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Lu JE, Wolkow N, Lee NG, Lefebvre DR, Freitag SK, Yoon MK. Perceived change in age after functional upper blepharoplasty. Orbit 2024; 43:165-167. [PMID: 37224403 DOI: 10.1080/01676830.2023.2214940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE To evaluate the perceived age of patients before and after functional upper blepharoplasty. METHODS Retrospective chart review of patients who underwent upper blepharoplasty by a single surgeon at an academic center. The inclusion criterion was having external photographs before and after blepharoplasty. Exclusion criteria included any other concurrent eyelid or facial surgery. Primary endpoint: perceived change in age after surgery as judged by the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS) surgeons. RESULTS Sixty-seven patients (14 men, 53 women) were included. Mean pre-operative age was 66.9 years (range 37.8-89.4) and mean post-operative age was 67.4 years (range 38.6-89). The mean perceived age pre-operatively was 68.9 years, and the mean perceived age post-operatively was 67.1 years, a change of 1.8 years (p = 0.0001 by two-tailed paired T-test). Inter-rater reliability of the observers was measured by intraclass correlation coefficient of 0.77 for pre-operative and 0.75 for post-operative photos. The decreased perceived age was 1.9 years for women, 1.4 years for men, 0.3 years for Asians, 1.2 years for Hispanics, and 2.1 years for whites. DISCUSSION Functional upper blepharoplasty by an experienced ASOPRS surgeon was shown to reduce the perceived age of a patient by an average of 1.8 years.
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Affiliation(s)
- Jonathan E Lu
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - N Grace Lee
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Daniel R Lefebvre
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
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Zhou L, Liu L, Yang J, Cao Z, Fan J, Tian J, Yang Z, Gan C, Jiao H, Zeng Y. Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach in Double-Eyelid Blepharoplasty Revision. Aesthetic Plast Surg 2024; 48:835-841. [PMID: 37991537 DOI: 10.1007/s00266-023-03731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Incisional double-eyelid blepharoplasty is the main surgical technique to obtain an artificial crease. Postoperative complications decrease patients' satisfaction, and patients with prominent depressed groove and persistent pretarsal swelling (sausage phenomenon) usually need revision surgery. To resolve the sausage phenomenon after blepharoplasty, we adopt Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach to create natural double eyelids. METHODS We included 68 patients in the study. The inclusion criteria for revision surgery were as follows: (1) pretarsal OOM remained after primary surgery, (2) prominent depressed surgical scar/groove and persistent pretarsal bulge (sausage phenomenon), (3) postsurgical abnormally wide crease. The surgical procedure involved releasing the pretarsal OOM, forming OFOOM-OOM flap, and OFOOM-OOM flap fixed with aponeurosis. Outcome observations were assessed using the FACE-Q questionnaire, and the follow-up period ranged from 6 to 36 months (mean=18 months). RESULTS The depressed groove and pretarsal bulge showed significant improvements, and FACE-Q scores of the 68 patients before surgery (mean scores=66) compared with those after surgery (mean scores=90) were significantly different (P<0.01). Four patients with palpebral fold asymmetry and two patients with shallow eyelids received revision surgery, and patients were satisfied with the secondary surgery effects. Six patients presented with unnatural curves of folds and revision surgery alleviated these situations. CONCLUSIONS Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach is an effective way to resolve the sausage phenomenon. The OFOOM-OOM flap is a reliable and flexible structure to create natural double eyelids. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Lu Zhou
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Liqiang Liu
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China.
