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Rafizadeh SM, Mirghorbani M, Tavakoli M, Haydar AA. Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic Review. Semin Ophthalmol 2024; 39:40-59. [PMID: 37904540 DOI: 10.1080/08820538.2023.2273850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach. METHODS A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis. RESULTS The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods. CONCLUSIONS Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.
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Affiliation(s)
- Seyed Mohsen Rafizadeh
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ali A Haydar
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ilaria P, Ersilia T, Ewa DA, Giulio B, Forte F, Nevena S, Concetta P. A combined approach using hyaluronic acid in alignment with MD codes™ U.E.F.A. Methodologies as an alternative for an effective management of post-enucleation socket syndrome (PESS). J Cosmet Dermatol 2023. [PMID: 38108107 DOI: 10.1111/jocd.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Proietti Ilaria
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Tolino Ersilia
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Dybala Agnieszka Ewa
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Bortone Giulio
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Felice Forte
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Skroza Nevena
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Potenza Concetta
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
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Karlin J, Vranis N, Dayan E, Parsa K. Post-Hyaluronic Acid Recurrent Eyelid Edema: Pathophysiologic Mechanisms and a Proposed Treatment Protocol. Aesthet Surg J Open Forum 2023; 5:ojad102. [PMID: 38828092 PMCID: PMC11140515 DOI: 10.1093/asjof/ojad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Background Hyaluronic acid (HA) filler injections for facial augmentation are commonly administered but can lead to post-hyaluronic acid recurrent eyelid edema (PHAREE). The pathophysiology of this condition has not been fully understood. Objectives To report the successful treatment of PHAREE using serial hyaluronidase and fractionated radiofrequency microneedling, with additional carbon dioxide laser skin resurfacing in selected patients. Methods Five patients with PHAREE were treated with serial hyaluronidase injections and fractionated radiofrequency microneedling, with 2 patients receiving carbon dioxide laser treatment. The patients were followed up for a minimum of 24 months. Results All patients reported a resolution of PHAREE signs/symptoms with no adverse effects or recurrence. One patient demonstrated complete resolution after a single treatment; 4 required a series of treatments. Conclusions The proposed treatment protocol may provide advantages over hyaluronidase alone for PHAREE. The impermeable malar septum, vulnerable eyelid lymphatics, and potential immunogenicity of HA fragments likely contribute to PHAREE pathophysiology. Further research on pathophysiologic mechanisms is warranted. Level of Evidence 4
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Affiliation(s)
| | | | | | - Kami Parsa
- Corresponding Author: Dr Kami Parsa, 465 N Roxbury Dr, Ste 1011, Beverly Hills, CA 90210, USA. E-mail:
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Naik MN, Walvekar P, Vasanthapuram VH, Shankar L. Eyelid Surgery in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2023; 39:S92-S104. [PMID: 38054989 DOI: 10.1097/iop.0000000000002543] [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: 12/07/2023]
Abstract
PURPOSE To review and summarize a comprehensive synopsis of surgery of the eyelid in thyroid eye disease (TED). METHODS A PubMed search for specific eyelid manifestations of TED was performed. Studies reporting surgical management of these were reviewed, along with the author's own experience. RESULTS The most common eyelid manifestations of TED include eyelid retraction, blepharoptosis, entropion, and epiblepharon, with most of them requiring surgical intervention. The correction of eyelid retraction has received maximum attention, with several surgical techniques that have stood the test of time. Blepharoptosis in TED that requires surgical intervention is usually aponeurotic. Entropion and Epiblepharon are rare in TED, and may resolve spontaneously, or following orbital decompression. CONCLUSIONS Retraction is the commonest eyelid manifestation of TED, with multiple surgical options available for its correction. Blepharoptosis, entropion, and epiblepharon are rare eyelid findings in TED, that may occasionally require surgical correction.
