Transcutaneous Lower Blepharoplasty Research Articles

Effects of Orbicularis Oculi Flap Suspension on Transcutaneous Lower Blepharoplasty.

The purpose of this study was to analyze the clinical effects of orbicularis oculi muscle suspension in conjunction with transcutaneous blepharoplasty in patients 60 years of age or older. A retrospective study was conducted on patients aged 60 or older who underwent orbicularis oculi flap suspension in conjunction with transcutaneous blepharoplasty to treat lower lid festoons, lower lid fat prolapse, and lid laxity at Korea University Guro Hospital. The outcomes were surgical success rate, recurrence rate, postoperative complications, and patient satisfaction. In total, 39 patients (18 males and 21 females) were included, with an average age of 67.5 years (60-86y) and a follow-up period of 145.7 days (95-195d). In all patients, eyelid laxity was effectively corrected, and there was no recurrence of eyelid laxity after surgery. Three patients suffered postoperative complications, transient skin edema in 2 patients, and transient ectropion in 1 patient. Subjective satisfaction score following surgery was high, with an average score of 2.56 out of 3 points. Orbicularis oculi flap suspension with transcutaneous blepharoplasty can shorten operation time due to surgical ease. It also has the advantage of not involving conjunctival-related complications such as conjunctival edema since it does not pass through the conjunctiva. Finally, it can successfully treat lid laxity and could be used in lower blepharoplasty procedures.

Prevention of eyelid malposition by three-step supporting technique in the transcutaneous lower blepharoplasty.

To investigate the effectiveness of the three-step supporting technique for prevention of eyelid malposition in the transcutaneous lower blepharoplasty. It was a chart review of more than 10-year experiences of our method. From 2006 to 2017, a total of 697 patients underwent the three-step supporting technique in the transcutaneous lower blepharoplasty. The three steps included septum tightening, orbicularis canthopexy, and muscle plication. The assessment of outcome was made at 6 months. The results were assessed by evaluating pre- and postoperative appearance with Garcia-McCollough scale for lower eyelid overall appearance evaluation. The complication of eyelid malposition was evaluated in accordance with the grading system for post blepharoplasty eyelid malposition. Among the 697 patients, 285 patients underwent fat excision and 412 received fat repositioning for correction of the trough deformity. The follow-up ranged from 6 to 36 months: 94.2% of the patients had improvement, 4.4% no improvement, and 1.4% poor results; 95.1% (n = 663) had almost normal position, 3.2% (n = 22) scleral show, only 1.7% (n = 12) mild eversion, no patient frank eversion. All the 12 patients with slight malposition recovered through conservative treatment. Three-step supporting technique is safe and effective for lower blepharoplasty with minimal chance of eyelid malposition.

Histopathological Characteristics of the Orbicularis Oculi Muscle After Lower Blepharoplasty With or Without Myotomy

A total of 268 patients underwent blepharoplasty performed by a single surgeon: transcutaneous lower blepharoplasty in 112 (41.7%) and transconjunctival lower blepharoplasty with retroseptal access in 156 (58.2%). Subsequent minor blepharoplasty procedures were performed in 32 patients with lower pretarsal orbicularis oculi muscle biopsy. Connective tissue, fibrillar elastic system, nerves, blood vessels, fiber diameter, and sarcomeres were analyzed. Without myotomy: collagen, 9.46 ± 0.41%; elastin, 7.03 ± 0.62%; blood vessels, 4.25 ± 0.06%; nerves, 5.2 ± 0.55%; fiber diameter, 62 ± 8.0μm; and sarcomere, 1.9 ± 0.11μm. With myotomy: collagen, 19.02 ± 1.66%; elastin, 7.88 ± 1.10%; blood vessels, 5.13 ± 0.70%; nerves, 2.9 ± 0.48%; fiber diameter, 49 ± 6.5μm; and sarcomere, 1.8 ± 0.17μm. Excess endomysial connective tissue, particularly between muscle fibers, should be considered pathological. The pathological changes in the pretarsal muscle complex after blepharoplasty with myotomy may have resulted from innervation interruptions as well as vascularization blockages. Surgeries with myotomy caused significant changes in collagen, nerves, and muscle fiber diameter. These observations strongly suggest the superiority of a technique that preserves orbicularis oculi muscle integrity. 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 .