| | - Jifan Yang
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zilong Cao
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jincai Fan
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jia Tian
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zengjie Yang
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Cheng Gan
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Hu Jiao
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Yan Zeng
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
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Chong Y, Liu X, Xiao Y, Yu N, Ting W, Liu H, Huang J, Long X. Does Double-Eyelid Blepharoplasty Improve Forehead Wrinkles? A Prospective Study Using FACE-Q Scale and Anthropometric Measurements. Aesthetic Plast Surg 2023; 47:2425-2431. [PMID: 37014412 DOI: 10.1007/s00266-023-03330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/19/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Single eyelids are common among Asians. It is not uncommon to see people with single eyelids raise their eyebrows to wide open their eyes. This results in frequent compensatory contraction of the frontalis muscle and thus leads to deep forehead wrinkles. Double-eyelid blepharoplasty creates a larger visual field. In theory, patients who receive the surgery will stop overusing the frontalis muscle. Therefore, the forehead wrinkles can be improved. METHODS 35 patients who underwent double-eyelid blepharoplasty were enrolled. FACE-Q forehead wrinkle assessment scale was adopted to evaluate the forehead wrinkles preoperatively and postoperatively. In addition, anthropometric measurements were taken to indirectly evaluate frontalis muscle contraction in maximum eye-opening position. RESULTS According to the FACE-Q scale, forehead wrinkles were improved after double-eyelid blepharoplasty, and the improvement was long-lasting in the 3-month follow-up. This was because the frontalis muscle contraction reduced after the surgery, as shown by the anthropometric measurements. CONCLUSION This study used subjective and objective methods to prove that double-eyelid surgery improves forehead wrinkles. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Yuming Chong
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuanchen Liu
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiding Xiao
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyun Ting
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Liu
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xiao Long
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Facial Cosmetic Surgery. J Oral Maxillofac Surg 2023; 81:E300-E324. [PMID: 37833027 DOI: 10.1016/j.joms.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Huang PJ, Mao SH, Yen CI, Yang SY, Hsiao YC, Yang JY, Chang SY, Chuang SS, Chen HC. Objective Comparison of Eyebrow Position after Internal and External Browpexy. Plast Reconstr Surg 2023; 152:414e-423e. [PMID: 36847688 DOI: 10.1097/prs.0000000000010310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Several brow-lift techniques have been used to prevent brow ptosis after blepharoplasty. For example, both internal and external browpexies have been adopted worldwide. However, few studies have compared these two methods. The authors compared postoperative eyebrow position changes between upper eyelid skin excision, internal browpexy, and external browpexy. METHODS The authors retrospectively reviewed the cases of 87 patients who underwent upper blepharoplasty performed by a single clinician at their institute between April of 2018 and June of 2020. Patients with routine outpatient photographs taken before and after surgery were enrolled in the study. ImageJ was used to measure brow height at eight points in each eye. Brow height changes were compared among the three groups. RESULTS Routine photographs were available for 68 patients (133 eyes). Thirty-nine patients underwent internal browpexy (78 eyes), nine underwent external browpexy (17 eyes), and 20 underwent upper eyelid skin excisions (38 eyes). Three months after surgery, significant elevation was noted on the lateral side of the brow in the internal browpexy group and across the whole brow in the external browpexy group. In the upper eyelid skin excision group, whole brow ptosis was observed. Brow-lift outcomes were better in the external than in the internal browpexy group, whereas both browpexy groups showed better outcomes than the upper eyelid skin excision group. CONCLUSIONS Within 3 months of surgery, both internal and external browpexy provided significant brow-lift effects, preventing brow ptosis caused by blepharoplasty with skin excision. External browpexy had better brow-lift outcomes than did internal browpexy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Po-Jen Huang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Shih-Hsuan Mao
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Cheng-I Yen
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Shih-Yi Yang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Yen-Chang Hsiao
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Jui-Yung Yang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Shu-Yin Chang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Shiow-Shuh Chuang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Hung-Chang Chen
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
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Liu Q, Wang Z, Yang J, Wu S, Zhang Y, Gan P, Yi Y. A Novel Preoperative Design to Address Dermatochalasis in Asian Upper Blepharoplasty. J Craniofac Surg 2023; 34:1312-1315. [PMID: 36735477 DOI: 10.1097/scs.0000000000009145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The preoperative design for the amount of skin excision of the upper eyelid is a common procedure in Asian blepharoplasty, but there lack of an effective method addressing dermatochalasis to acquire esthetically pleasing results. Our aim was to propose an alternative technique to determine the skin excision combined with the esthetics of eyes for correcting skin laxity and therefore to create attractive double eyelids. MATERIALS AND METHODS The preoperative invaginating-simulating design combined with esthetic criteria for determining the amount of excised skin were performed during blepharoplasty. The Strasser grading system and the Global Aesthetic Improvement Scale were evaluated by analyzing the preoperative and 6-month-postoperative photographs. RESULTS One hundred forty-two patients were included. The general outline of the "optimal incision" took on a knife in shape with a mean of 2.2±3.32 points of Strasser grading score. A total of 130 of 142 patients (91.5%) were judged as "good results" and 12 of 142 patients (8.5%) were judged as "mediocre". The Global Aesthetic Improvement Scale showed a significant cosmetic improvement with the result of 89.4%(127 of 142 patients) for "very much improved", 7.8% for "much improved" and other patients for "improved". No severe complications were observed. CONCLUSIONS This preoperative design approach has been proven to be effective to address dermatochalasis (especially for lateral hooding) by simulating the expected appearance of a double eyelid combined with esthetic criteria of eyes simultaneously, which can contribute to achieving upper-lid rejuvenation and beautiful and natural outcomes.
