Upper-eyelid Blepharoplasty Research Articles

High Therapeutic and Esthetic Properties of Extracellular Vesicles Produced from the Stem Cells and Their Spheroids Cultured from Ocular Surgery-Derived Waste Orbicularis Oculi Muscle Tissues.

Extracellular vesicles (EVs) are paracrine factors that mediate stem cell therapeutics. We aimed at evaluating the possible therapeutic and esthetic applications of EVs prepared from the waste human facial tissue-derived orbicularis oculi muscle stem cells (OOM-SCs). OOM-SCs were isolated from the ocular tissues (from elders and youngsters) after upper eyelid blepharoplasty or epiblepharon surgeries. EVs were prepared from the OOM-SCs (OOM-SC-EVs) and their three-dimensional spheroids. OOM-SCs showed a spindle-like morphology with trilineage differentiation capacity, positive expression of CD105, CD 90, and CD73, and negative expression of CD45 and CD34, and their stem cell properties were compared with other adult mesenchymal stem cells. OOM-SC-EVs showed a high inhibitory effect on melanin synthesis in B16F10 cells by blocking tyrosinase activity. OOM-SC-EVs treatment led to a significant attenuation of senescence-associated changes, a decrease in reactive oxygen species generation, and an upregulation of antioxidant genes. We demonstrated the regeneration activity of OOM-SC-EVs in in vitro wound healing of normal human dermal fibroblasts and upregulation of anti-wrinkle-related genes and confirmed the therapeutic potential of OOM-SC-EVs in the healing of the in vivo wound model. Our study provides promising therapeutic and esthetic applications of OOM-SC-EVs, which can be obtained from the ocular surgery-derived waste human facial tissues.

Epiphora before and after upper eyelid functional blepharoplasty: A retrospective cohort study.

Epiphora and dermatochalasis are common presentations in the ophthalmology clinic. To evaluate the change of epiphora before and after functional blepharoplasty, this retrospective cohort study reviewed 39 medical records of epiphora patients who underwent upper blepharoplasty. Severity of epiphora using MUNK score was collected and compared between before and at 6 months after blepharoplasty. The analysis model was performed to measure tear breakup time (TBUT) and frequency of artificial tears use. Subgroups of subjects before blepharoplasty to short baseline TBUT (≤ 10 seconds) and long TBUT (≥ 10 seconds) were also evaluated for the MUNK score change. From the analysis of 39 patients, the results showed a statistically significant decrease in post blepharoplasty MUNK score compared to the baseline (all P < 0.001). There was no significant difference between baseline and post-operative TBUT (P > 0.05). Twenty patients were in the short TBUT group and 19 in the long TBUT group. The reduction of MUNK score after blepharoplasty in the short TBUT group was not different to the long TBUT group (P = 0.50, 95% CI -0.84 to 0.41). However, in short TBUT group, frequency of artificial tears use after surgery was less than pre-operation. From the study, upper eyelid blepharoplasty might be one technique reducing the bothersome epiphora in dermatochalasis patients.

Unsatisfactory Upper Blepharoplasty Revision Technique: Reconstruction of the Upper Orbital Septum and its Fusion Point.