Changes in Tear Meniscus Height Following Lower Blepharoplasty as Measured by Optical Coherence Tomography.

PurposeThe lower eyelid serves important roles in tear distribution and drainage. The purpose of this study was to measure the tear meniscus height (TMH) with anterior segment optical coherence tomography after lower blepharoplasty.MethodsA total of 52 eyes from 26 patients treated between July 2012 and June 2015 were included in the study. A transcutaneous or transconjunctival approach was performed, depending on whether (1) the supportive lower lid orbicularis oculi muscle was tightened, (2) the middle lamella was elongated, (3) minimal fat was removed or transpositioned, and (4) lateral canthal support was established. Marginal reflex distance 2 and marginal nose distance were analyzed with Image J software. TMH was measured with anterior segment optical coherence tomography. A paired t-test and Wilcoxon signed-rank test were used for statistical comparisons.ResultsMarginal reflex distance 2 decreased and marginal nose distance increased with both surgical techniques. TMH decreased from 337.3 ± 117.9 to 289.3 ± 69.1 µm (p = 0.024) in patients who had transcutaneous lower blepharoplasty, but increased from 186.5 ± 35.5 to 274.8 ± 58.3 µm (p = 0.000) in patients who had transconjunctival lower blepharoplasty. Medial and lateral TMHs decreased significantly from 228.8 ± 80.7 to 152.7 ± 42.1 µm (p = 0.008) in patients with transcutaneous lower blepharoplasty. TMH was significantly restored after lower blepharoplasty with either approach.ConclusionsEnhancing the lower eyelid position combined with orbicularis muscle tightening and lateral canthal support can normalize the TMH following lower eyelid blepharoplasty.

Comparison of Colorado Microdissection Needle Versus Scalpel Incision for Aesthetic Upper and Lower Eyelid Blepharoplasty.

Traditionally, eyelid skin incisions with electro-cautery devices have been avoided due to the concerns of aesthetically unacceptable scar formation. The purpose of this study is to compare ecchymosis, cosmesis, and histologic tissue damage of incisions made with a scalpel or Colorado needle in patients undergoing upper and lower aesthetic blepharoplasty. To the best of authors' knowledge, no previous study has been performed before to compare these 2 modalities in aesthetic blepharoplasty surgery. This is a multicenter, prospective, interventional, comparative case series. The study protocol was approved by Institutional Review Board in each institution. Patients underwent bilateral upper and/or transcutaneous lower blepharoplasty with 1 side randomly selected for skin incision with the scalpel, the other side with the Colorado needle. Ecchymosis was evaluated using a 10-point Likert scale and the wounds using a Hollander score. The margins of excised tissues were evaluated histologically. A total of 254 eyelids of 101 patients were included in the study. No significant difference was observed in ecchymosis on postoperative day 1 and 7 and scar cosmesis on day 30 and 180 between the 2 techniques. Histologically, necrosis was noted only with the Colorado needle sides (p = 0.001). No adverse events occurred on the Colorado needle side at any time after surgery. No clinical difference is noted between Colorado needle and scalpel incisions in terms of ecchymosis and scar cosmesis after aesthetic blepharoplasty.