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Affiliation(s)
- Milind N Naik
- Hariram Motumal Nasta, and Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
| | - Priyanka Walvekar
- Ophthalmic Plastic Surgery Service, Narayana Nethralaya, Bangalore, India
| | | | - Lekshmy Shankar
- Hariram Motumal Nasta, and Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
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Ryu C, Chundury RV. Efficacy of the Buried Temporary Suture Tarsorrhaphy: A Novel Technique. Ophthalmic Plast Reconstr Surg 2023; 39:640-643. [PMID: 37615290 DOI: 10.1097/iop.0000000000002459] [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: 08/25/2023]
Abstract
PURPOSE To describe a buried variation of the temporary suture tarsorrhaphy and determine its efficacy period. METHODS This retrospective case review includes 11 patients needing corneal protection. Six patients had lagophthalmos from facial nerve palsy, 4 had cicatricial ectropion, and 1 had neurotrophic keratopathy. A total of 14 buried temporary suture tarsorrhaphies (BTSTs) were placed. The duration of the BTST was the main outcome. The corneal status before and throughout the BTST was monitored. The eyelids were examined for any undesired changes from the BTST. RESULTS The mean duration of the BTST was 97.5 days, with a maximum of 273 days. Aside from one spontaneous dehiscence 5 days after placement, all BTSTs held until intentional removal. Five BTSTs were removed for a more definitive surgical procedure, 6 were removed after resolution of the initial indication, and 2 are still in place as the patient awaits surgery. All cases of keratopathy improved after BTST placement. There were no complications and no undesired eyelid changes. CONCLUSIONS The BTST is a simple, fast, safe, and effective procedure that can be performed in the clinic or inpatient to immediately improve ocular surface coverage. As a minimally invasive procedure that can easily last several months, the BTST is an excellent option for patients who require more intense intervention than medical management alone. It can also securely bridge patients to a permanent solution such as lateral canthal resuspension.
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Affiliation(s)
- Christine Ryu
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, U.S.A
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Chen S, Chen HC, Tang YB. Integrated Approaches for Reconstruction of Facial Paralysis. Ann Plast Surg 2023; 90:S165-S171. [PMID: 37192417 DOI: 10.1097/sap.0000000000003427] [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: 05/18/2023]
Abstract
BACKGROUND Facial paralysis can affect periorbital muscles, oral competence, and facial expressions with significant facial deformities, which could occur in either children or adults with variable severity, duration, and degree of recovery. OBJECTIVE The present study was aimed to delineate treatment plans for facial paralysis with different clinical scenarios and to report the results of these patients. METHODS Patients were grouped according to different presentations as follows: (1) facial paralysis with incomplete recovery; (2) young patients of facial paralysis without recovery; (3) senile patients of facial palsy without recovery; (4) combined facial palsy with mandibular deficiency, vascularized bone reconstruction for mandible with (a) subsequent muscle transfer or (b) simultaneous sling operation or (c) simultaneous facial nerve exploration and cross nerve grafting; (5) palsy of frontal branch of facial nerve; (6) palsy of zygomatic-buccal branch of facial nerve; (7) palsy of marginal mandibular branch of facial nerve; (8) partial recovery with dyskinesia; and (9) facial paralysis with dynamic asymmetry and muscle atrophy. According to clinical scenarios, different treatment plans were provided, and clinical outcomes were evaluated and presented. RESULTS All patient groups achieved fair or satisfactory outcomes. Revisions using sling procedures, botulinum toxin injection, and filler or fat graft as supplement further refined the ultimate outcomes. CONCLUSIONS For reconstruction of facial paralysis, individualized integrated treatment plans are mandatory according to the presentation and condition of the patient. Comprehensive considerations and strategic solutions for the existing disabilities have been appreciated by the patients. The least numbers of operations with considerate correction of asymmetry were the major concerns of the patients.