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Affiliation(s)
- Qing Liu
- Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Told R, Placheta-Györi E, Lackner B, Kuchar A, Brugger J, Schmidt-Erfurth U, Dunavölgyi R. FACE-Q Patient Report-Assisted Subjective and Objective Evaluation of Blepharoplasty Outcomes Using Two Different Suturing Techniques: A Randomized and Patient-Blinded Pilot Study. Aesthetic Plast Surg 2023:10.1007/s00266-023-03339-6. [PMID: 37127811 PMCID: PMC10390350 DOI: 10.1007/s00266-023-03339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND /Objectives To compare two suturing techniques in patients undergoing upper eyelid blepharoplasty by using the FACE-Q™ Eye Module questionnaire to assess patient-reported outcomes and by blinded Likert-scale gradings of two experienced surgeons. METHODS 90 patients undergoing bilateral blepharoplasty were randomly assigned to a suturing technique (running cutaneous or subcuticular closure) using Prolene 6.0. Patients completed the FACE-Q eye module questionnaire before surgery and 7 days and 3 months after surgery. Further, two trained oculoplastic surgeons assessed the outcome. FACE-Q ratings were RASCH-transformed, and linear models were fitted for appraisal and satisfaction results. Intraclass correlation coefficient (ICC) was calculated to assess the surgeons' rating agreement. RESULTS There was no statistically significantly difference in patients' FACE-Q self-assessments regarding satisfaction with eyes and appraisal of upper eyelids between the two suturing techniques investigated, both 7 days and 3 months after blepharoplasty. The more content the patient at baseline, the less the increase in satisfaction after 3 months. There was good agreement between blinded graders in outcome assessment expressed by an ICC of 0.86. Dry-eye symptoms increased after surgery, independent of the suturing technique, patient age or sex. CONCLUSION In conclusion, this study shows that post operative patient satisfaction is independent of suturing technique, but depends on baseline FACE-Q reports. These findings are valuable in patient communication and selection and are in line with observer-based assessments. LEVEL OF EVIDENCE III 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 http://www.springer.com/00266 .
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Affiliation(s)
- Reinhard Told
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| | - Eva Placheta-Györi
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Birgit Lackner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Kuchar
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Roman Dunavölgyi
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Maamari RN. Upper Blepharoplasty: An Evidence-Based Assessment of Preoperative Considerations and Surgical Techniques. Facial Plast Surg 2023; 39:273-278. [PMID: 36929066 DOI: 10.1055/s-0043-1764393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Upper blepharoplasty is one of the most common facial plastic surgical procedures performed. Due to its growing popularity, an abundance of articles is available describing variations in the surgical technique and outcomes. As a result, it has become increasingly difficult to identify appropriate surgical literature validated by a high level of evidence. The purpose of this review is to identify and describe specific evidence-based components of the preoperative evaluation and surgical approach in upper blepharoplasty surgery.
