Simplified Lateral Brow Lift under Local Anesthesia for Correction of Lateral Hooding

New-Onset Dupuytren After Surgical Treatment of Carpal Tunnel and Trigger Finger

BACKGROUND

Dupuytren disease is a progressive fibrotic condition of the hand that often leads to contractures. Although its etiology remains multifactorial, recent studies suggest potential associations with surgical interventions for carpal tunnel syndrome (CTS) and trigger finger (TF). Understanding the incidence and risk factors for Dupuytren disease development following these procedures may improve postoperative management and early detection.

METHODS

A retrospective study was conducted on 426 patients who underwent surgical treatment for CTS or TF. The incidence of Dupuytren disease development postsurgery was assessed, and data on demographics, comorbidities, occupational factors, and type of surgery were collected. Statistical analysis, including odds ratio (OR) calculations, was used to identify risk factors associated with Dupuytren disease onset.

RESULTS

Seven percent of the study population developed new-onset Dupuytren disease within an average of 15.2 weeks postsurgery, with most cases presenting as early-stage nodule formation. The fourth digit was most commonly affected (73.3%). Significant associations were observed between Dupuytren disease onset and comorbidities, such as rheumatoid arthritis (OR = 3.24) and shoulder capsulitis (OR = 9.7), as well as occupational factors like manual labor and vibration exposure (OR = 2.45). Patients treated for TF had a 2.3-fold higher risk of developing Dupuytren disease compared with those treated for CTS.

CONCLUSIONS

The findings highlight the potential for Dupuytren disease development following CTS and TF surgeries, emphasizing the need for proactive monitoring of at-risk patients. Further research is warranted to explore underlying mechanisms and optimize preventive and management strategies for this patient population.

[Traditional brow lift vs. endoscopic brow lift: Techniques and indications]

The forehead lift is designed to raise the eyebrows and reduce forehead wrinkles to rejuvenate the face. Since 1991, endoscopic surgery has revolutionized forehead lift techniques, bringing significant improvements in both cosmetic and reconstructive surgery. This article aims to present the indications and techniques of fronto-temporal plastic surgery, detailing the frontal and temporal areas. The study includes operations using an endoscope, a light source, a video camera, and a monitor to transmit images. Subperiosteal and supraperiosteal incisions and dissections are performed, followed by temporal and frontal suspensions. The advantages of endoscopy include reduced scarring and a lower risk to hair follicles. The main disadvantages primarily concern the difficulty of muscle excision. Endoscopic forehead lift remains a preferred technique for long-lasting results, despite advancements in botulinum toxin. It offers precise and durable aesthetic corrections, justifying its importance in cosmetic surgery.

Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries

Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.

Periorbital rejuvenation in the clinic: A state-of-the-art review

Objective

To provide an overview of the various treatment options available in the clinic to achieve periorbital rejuvenation.

Data Sources

Literature review and expert opinion.

Conclusions

Periorbital rejuvenation in the clinic can be accomplished through a variety of treatment modalities, including topical therapies, skin resurfacing, and fillers and injectables. Furthermore, some surgical approaches, such as upper blepharoplasties, ptosis, and brow lifts, can be performed in the clinic under local anesthesia with only mild oral sedation. However, the successful execution of such procedures depends on proper patient selection and maximizing patient comfort.

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

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

Comparison of the effectiveness and safety of the "endoscope-assisted polypropylene mesh lift" and "gliding brow lift" techniques for the treatment of lateral brow ptosis

BACKGROUND

There are many techniques used to treat lateral brow ptosis. This study compared two techniques that are used for lateral brow rejuvenation in terms of effectiveness and safety-namely, endoscope-assisted polypropylene mesh lift (EAML) and gliding brow lift (GBL).

METHOD

Eighty-six patients who underwent brow lift surgery between March 2018 and June 2020 were included in this retrospective study. Forty-four patients were operated on using the EAML technique, whereas 42 patients were operated on using the GBL technique. The measurement of defined distances in photographs was carried out using a software, and the Brow Positioning Grading Scale (BPGS) and Global Aesthetic Improvement Scale (GAIS) were applied in the pre and postoperative periods.