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Affiliation(s)
- Shihheng Chen
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University and College of Medicine, Taoyuan, Taiwan
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A Surgeon's Armamentarium for Ocular Management in Facial Paralysis: A Comprehensive Review. J Craniofac Surg 2023; 34:214-221. [PMID: 36608099 DOI: 10.1097/scs.0000000000009089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/04/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To review the current management paradigm of the eye in patients with facial paralysis. METHODS A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "ocular," "facial," "synkinesis," "palsy," "neurotization," and various combinations of the terms. A total of 65 articles were included. RESULTS Facial paralysis may result in devastating ocular sequelae. Therefore, assessment of the eye in facial paralysis is a critical component of patient management. Although the management should be individualized to the patient, the primary objective should include an ophthalmologic evaluation to implement measures to protect the ocular surface and preserve visual acuity. The degree of facial paralysis, lacrimal secretion, corneal sensation, and position of the eyelids should be assessed thoroughly. Patients with the anticipated recovery of facial nerve function may respond to more conservative temporizing measures to protect the ocular surface. Conversely, patients with expected prolonged paralysis should be appropriately identified as they will benefit from surgical reconstruction and rehabilitation of the periorbital complex. The majority of reconstructive measures within a facial surgeon's armamentarium augment coverage of the eye but are unable to restore blink. Eyelid reanimation restores the esthetic proportionality of the eye with blinking and reestablishes protective functions necessary for ocular preservation and function. CONCLUSIONS Ocular preservation is the primary priority in the initial management of the patient with facial paralysis. An accurate assessment is a critical component in identifying the type of paralysis and developing an individualized treatment plan.
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Diaspro A, Calvisi L, Sito G. Hyaluronic Acid Gel Injection for the Treatment of Tear Trough Deformity: A Multicenter, Observational, Single-Blind Study. Aesthetic Plast Surg 2022; 46:1860-1867. [PMID: 35478038 DOI: 10.1007/s00266-022-02887-7] [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: 12/13/2021] [Accepted: 03/31/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) gel injections were first used to treat the tear trough in 2005 and since then it has been a mainstay of the approach to lower eyelid deformities. OBJECTIVE The authors present this retrospective multicentric observational study based on single-blind objective and subjective evaluation and patient satisfaction in relation to the aesthetic improvement of a large group of patients treated. METHODS AND MATERIALS Between January 2016 and December 2019, 600 patients (468 women and 132 men), were enrolled in this study, and 1200 tear trough deformities were treated with both needle and cannula techniques. RESULTS Average follow-up time was 12 ± 1 months, and the outcomes were assessed both objectively and subjectively with respect to Hirmand's classification. Statistical analysis shows an inverse correlation between age and class amelioration. CONCLUSION HA injection of the tear trough is most effective in patients between 30 and 40 years of age, while its benefits extend to up to 50 years old; afterward, it should no longer be the treatment of choice. This confirms that correction of tear trough with hyaluronic acid injections may provide an option to achieve immediate and durable results for up to one year after the injection. 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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Osaki M, Osaki T, Monteiro L. Management of eyelid retraction related to thyroid eye disease. Taiwan J Ophthalmol 2022; 12:12-21. [PMID: 35399960 PMCID: PMC8988987 DOI: 10.4103/tjo.tjo_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Eyelid retraction related to thyroid eye disease (TED) is a challenging condition. It is one of the main clinical signs and a major diagnostic criterion in TED. This condition may threaten vision due to exposure keratopathy, in addition to its esthetic alterations, which may lead to psychosocial implications and affect the patient's quality of life. Although it is more commonly observed in the upper eyelid, it may be present on both the upper and lower lids. Numerous surgical and nonsurgical treatment modalities have been described and will be reviewed in this article. Management should be based on an individual patient assessment, taking into consideration the disease stage, severity, and clinician experience.
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10
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Treatment Options for Lower Eyelid Retraction in Thyroid Eye Disease. Int Ophthalmol Clin 2021; 61:145-159. [PMID: 33743535 DOI: 10.1097/iio.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Landsberger H, Wang Y, Douglas RS. The Prominent Eye-What to Watch Out For. Facial Plast Surg Clin North Am 2021; 29:311-321. [PMID: 33906763 DOI: 10.1016/j.fsc.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Globe prominence (proptosis) may be caused by a variety of congenital or acquired conditions and poses unique challenges to aesthetic and reconstructive surgery. Once the underlying cause of proptosis is determined, a treatment plan consisting of surgical and medical procedures can be formed. Thyroid eye disease is the most common cause of proptosis and helps guide treatment options for proptosis. Although common eyelid and orbital procedures are used for proptosis correction, special care must be taken due to the unique difficulties of the distorted anatomy. Various surgical procedures and less invasive treatments can be combined to provide optimal aesthetic and functional results.