Transcutaneous Lower Blepharoplasty, Painless Suture Removal

Despite being referred to as one of the more challenging procedures in plastic surgery, lower blepharoplasty is one of the most commonly requested and performed aesthetic procedures.Our experience, from February 2007 to March 2012, is based on 214 transcutaneous lower blepharoplasty procedures in which the skin flap was sutured by means of the epidermal-dermal U stitch, a new, simple, and reliable method. Patients were followed up for a mean period ranging from 7 to 70 months. To our knowledge, the literature proposes a single-stitch closure or continuous suture in transcutaneous lower blepharoplasty using nylon or silk 4-5-0 to close the skin incision (1-3-5). According to our experience before 2007 based on patients' reports, single-stitch subciliary suture removal is a source of stress for the patient that causes anxiety, discomfort, and pain.Thus, in February 2007, following transepithelial lower blepharoplasty, we started using a new, simple way to suture the subciliary skin flap adopting the epidermal-dermal U nylon 5-0 stitch to avoid any discomfort and drastically reduce the level of anxiety and pain at the time of suture removal. According to our experience, the healing of the wound does not require any subsequent scar revision resulting from healing defects or pathological scar tissue; the complication rate in our series is in keeping with that reported by other authors in the literature.In conclusion, our experience indicates that the suture technique we describe is an easily reproducible, rapid, discomfort-free, and painless means of removing stitches.

Comprehensive Considerations in Blepharoplasty in an Asian Population: A 10-year Experience

This article discusses the effectiveness, patient selection criteria, complications, and the appropriate procedures for lower blepharoplasty in an Asian population. During the past 10 years (1998-2008), a total of 2400 patients underwent lower blepharoplasty in our department. Four different types of lower-blepharoplasty procedures were performed, including the traditional transcutaneous skin flap procedure (n = 862), the transcutaneous skin-muscle flap procedure (n = 738), the transconjunctival procedure (n = 433), and Hamra's procedure (septal reset and fat-replacing technique) (n = 367). Among these 2400 patients, 925 were available for follow-up. The length of follow-up ranged between 1 month and 10 years. Most of the patients were satisfied with the result, but 32 patients had some postoperative complications, including five patients with ectropion, five with hollow eyes, two with dry eyes, and 20 with retraction. Transconjunctival blepharoplasty is the first choice for primary eyelid bags. Transcutaneous lower blepharoplasty (skin flap or skin-muscle flap procedures) is indicated for the senile eyelid with excess skin and muscles. If supporting structures (skin, muscle, and septum) show laxity and other aging stigma are present, including tear trough deformity and obvious skeleton rim, Hamra's procedure (septal reset and fat-replacing technique) is performed.

Restoring palpebral fissure shape after previous lower blepharoplasty.

The youthful palpebral fissure can be described as long and narrow. Both the aging process and transcutaneous lower blepharoplasty can cause descent of the lower lid margin and medial migration of the lateral canthus, resulting in a rounding of the palpebral fissure. This article presents a technique to correct significant postsurgical lower lid malposition and palpebral fissure distortion without the use of outer or inner lamellar grafts. In overview, subperiosteal dissection frees scarred lid structures and cheek soft tissues, creating a continuous composite flap. Elevation of the cheek soft tissues recruits deficient outer lamellae and allows the sub-orbicularis oculi fat to be positioned between the orbital rim and scarred lid structures, filling this space and helping to support the repositioned lid margin. Titanium screws placed in the lateral orbit provide a point for secure fixation of elevated cheek tissues. Transosseous wire fixation securely repositions the lateral canthus. This procedure not only restores lower lid position and the vertical height of the palpebral fissure, but it also restores the palpebral fissure's horizontal length and the lateral canthal angle. It has been effective in correcting palpebral fissure distortion after lower blepharoplasty in 15 patients during a 6-year period.

Transcutaneous lower blepharoplasty.

Transcutaneous lower blepharoplasty as a standard procedure for cosmetic lower blepharoplasty is being replaced by transconjunctival blepharoplasty and laser resurfacing techniques. Nevertheless, there remain specific indications for the transcutaneous approach and its modifications. The accomplished facial plastic surgeon will be able to choose the appropriate technique based on the patient's concerns, the eyelid pathology, and his or her clinical experience.