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Affiliation(s)
- Robi Nicolas Maamari
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri
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Abdolalizadeh P, Kashkouli MB, Khamesi V, Karimi N, Ghahvehchian H, Ghiasian L. Upper blepharoplasty: advanced techniques and adjunctive procedures. EXPERT REVIEW OF OPHTHALMOLOGY 2023. [DOI: 10.1080/17469899.2023.2175673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Parya Abdolalizadeh
- Department of Ophthalmology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohsen Bahmani Kashkouli
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Vahid Khamesi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Nasser Karimi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hossein Ghahvehchian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Leila Ghiasian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
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Mahrhofer M, Schwaiger K, Weitgasser L, Schoeller T, Hitzl W, Wechselberger G. Patient-Reported Outcome Analysis after Resident Performed Upper Blepharoplasty: A Suitable Procedure for Young Surgeons. Facial Plast Surg 2023; 39:98-103. [PMID: 36100243 DOI: 10.1055/s-0042-1749168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Upper blepharoplasty is one of the most frequently performed aesthetic surgeries worldwide. While it is considered a low risk procedure, patients have high expectations regarding the outcome of elective surgery of the face and the majority of residents usually have little exposure to cosmetic surgeries in the early years of their training. All eligible patients who had undergone bilateral upper blepharoplasty at the senior author's institution between January 2016 and August 2019 were invited to participate in an online questionnaire. Our study used a 27-item questionnaire to evaluate postoperative patient satisfaction and compared the patient reported outcome between operations conducted by surgeons with more than 3 years of experience and less than 3 years. In total, 102 patients returned the completed questionnaire and were included in our study after further screening. There was no significant difference in patient reported satisfaction concerning the aesthetic outcome (8.75 vs. 8.29, p=0.49), and complications (6.2 vs. 18.6%, p=0.63), related to the experience of the surgeons. Overall patient satisfaction was very high, while the rate of complications was low. Patient reported aesthetic outcomes after blepharoplasty demonstrated no significant difference comparing the experience of the surgeons.
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Affiliation(s)
- Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria.,Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Karl Schwaiger
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria
| | - Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria
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Hollander MH, van der Hoeven JH, Verdonschot KH, Delli K, Vissink A, Jansma J, Schepers RH. Effects of Upper Blepharoplasty Techniques on Headaches, Eyebrow Position, and Electromyographic Outcomes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1559. [PMID: 36674313 PMCID: PMC9866996 DOI: 10.3390/ijerph20021559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The aim of this study was to assess changes in headaches, eyebrow height, and electromyographic (EMG) outcomes of the frontalis and orbicularis oculi muscles, after an upper blepharoplasty with or without resecting a strip of orbicularis oculi muscle. In a randomized controlled trial, 54 patients received an upper blepharoplasty involving either only removing skin (group A) or removing skin with an additional strip of orbicularis muscle (group B). Preoperative, and 6 and 12 months postoperative headache complaints were assessed using the HIT-6 scores and eyebrow heights were measured on standardised photographs. Surface EMG measurements, i.e., electrical activity and muscle fatigue, were assessed for the frontalis and orbicularis oculi muscles preoperatively and 2, 6, and 12 months postoperatively. Significantly fewer headaches were reported following a blepharoplasty. The eyebrow height had decreased, but did not differ between groups. Regarding the surface EMG measurements, only group A's frontalis muscle electrical activity had decreased significantly during maximal contraction 12 months after surgery (80 vs. 39 mV, p = 0.026). Fatigue of both the frontalis and the orbicularis oculi muscles did not change significantly postoperatively compared to baseline. EMG differences between groups were minor and clinically insignificant. The eyebrow height decreased and patients reported less headaches after upper blepharoplasty irrespective of the used technique.
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Affiliation(s)
- Maria H.J. Hollander
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Johannes H. van der Hoeven
- Department of Clinical Neurophysiology, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Koen H.M. Verdonschot
- Faculty of Science and Technology, Department of Technical Medicine, University of Twente, 7522 NB Enschede, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Rutger H. Schepers
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