The orbital septum prevents both superficial eyelid infection and the spread of bleeding into the orbit. The fusion point between the upper eyelid orbital septum and the levator aponeurosis or the tarsal plate plays an important role in determining the width of the natural double eyelid. We observed a number of unsatisfactory upper eyelid blepharoplasty outcomes resulting from improper handling of the orbital septum-such as excessive destruction of orbital septum tissue and failure to form a firm attachment point between the orbital septum and the levator aponeurosis or palpebrae plate-during primary surgery. The three most common types of unsatisfactory upper blepharoplasty outcomes include abnormally high double eyelid creases, multiple creases, and disappearance of creases. In the repair operation, we try to determine the remaining orbital septum tissue for reconstruction and form a firm attachment between the orbital septum and the levator aponeurosis or tarsal plate. Follow-up after surgery was performed to observe whether our technique can ensure effective and favorable long-term natural-looking upper eyelid blepharoplasty outcome. From January 2018 to January 2020, secondary blepharoplasty involving the above-mentioned unsatisfactory double eyelid results was performed in 83 patients, including 63 patients (141 eyes) with abnormally high skin creases, 6 patients (8 eyes) with multiple creases, and 14 patients (24 eyes) with double eyelid disappearance. The outcomes were assessed 6months to 2years after the surgery by reviewing the photographs to evaluate the esthetic outcomes including stability of double eyelid, double fold curve, symmetry, patient satisfaction, and the incidence of complications. After an average follow-up of 12months, most patients achieved a better double eyelid appearance. The esthetic outcome was graded as good in 80 patients, poor due to recurrence of double eyelid disappearance in 2, and poor because of asymmetry of the double eyelid curve in length or width in 1 patient. All patients had acceptable scars. No cases of infection or ptosis were observed. Reconstructing the orbital septum and ensuring a firm fixation with the levator aponeurosis or tarsal plate is an effective method to repair unsatisfactory upper eyelid blepharoplasty. Moreover, it is very important to protect the orbital septum and proper treatment during the initial surgery. 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 .

Evaluating the Reliability and Quality of the Upper Eyelid Blepharoplasty Videos on YouTube.

The aim of the study was to assess the quality of videos on YouTube as educational resources for patients and physicians about blepharoplastic surgery. This study is a retrospective and cross-sectional study. A YouTube search for the term "blepharoplasty" was made and the first 210 videos were recorded (all video searches were done by clearing all search history without any user login). The number of views, likes and dislikes, upload time (i.e. age) of all videos, video duration, and source (i.e. physicians, non- physicians) were recorded. The video uploader, physicians, healthcare provider, health-related channels were gathered in a group. Video sources were evaluated as physician and non-physician. The DISCERN, Journal of the American Medical Association (JAMA), and Global Quality scores of all videos were also evaluated and recorded by two experienced oculoplastic surgeons. Considering our exclusion criteria from 210 videos we evaluated, 186 videos were included in the study. 147 (79%) of these videos were uploaded by physicians and 39 (21%) by non-physicians users. The total viewing average was 69,548 ± 14,533. The average length (min) of all videos was 7.59 ± 8.75 min. The average of total likes was 301.72 ± 578.89, dislike was 28.47 ± 68.90. The mean DISCERN score was 45.06 ± 12.88 (fair quality), the mean JAMA score was 1.39 ± 1.06 (poor quality), and the mean Global Quality score was 2.39 ± 1.03 (intermediate quality). DISCERN, JAMA, GQS scores were statistically significant between videos uploaded by physicians and non- physicians (p< 0.001). As a result of the videos reviewed, YouTube videos can be educational and informative for patients and physicians. Only if the video source and content are selected correctly. We hope that YouTube will become more useful in terms of healthcare and education once its role in e-learning is clear. 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 .

A Prospective Randomized Study of Lateral Brow-Eyelid Complex Volume after Internal Browpexy Using Three-Dimensional Stereophotogrammetry.

Background: A full lateral brow-eyelid complex may help rejuvenate and feminize the face. Objectives: To compare periorbital volume change of patients as measured by three-dimensional (3D) stereophotogrammetry before and after blepharoplasty with or without internal browpexy sutures. Methods: This is a prospective randomized controlled study of 124 eyelids of 62 adult female patients who underwent cosmetic upper eyelid blepharoplasty by a single surgeon. Subjects were randomized to blepharoplasty alone (control) or blepharoplasty with an adjunctive "brassiere suture" internal browpexy (intervention). An observer masked to the intervention measured the brow-eyelid volume using standardized images obtained with a 3D camera, before and after surgery. The minimum follow-up was 6 months postoperatively. Results: Sixty eyelids (30 patients) were treated with upper blepharoplasty alone and 64 eyelids (32 patients) had blepharoplasty plus internal browpexy. The mean volume gain was 0.85 mL in the internal browpexy intervention group and 0.19 mL in the control group. The volume increased in all patients receiving browpexy and this change was greater than after blepharoplasty alone (p < 0.05). The mean follow-up time was 16.8 months (range 6-24 months). Conclusions: Adjunctive internal browpexy during blepharoplasty was associated with increased volume of the lateral brow-eyelid complex.

