. Scores were reassessed, and satisfaction survey was conducted after 6months follow-up. The preoperative and postoperative scores of the three groups were significantly different (p < 0.05), and the difference in preoperative and postoperative scores between the three groups was also statistically significant (p < 0.05). The severe aging group had the greatest difference in score. Aside from 8 patients requiring reoperation, patients reported satisfied results after the 6month follow-up. Comprehensive surgical treatment for patients with different grades of upper eyelid aging can achieve a satisfactory effect of upper eyelid 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.

Fractional CO2 laser vs. Fraxel laser for lower eyelid rejuvenation following transconjunctival lower blepharoplasty

Aim: Transconjunctival CO2 laser lower blepharoplasty is considered to be a safe and reliable approach. A retrospective review of transconjunctival approached CO2 laser lower blepharoplasty associated with fractional CO2 laser ablation or fractioned non-ablative Fraxel laser resurfacing for lower eyelid rejuvenation is presented for comparison.

Double-Incision approach with suspension of the orbicularis oculi muscle and relieving of tension for upper eyelid rejuvenation in Asian women

In Asian women, upper eyelid skin laxity, lateral hooding, and upper eyelid and brow asymmetry in the aging upper eyelid are prominently and frequently seen. It is difficult to completely resolve these problems with the classical single-incision method. In this study, we investigate the utility of a double-incision approach to address aging-related changes of the upper eyelid. From September 2017 to March 2019, 51 patients underwent this procedure. Through a sub-brow incision, the skin and subcutaneous tissue were excised and the orbicularis oculi muscle (OOM) flap and muscular-cutaneous flap were separated. The OOM flap was lifted and fixed to the periosteum through the sub-brow fat pad and covered by the upper muscular-cutaneous flap. Through an eyelid crease incision, the supratarsal upper eyelid skin, muscle, and orbital fat were excised, excessive tension was alleviated, and double-fold eyelids were adjusted and reshaped if needed. The results were evaluated by asking the surgeon and patient involved to allocate a categorical (poor, fair, good, very good, excellent) scores and comparisons between pre- and postoperative brow position. The average follow-up period was 12 months. Most patients were satisfied with the results, barring two cases each of vomiting and transient numbness over the forehead region and three revisions. The mean surgeon and patient categorical scores associated with satisfaction with the overall outcome at 6 months were 4.2 ± 0.6 (range 3.0-5.0) and 4.0 ± 0.7 (range 2.0-5.0), respectively. The brow position was stable during follow-up period. A double-incision approach is a safe, effective, durable, and esthetic way for treating patients presenting with upper eyelid aging.