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Traditional versus Laterally Extended Upper Blepharoplasty Skin Excisions: Objective and Patient-Reported Outcomes. Plast Reconstr Surg 2023; 151:73-82. [PMID: 36205656 DOI: 10.1097/prs.0000000000009801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Different skin excision shapes may result in different aesthetic outcomes after upper blepharoplasty. METHODS Two skin-only excision shapes were evaluated objectively and subjectively in 28 matched patients with laterally extended skin excision (group A) or traditional elliptical skin excision (group B). The pretarsal show, lateral eyebrow height, amount of scarring (evaluated with the Patient and Observer Scar Assessment Scale), and patient-reported aesthetic results (evaluated using FACE-Q) were scored and compared at 6 and 12 months postoperatively. RESULTS In both groups, pretarsal show improved significantly after blepharoplasty. The homogeneity of pretarsal show improved significantly in the lateral extension group (group A) together with slightly more pretarsal show (0.5 to 0.8 mm at central pupil region) at 6 and 12 months of follow-up compared with group B ( P = 0.004). A trend was observed in the exocanthion 45-degree measurement, in which group A had 0.6 mm greater pretarsal show 6 months postoperatively. Homogeneity of the pretarsal show had improved significantly in group A, but not in group B, at 12 months after blepharoplasty. No other significant differences were observed between the groups regarding pretarsal show measurements or FACE-Q scores. Both groups showed descent of the lateral eyebrow, but this was only significant in group B. Group B showed 1.4 to 2.0 mm more descent compared with group A. Scarring and adverse effects scores were low in both groups and did not differ. CONCLUSION Laterally extended skin excision and traditional elliptical skin excision both result in positive aesthetic results, but the laterally extended skin excision technique is accompanied by a slightly more favorable outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Jansma J, Schepers RH. Adjunctive Aesthetic Procedures in Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2022; 35:139-152. [DOI: 10.1016/j.coms.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Dobreva D, Gkantidis N, Halazonetis D, Verna C, Kanavakis G. Smile Reproducibility and Its Relationship to Self-Perceived Smile Attractiveness. BIOLOGY 2022; 11:biology11050719. [PMID: 35625447 PMCID: PMC9138875 DOI: 10.3390/biology11050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
The reproducibility of facial expressions has been previously explored, however, there is no detailed information regarding the reproducibility of lip morphology forming a social smile. In this study, we recruited 93 young adults, aged 21−35 years old, who agreed to participate in two consecutive study visits four weeks apart. On each visit, they were asked to perform a social smile, which was captured on a 3D facial image acquired using the 3dMD camera system. Assessments of self-perceived smile attractiveness were also performed using a VAS scale. Lip morphology, including smile shape, was described using 62 landmarks and semi-landmarks. A Procrustes superimposition of each set of smiling configurations (first and second visit) was performed and the Euclidean distance between each landmark set was calculated. A linear regression model was used to test the association between smile consistency and self-perceived smile attractiveness. The results show that the average landmark distance between sessions did not exceed 1.5 mm, indicating high repeatability, and that females presented approximately 15% higher smile consistecy than males (p < 0.05). There was no statistically significant association between smile consistency and self-perceived smile attractiveness (η2 = 0.015; p = 0.252), when controlling for the effect of sex and age.
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Affiliation(s)
- Denitsa Dobreva
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland; (D.D.); (C.V.)
| | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3001 Bern, Switzerland;
| | - Demetrios Halazonetis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, GR-11527 Athens, Greece;
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland; (D.D.); (C.V.)
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland; (D.D.); (C.V.)
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA 02111, USA
- Correspondence:
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15
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Domela Nieuwenhuis I, Luong KP, Vissers LCM, Hummelink S, Slijper HP, Ulrich DJO. Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study. Aesthet Surg J 2022; 42:340-348. [PMID: 34791033 DOI: 10.1093/asj/sjab389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To determine the success of an upper blepharoplasty, a popular cosmetic procedure, it is essential to measure outcomes from the patient perspective because these often outweigh objective outcomes. OBJECTIVES This study aimed to assess patient-reported satisfaction with facial appearance, psychological well-being, and aging appraisal after upper blepharoplasty with validated questionnaires. METHODS This prospective cohort study included upper blepharoplasty patients from 8 outpatient clinics. Patient-reported satisfaction was assessed with the FACE-Q at intake, and 6 and 12 months postoperatively. RESULTS In total, 2134 patients were included. High satisfaction with outcome and decision to undergo treatment were measured 6 months postoperatively. Large improvements in FACE-Q scores (range, 0-100) between intake and 6 months postoperatively were seen for satisfaction with appearance (mean, effect size: eyes +48, 2.6; upper eyelids +48, 3.1; facial appearance overall +26, 1.4), psychological well-being (+11, 0.56), and aging appraisal (+22, 1.0). Patients reported they appeared a mean [standard deviation] 3.3 [5.2] years younger postblepharoplasty. No clinically relevant changes were seen between 6 and 12 months. Additionally, improvements in appearance were not dependent on their intake scores, whereas improvements in psychological well-being and aging appraisal were smaller in patients with higher intake scores. Satisfaction with treatment outcome was strongly correlated with appearance satisfaction but not with aging appraisal. CONCLUSIONS Significant improvements in patient satisfaction regarding appearance, psychological well-being, and aging appraisal can be seen 6 months after blepharoplasty, and outcomes remain stable up to 12 months postoperatively. These data may be used to inform patients and clinicians and improve the overall quality of care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ileen Domela Nieuwenhuis
- Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kim Phi Luong
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lieke C M Vissers
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Dietmar J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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16
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Lu TJ, Nguyen AXL, Trinh XV, Wu AY. Sentiment Analysis Surrounding Blepharoplasty in Online Health Forums. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4213. [PMID: 35492229 PMCID: PMC9038503 DOI: 10.1097/gox.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Upper and lower blepharoplasty are among the most common procedures in aesthetic surgery and are often emotionally laden due to the subjective nature of outcomes and implications with beauty and self-identity. This article capitalizes on the increasing wealth of patient-provided health information online and is the first to analyze the emotions surrounding blepharoplasty discussions in an open internet health forum, MedHelp. METHODS We used Python to scrape MedHelp for threads that contained "blepharoplasty" and then used IBM Watson Natural Language Understanding to perform sentiment analyses, calculating a general sentiment score (-1 to +1) as well as emotion scores for anger, sadness, joy, fear, and disgust (0 to 1) for posts and keywords contained within the posts. Keywords were then manually grouped into five distinct clinical categories: symptoms, doctor, treatment, medication, and body. RESULTS We collected 52 threads containing "blepharoplasty," yielding 154 posts and 1365 keywords. The average sentiment score was negative among all posts (-0.15) and keywords (-0.30). Among all posts and keywords, sadness had the highest score and disgust had the lowest score. CONCLUSIONS Fear and sadness are the predominant emotions for blepharoplasty patients online, and the most negative symptoms cited are not ones that surgeons typically expect.
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Affiliation(s)
- Tracy J. Lu
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, Calif
| | | | - Xuan-Vi Trinh
- Department of Computer Science, McGill University, Montreal, QC, Canada
| | - Albert Y. Wu
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, Calif
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17
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Hollander M, Delli K, Vissink A, Schepers R, Jansma J. Patient-reported aesthetic outcomes of upper blepharoplasty: a randomized controlled trial comparing two surgical techniques. Int J Oral Maxillofac Surg 2022; 51:1161-1169. [DOI: 10.1016/j.ijom.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/20/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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18
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Ramanathan D, Chu S, Prendes M, Carroll BT. Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Eyelid Surgery: A Systematic Review. Dermatol Surg 2021; 47:914-920. [PMID: 33988553 DOI: 10.1097/dss.0000000000003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Determining which postsurgical scar assessment instruments, if any, cover important eyelid outcome measures can either attest to the strength of one or more instruments or reveal the need for a more comprehensive scale. OBJECTIVE To systematically review validated outcome measures after eyelid surgery and postsurgical scar assessment tools to see whether any individual or combination of 2 assessment tools encompass all relevant, validated eyelid outcome measures. METHODS Systematic reviews of validated eyelid outcome measures and postsurgical scar assessment tools were conducted using PubMed/MEDLINE and Ovid. Outcome measure papers that met inclusion criteria were sorted into 8 categories: Patient Subjective, Visual Function, Mechanical Function, Daily Activities, Adverse Effects, Aesthetic Quantitative: Clinical Measurements, Aesthetic Qualitative: Global, and Aesthetic Qualitative: Specific. Outcome measure papers were categorized into tiers of evidence support, and assessment tools were evaluated based on which outcome measures each covered. RESULTS No one or combination of 2 assessment tools covered all selected eyelid outcome measures. Although measures related to the subjective patient experience were included in several of the assessment scales, none covered measures of visual function or eyelid-specific clinical measurements. CONCLUSION There is currently no existing postsurgical scar assessment instrument that covers all important eyelid-specific outcome measures.
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Affiliation(s)
- Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark Prendes
- Department of Ophthalmology and Visual Sciences, University Hospitals, Case Western
- Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Zhang S, Zhou Y, Yu F, Yan D, Yan Y, Zhou M, Fu Y, Lu Y. Management of Unsatisfactory Postoperative Double Eyelid With Intralesional Corticosteroid Injection. Front Med (Lausanne) 2021; 8:619547. [PMID: 33842499 PMCID: PMC8024474 DOI: 10.3389/fmed.2021.619547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Siyi Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yixiong Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Fei Yu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Dan Yan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yan Yan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Meng Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yao Fu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yang Lu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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