Evaluation of refractive and corneal topographic changes following upper eyelid blepharoplasty

Evaluation of refractive and corneal topographic changes following upper eyelid blepharoplasty

Upper eyelid blepharoplasty following hyaluronic acid injection with improved facial aesthetics and eye symptoms: a case report

BackgroundDermatochalasis of the upper eyelids (blepharochalasis) is a typical age-related change in the upper third of the face and a major concern for facial aesthetics. Nowadays both surgical and nonsurgical interventions are available for patients complaining of upper eyelid dermatochalasis. Although nonsurgical treatments are often easier to perform, if they are not performed correctly, complications may ensue and worsen the condition.Case presentationWe describe the case of a Caucasian patient presenting with bilateral upper eyelid dermatochalasis, previously treated with multiple injections of hyaluronic acid filler. Following these procedures, the patient reported nonspecific eye symptoms (such as a sense of heaviness and asthenopia) and cosmetic concerns. We decided to perform an upper eyelid blepharoplasty. During the procedure we found a ribbon of hard, fibrous material, which was carefully removed. The patient reported resolution of functional eye symptoms owing to the reduction of upper lid heaviness, which also resulted in subjective improvement of the visual field. Patient satisfaction was assessed preoperatively and 3 months postoperatively using the Blepharoplasty Outcomes Evaluation (BOE), which showed an overall satisfaction rate of 95.8 %.ConclusionsBlepharoplasty not only treated the patient’s blepharochalasis but also allowed us to correct the previous nonsurgical intervention by removing the excessive amount of injected hyaluronic acid. Both aesthetic and functional results were successfully achieved.

Management of Unsatisfactory Postoperative Double Eyelid With Intralesional Corticosteroid Injection.

Purpose: The present study was designed to observe the curative effect of early intralesional corticosteroid injection to treat unsatisfactory double eyelid.Methods: This retrospective, observational study included 30 female patients (age 22–35 years) receiving intralesional corticosteroid injection after complaining about the unsatisfactory double eyelid post-transcutaneous upper eyelid blepharoplasty. The postoperative double eyelid anomalies included multiple folds, sunken eyelids, and severe postoperative eyelid edema. The evaluation of the clinical effect was based on the bilateral symmetry of the eyelid, the placement of the lid fold, the radian of the double eyelid, and the extent of the swelling and depression.Results: Multiple folds were observed in 11 (36.67%) patients, sunken eyelids in 9 (30.00%) patients, and severe postoperative eyelid edema in 10 (33.33%) patients. Among them, 17 (56.67%) patients received one intralesional injection and experienced significant improvement in the eyelid, while 8 (26.67%) accepted another injection at 1 month after the first injection and achieved marked improvement. The remaining 5 (16.67%) patients were dissatisfied with the results and might need further repair surgery: 2 patients had multiple folds, 2 showed postoperative edema, and 1 presented sunken eyelids. None of the patients reported any adverse reactions.Conclusion: Intralesional corticosteroid injection for the correction of the postoperative unsatisfactory double eyelid is safe and convenient, and provides a novel method for early intervention.

Ocular surface and tear film changes after eyelid surgery

: Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries. There are many categories of eyelid surgeries, the most common of which include blepharoplasty, ptosis surgery, and eyelid reconstruction. In many cases, these procedures are combined, and there are many different techniques for each type of operation. Upper eyelid blepharoplasty usually includes the excision of skin, preseptal orbicularis oculi muscle, and orbital fat. Common methods of lower eyelid blepharoplasty are the skin-muscle flap, the skin flap, and the transconjunctival. Ptosis surgery is mainly divided into three types: transcutaneous, transconjunctival, and sling surgery. Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction. Different types and methods of surgery have their own advantages and disadvantages, and postoperative complications may occur. Therefore, postoperative complications of eyelid surgeries, such as dry eye symptoms, should be taken into serious consideration. Relevant literature involving these complaints can be found in PubMed by searching the terms “dry eye”, “eyelid”, “surgery”, and other related keywords. Moreover, various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index (OSDI), tear film breakup time, Schirmer test, fluorescein staining, and lissamine green staining after various eyelid surgeries. As dry eye disease is prevalent in the general population, it is more urgent to figure out what we can learn from these complaints. Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.