RESULTS

The measurement results obtained in the postoperative period were better than those obtained in the preoperative period for both the techniques, whereas the results obtained at postoperative month 3 were found to be better than those obtained at month 12 (p < 0.05). The results were similar between the measurements at postoperative months 3 and 12 for both the techniques. The loss of brow height from postoperative months 3-12 was greater in the GBL group (p < 0.05). The postoperative scores on the BPGS were found to be better in both techniques than the preoperative scores (p < 0.05). The GAIS score at postoperative month 12 was found to be better in the EAML group. The two groups had similar rates of complications.

CONCLUSION

The two techniques were found to have similar effectiveness and safety profiles for brow rejuvenation.

LEVEL OF EVIDENCE: 4

Creating Harmonious Arcs: The Importance of Brow Shape in Determining Upper Lid Aesthetics

Brow lifting, when indicated, can significantly improve upper eyelid aesthetics. Brow lifting is a powerful maneuver to shape and lateralize the curvature of the brow arc and directly influences the upper eyelid fold height and the curvature of the upper eyelid crease. This article reviews the importance of upper periorbital aesthetic assessment because it lays the foundation to tailor the appropriate operative intervention. Highlighted are the authors' preferred approach to aesthetically shape the brow along with other complimentary upper eyelid aesthetic procedures including upper blepharoplasty, blepharoptosis repair, fat grafting, and upper periorbital fat shifting to optimize brow lifting outcomes.

Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members

BACKGROUND

Patients presenting for upper blepharoplasty can exhibit different aging patterns and we have anecdotally observed wide variability in upper blepharoplasty approaches among surgeons. However, upper blepharoplasty practice patterns have not been systematically analyzed among members of The Aesthetic Society.

OBJECTIVES

The aim of this study was to report upper blepharoplasty practice patterns, the recognition of different patient presenting features, and to assess the incidence and management of ptosis as reported by members of The Aesthetic Society.

METHODS

A 29-item electronic questionnaire was distributed to 1729 Aesthetic Society members with available email addresses.

RESULTS

In total, 214 Aesthetic Society members submitted the questionnaire, for a response rate of 12.4%. There was a significantly increased rate of volume preservation among surgeons with greater experience (≥10 years in practice) and a high-volume (≥100 cases in past 12 months) of upper blepharoplasty cases. Furthermore, high-volume upper blepharoplasty surgeons were significantly more likely to perform concomitant upper lid fat grafting (P = 0.03), browlift (P = 0.02), and ptosis repair (P = 0.01). Ninety-five percent of respondents reported a mild/moderate ptosis (MRD1 2 to <4mm) incidence of <25%. Among surgeons who perform ptosis repair, 97.4% utilize levator advancement or plication as their most commonly used technique.

CONCLUSIONS

High-volume upper blepharoplasty surgeons are more likely to preserve upper lid volume and perform concomitant browlift and ptosis repair. Our data suggest that different upper eyelid aging patterns and mild/moderate ptosis are underrecognized.

Upper Blepharoplasty with Endoscopically Assisted Brow Lift to Restore Harmonious Upper Lid Arc Curvatures

BACKGROUND

Achieving excellent results in upper lid rejuvenation requires a balanced approach to address skin, muscle, fat, upper lid margin position, and brow aging changes. In the appropriately selected patient, brow lifting plays an essential complement to upper blepharoplasty to restore more youthful upper lid fold-to-pretarsal ratios. The goal of this study is to describe a safe and reproducible method to perform brow lifting and upper blepharoplasty.

METHODS

Medial to the temporal line of fusion, in-line with the brow peak, a 2-cm scalp incision is oriented parallel to the course of the deep branch of the supraorbital nerve to minimize the risk of nerve injury. The brow vector of pull is maximal in this location and secured to a monocortical bone channel with 3-0 polydioxanone. Lateral to the temporal line of fusion, an ellipse of scalp tissue is excised to gently elevate the brow tail. Upper blepharoplasty is performed in an individualized fashion to achieve a youthful contour of the upper lid fold.

RESULTS

The endoscopically assisted technique is designed to achieve tissue release under direct visualization. The brow-lift maximal vector of pull is centered over the brow peak and, to a lesser extent, at the brow tail to improve lateral upper lid fold height and a smooth contour of the pretarsal space. Muscle shaping sutures improve convexity of the lateral upper lid fold.

CONCLUSION

In the appropriately selected patient, combined brow lift and upper blepharoplasty with muscle contouring are safe and effective techniques that help improve aesthetic upper lid topographic proportions.