A Reverse Orbicularis-Tarsus Fixation Technique in Double-Eyelid Blepharoplasty: A Novel Fixation Technique Different From Park's Technique.

Although Park's "orbicularis-levator fixation technique" has been widely used as a mature double-eyelid surgery in China recently. Shortcomings related to this method cannot be ignored. Thus, a reverse orbicularis-tarsus fixation technique in double-eyelid blepharoplasty has now been devised. The method is to create a physiological double-eyelid fold based on the formation mechanism of double-eyelid creases. A retrospective study of 112 Chinese patients who underwent double-eyelid surgery between October 2017 and September 2019 was undertaken through a review of medical records. All these patients underwent a reverse tarsus and orbicularis oculi muscle fixation technique, with postoperative follow-up ranging from 6 months to 2 years. Postoperative outcomes were reviewed, evaluated, and analyzed. Altogether, 112 patients who underwent the double-eyelid surgery were reviewed. Among them, the results were judged as excellent in 104 cases (92.9%), good in 4 cases (3.6%), fair in 3 cases (2.7%), and poor in 1 case (0.8%). Clinical effectiveness was satisfactory in most of the patients (104/112, 92.9%). Only 5 patients (4.5%) expressed subjective dissatisfaction with postoperative outcomes; of these, 3 patients complained of eyelids asymmetry (2.7%). Two patients complained of eyelids scar formation (1.7%); Whereas surgical revision was required in only 1 patient (0.8%). The reverse orbicularis-tarsus fixation technique for upper eyelid blepharoplasty is safe and effective, with better biomechanics and a satisfying aesthetic outcome. Therefore, this provides an alternative option in Chinese double-eyelid surgery.Level of Evidence: Level IV, case studies.

Comparison of Clinical Outcomes of Upper Eyelid Blepharoplasty Using Two Different Suture Techniques.

Objectives:To compare upper eyelid blepharoplasty patients’ suture techniques with interrupted cutaneous in one eye and running cutaneous in the other in terms of edema, ecchymosis, and scar index.Methods:Among patients whose suture techniques with interrupted cutaneous in one eye and running cutaneous in the other, 34 patients in the vicryl group and 46 patients in the polypropylene group were included in the study. The patients’ edema and ecchymosis levels on postoperative days 1, 7, and 30 days and 3 months were selected. The Manchester Scar Scale was used to evaluate the scar index at 30 days and 3 months after surgery. Suture material (either 6-0 polypropylene sutures or 6-0 vicryl sutures) were evaluated independently.Results:In vicryl group, there was significantly less ecchymosis and edema first week postoperatively in interrupted sutured eyelid than running sutured eyelid (p=0.001, p=0.011, respectively). In polypropylene group, there was significantly less ecchymosis at the first day and first week postoperatively in interrupted sutured eyelid than running sutured eyelid (p=0.025, p=0.001, respectively). The total scar index scores in both groups at first month and third month were significantly better at the interrupted sutured eyelid than running sutured eyelid (p<0.05, for all).Conclusion:In upper eyelid blepharoplasty, an interrupted suture technique yielded the lowest rates of edema, ecchymosis, and scar formation compared with a running suture technique.

Influence of upper blepharoplasty on intraocular lens calculation.

To determine the effect of upper blepharoplasty on corneal topography and intraocular lens power calculation using Galilei and IOLMaster. Thirty patients submitted to upper blepharoplasty from May 2014 to March 2017 at the Hospital Oftalmológico de Sorocaba (São Paulo, Brazil) were included in this observational case series. All patients underwent imaging sessions with Galilei and IOLMaster preoperatively (baseline) and at 1 and 6 months postoperatively. Primary outcome measures using both devices included flattest, average, and steepest corneal curvature, corneal astigmatism, and blepharoplasty-induced corneal astigmatism. Determination of axial length and lens power calculation were performed using only IOLMaster (Holladay formula). Paired t-test and vectorial analysis were used for statistical analysis. Sixty eyes from 30 patients were prospectively included. Vectorial analysis showed that 6 months after surgery, blepharoplasty induced on average 0.39 D and 0.31 D of corneal astigmatism, as measured with Galilei and IOLMaster, respectively. IOLMaster measurements showed that average corneal curvature (44.56 vs 44.64 D, p=0.01), steepest corneal curvature (45.17 vs 45.31, p=0.01) and corneal astigmatism (1.22 vs 1.34, p=0.03) were higher 6 months after surgery. IOLMaster measurements also showed that intraocular lens power was significantly smaller 6 months after surgery (22.07 vs 21.93, p=0.004). All other parameters showed no change for comparisons between baseline and 6 months (p>0.05 for all comparisons). Upper eyelid blepharoplasty influenced intraocular lens calculation using the IOLMaster. However, the influence was not clinically significant. No topographic changes were found using Galilei.

Upper eyelid blepharoplasty, tarsal margin rotation, and posterior lamellar super-advancement for correction of severe upper eyelid cicatricial entropion and dermatochalasis

Objective: To report the long-term efficacy and safety of simultaneous correction of upper eyelid cicatricial entropion and dermatochalasis. Method: A retrospective non-comparative chart review of consecutive patients with severe upper eyelid cicatricial entropion and dermatochalasis who underwent surgical correction from July 2012 to July 2014 at a tertiary referral centre by a single surgeon. Results: Twelve eyes of 10 patients aged 80±7 (range, 65-92) years old received upper eyelid blepharoplasty, tarsal margin rotation, and graded posterior lamellar super-advancement. All eyes resumed normal upper eyelid margin position with no recurrence over a mean follow-up of 48.3±18 (range, 9-70) months. Complications including suture granuloma (n=1), transient lagophthalmos (n=1), mild lid notching (n=2) and residual peripheral asymptomatic trichiasis or distichiasis (n=3) were managed conservatively successfully. No patients developed exposure keratopathy after surgery, and the number of lubricants required was statistically significantly reduced (p=0.005). Conclusion: Our pilot study showed that combining upper lid blepharoplasty, tarsal margin rotation and graded posterior lamellar super-advancement is safe and effective in achieving long-term correction of severe upper eyelid cicatricial entropion and dermatochalasis.

The effect of upper lid blepharoplasty on forehead and glabellar lines

ABSTRACT Purpose To assess the role of upper blepharoplasty on probable reduction of forehead horizontal lines and glabellar frowns in patients who underwent upper eyelid blepharoplasty. Design This is a prospective study on 32 female patients with aged between 35 and 75 years and underwent standard blepharoplasty. Method Measurement of mid brow to hairline distance (MBHLD) and inter brow distance (IBD) were performed within 3 days before, 1 and 6 months after the blepharoplasty surgery. The surgeon and patients reported the extent of their satisfaction about the beneficial effect of upper lid blepharoplasty on decreasing forehead and glabellar lines. Results Compared to MBHLD at baseline time before the surgery, significant increase was observed in MDHLD after 1 and 6 months follow up in both eyes (p-values were less than 0.05). IBD reached the significant increase after 1 and 6 month(s) after upper lid blepharoplasty (p-values were less than 0.05). On the other hand, compared to mean of IBD in 1 month after surgery, IBD decreased significantly. 59.3% of patients reported satisfaction of high level of improvement in lessening of wrinkles. Conclusion Our observations documented the beneficial effects in reducing the forehead and glabellar line in patients who underwent upper lid blepharoplasty.

Upper eyelid blepharoplasty using plasma exeresis: Evaluation of outcomes, satisfaction, and symptoms after procedure.

Facial care treatments have grown a remarkable demand for effective and minimally invasive techniques with fast recovery time. Plasma technology is a nonsurgical alternative technique for skin rejuvenation. We assessed patient satisfaction and symptoms after upper eyelid blepharoplasty with plasma technology. Observational study including 16 patients submitted to upper eyelid blepharoplasty using plasma technology to treat dermatochalasis. Patient satisfaction, symptoms, and quality of life were assessed using 2 questionnaires at follow-up days 7 and 30. Also, the answers were correlated with age, Fitzpatrick skin type, and quantity of eyelid skin treated with plasma. All 16 patients were treated and completed the survey. Fourteen (87.5%) were female, and the mean age was 50.5years. Physical appearance was the most relevant factor impacting on quality of life at first week postoperative. Regarding satisfaction with results, most patients stated higher level of satisfaction at day 7 follow-up analysis (P=.038). Less impact on quality of life and higher satisfaction was associated with eyelid-treated area (P=.044 and P=.036) and Fitzpatrick skin type (P=.043) at 7 and 30days after procedure, respectively. Eyelid edema and itching were the symptoms most reported at 7 and 30days, respectively. Upper blepharoplasty with plasma is a minimally invasive treatment with low impact on quality of life. However, overall patient satisfaction is questionable when considering less willing of undergoing procedure again and decreased expectation with results over postoperative period. Symptoms are reported mainly at the first week after procedure.

Pupillary and Anterior Chamber Changes Following Upper Eyelid Blepharoplasty.

This study investigated the preoperative and postoperative pupillary and anterior chamber (AC) characteristics of patients undergoing upper eyelid blepharoplasty. This prospective, cross-sectional study examined 32 eyes from 20 dermatochalasis patients. Following a detailed ophthalmological examination, quantitative pupillometry and Scheimpflug corneal topography were used to evaluate the pupil and AC characteristics of eyes on the day of operation and postoperative days 1 and 7. Static and dynamic pupillometry characteristics, including scotopic, mesopic, low photopic, and high photopic pupil diameter (PD), resting diameter, amplitude, latency, duration, and velocity of pupil contraction, and latency, duration, and velocity of pupil dilation, were measured. Additionally, AC volume, depth, and angle parameters were analyzed. There were significant differences between scotopic, mesopic, and resting PD and the amplitude of pupil contraction. Pairwise comparisons showed that postoperative day 1 scotopic, mesopic, and resting PD and amplitude of pupil contraction measurements were significantly higher than preoperative measurements (p = 0.008, p < 0.001, p = 0.006, and p = 0.033, respectively). Additionally, scotopic and resting PD were significantly lower on postoperative day 7 compared with postoperative day 1 (p = 0.001 and p = 0.041, respectively). However, there were no significant differences in AC parameters. This study revealed that static and dynamic pupil measurements changed following blepharoplasty, with postoperative increased PD occurring particularly under low-light conditions. Therefore, low-light environments should be avoided following blepharoplasty, and patients with angle-closure risk factors should be closely monitored in the early postoperative period.

Occult Rosacea Diagnosed After Recurring Blepharoplasty Incision Inflammation

We report an unusual case of a 58-year-old Caucasian female who developed intermittent eyelid erythema, edema, and wound thickening in the early postoperative period after bilateral upper eyelid blepharoplasty. These flares of inflammation sometimes appeared to respond to systemic antibiotics and steroid preparations and sometimes not. Because of concerns for possible mycobacterial infection, biopsy of the upper eyelid incision was performed and histopathology confirmed rosacea. Symptoms resolved with oral azithromycin. Our patient did not have a diagnosis of rosacea preoperatively. We believe that rosacea should be kept in mind in cases with either prolonged inflammation or recurrent inflammation in previously quiet eyelid incisions.

Cryoanalgesic versus EMLA® cream to reduced pain during analgesic injection in upper eyelid surgery: a randomized trial

ABSTRACT Introduction Eyelid surgery under local anesthesia is a common procedure in ophthalmology. The most painful part is usually injecting local anesthesia. Decreased sensation from the very sensitive eyelid skin before injection is one of the few methods to relieve this stressful condition. In this study, we compared the use of the aesthetic property of cooling (cryoanalgesic) with topical EMLA® cream preparation before local anesthetic injection on the eyelid. Methods Thirty patients aged 47–81 years (mean = 65.6, SD = 9.75) undergoing upper eyelid blepharoplasty or levator advancement surgery were enrolled. Each subject’s upper eyelid was randomly allocated by a computer-generated randomization sequence to an EMLA® cream or cryoanalgesic group before injecting local anesthetic. Pain monitoring was performed subjectively and objectively using a visual analog scale (VAS). Results were analyzed using the paired t-test. Results No statistical difference was found in VAS score between the EMLA® cream (mean = 5.9) and cryoanalgesic groups (mean = 5.67) (p-value 0.5999). Conclusion Topical EMLA® cream and cryoanalgesic have no difference in pain score from anesthetic infiltration during eyelid surgery.

Videographic Analysis of Blink Dynamics following Upper Eyelid Blepharoplasty and Its Association with Dry Eye

Background:This study was undertaken to characterize the effects of upper eyelid blepharoplasty on blink dynamics and to evaluate the hypothesis that changes in blink dynamics following blepharoplasty are associated with postoperative dry eye.Methods:The voluntary blink of 14 eyes of 7 patients with dermatochalasis undergoing upper eyelid blepharoplasty was recorded with a high-speed camera preoperatively and 6–8 months postoperatively, alongside a group of 11 controls. The images were analyzed for palpebral aperture, blink duration, and maximum velocity during opening and closing phases. Patients undergoing blepharoplasty were assessed for dry eye symptoms pre- and postoperatively at 6–8 months using the ocular surface disease index score.Results:Despite intraoperative orbicularis oculi resection, there was no significant compromise of blink duration or maximum velocity of eyelid opening or closure post-blepharoplasty. Postoperatively, patients had an increase in palpebral aperture compared with both preoperatively (8.71 versus 7.85 mm; P = 0.013) and control groups (8.71 versus 7.87 mm; P = 0.04). Postoperatively at 6–8 months, there was an increase in dry eye symptoms in 6 of 7 patients compared with preoperatively (ocular surface disease index, 16.6 versus 12.5; P < 0.05). There was no positive correlation between the increase in palpebral aperture and the increase in dry eye symptoms (r = –0.4; P = 0.30).Conclusions:Using modern videographic technology, this study demonstrates that upper eyelid blepharoplasty results in an increase in resting palpebral aperture but has no effect on dynamic blink parameters. Changes in palpebral aperture or blink dynamics are unlikely to be the cause of dry eye syndrome following blepharoplasty.

Effects of Upper Eyelid Blepharoplasty on Contrast Sensitivity in Dermatochalasis Patients

Objectives:To evaluate the impact of upper eyelid blepharoplasty on contrast sensitivity in dermatochalasis patients.Materials and Methods:Best corrected visual acuity, ophthalmologic examination, eyelid examination, lash ptosis, contrast sensitivity using sine-wave contrast sensitivity chart, keratometric parameters, and corneal aberrations of 34 eyes of 34 patients who underwent upper eyelid blepharoplasty due to dermatochalasis in our clinic between the years 2014 and 2018 were evaluated preoperatively and at postoperative 3 months.Results:Twenty-three (68%) of the patients were females and 11 (32%) were males. Mean age was 63.1±7 (52-81) years. Mean best corrected visual acuity was 0.036±0.06 (0-0.15) logMAR preoperatively and postoperatively (p>0.05). Contrast sensitivity values of the patients at the frequencies of 1.5, 3, 6, 12, and 18 cycles per degree were 44.38±19.5, 59.03±27.2, 41.44±34.1, 15.15±19.3, and 5.15±4.26 preoperatively and 44.80±20.9, 76.85±33.4, 63.21±46.4, 28.21±31.1, and 10.5±9.5 postoperatively, respectively. The difference between contrast sensitivity values was statistically significant at the frequencies of 3, 6, 12, and 18 cpd (p=0.005, =0.001, <0.001, and <0.001, respectively). Although lash ptosis of the patients improved significantly after the surgery, there was no correlation between lash ptosis improvement and change in contrast sensitivity (p>0.05). Keratometric values and corneal high order aberrations did not change significantly after the surgery (p>0.05).Conclusion:Contrast sensitivity significantly increases after upper eyelid blepharoplasty, especially at higher spatial frequencies which are known to deteriorate due to age-related changes in the lens and retina in older adults. Our results show that blepharoplasty may have additional functional indications for elderly dermatochalasis patients in terms of improving the functions such as performing daily tasks and reading.