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Affiliation(s)
- Hannah Landsberger
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, 11766 Wilshire Blvd, Suite 325, Los Angeles, CA 90025, USA
| | - Yao Wang
- Department of Surgery, Division of Ophthalmology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raymond S Douglas
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Steinsapir KD, Steinsapir S. The Treatment of Post-blepharoplasty Lower Eyelid Retraction. Facial Plast Surg Clin North Am 2021; 29:291-300. [PMID: 33906761 DOI: 10.1016/j.fsc.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Numerous solutions for post-blepharoplasty lower eyelid retraction are reviewed. Patients require permanent recruitment of skin and soft tissue to lengthen the lower eyelid and control of the lower eyelid shape. The authors use a hand-carved expanded polytetrafluoroethylene (ePTFE) implant held with microscrews to provide volume and felting material at the orbital rim and to permanently fix vertically lifted cheek soft tissue into the lower eyelid. The eyelid margin is also controlled with a hard palate graft inset into the conjunctival surface below the tarsus. This eyelid reconstruction avoids tension on the lateral canthoplasty, a point of failure in other solutions.
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Affiliation(s)
- Kenneth D Steinsapir
- Orbital and Ophthalmic Plastic Surgery Division, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Samantha Steinsapir
- Orbital and Ophthalmic Plastic Surgery Division, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Bagheri A, Feizi M, Sahebghalam R, Tavakoli M. Augmented fascia temporalis sling for paralytic ectropion of the lower lid. Eur J Ophthalmol 2021; 32:140-147. [PMID: 33607927 DOI: 10.1177/1120672121995744] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the effect of lower eyelid temporalis fascia sling combined with lateral canthoplasty and tarsorrhaphy for paralytic ectropion. METHODS Prospective case series of 10 patients with lower lid paralytic ectropion who were treated with lower eyelid fascia temporalis sling and lateral canthoplasty in addition to lateral tarsorrhaphy as a single-session procedure. Additional medial tarsorrhaphy was applied if the medial lower lid apposition was not adequate at the end of the procedures. Eyelid configuration and function were compared before and after surgery. RESULTS The mean age of patients was 65.8 ± 10 years. Mean marginal reflex distance 1 (MRD1) and MRD2 changed from 3.5 ± 1.4 and 8.6 ± 2.4 mm to 2.2 ± 1.4 and 5.3 ± 1.2 mm respectively (p = 0.001 and 0.006). Mean pre-operative lagophthalmos improved from 9.2 ± 4.9 to 3.4 ± 1.3 mm (p = 0.001). The mean follow-up was 28.9 ± 12.1 months. Three patients required additional medial tarsorrhaphy to address residual medial ectropion in the same session. CONCLUSION Combination of lower lid fascia temporalis sling, lateral canthoplasty and tarsorrhaphy as a single-session procedure can effectively improve the functional and aesthetic complications of paralytic ectropion.
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Affiliation(s)
- Abbas Bagheri
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Feizi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Sahebghalam
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology, The University of Alabama at Birmingham, Callahan Eye Hospital, Birmingham, AL, USA
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Hassan Hussien M, Abd El-Wahed Hassan E, El-Haddad NSEDM. Comparison between hyaluronic acid filler and botulinum toxin type A in the treatment of thyroid upper eyelid retraction. Ther Adv Ophthalmol 2021; 12:2515841420979113. [PMID: 33447731 PMCID: PMC7780183 DOI: 10.1177/2515841420979113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aim of this study was to compare between hyaluronic acid filler (HA) and botulinum toxin type A (BTX-A) in the treatment of thyroid upper eyelid retraction. Study design: This was a prospective comparative study. Methods: A total of 50 eyes with upper thyroid eyelid retraction were divided into 2 groups. Each group included 25 eyes, (a) hyaluronic acid filler (HA) group: received subconjunctival HA injection and (b) botulinum toxin (BTX-A) group: received subconjunctival botulinum toxin type A injection. Full ophthalmic examination and thyroid profile were done. Marginal reflex distance 1 (MRD1) and total palpebral fissure height (TPFH) were measured before and after injection weekly for 6 months. Results: There is no significant difference between the two groups regarding MRD1 till the 10th week of follow up, then it became significant from the 11th to 15th week with better results in HA filler group, then the difference between the two groups become highly significant from the 16th week afterward with better results for the HA filler over the BTX-A. With regard to TPFH, there were significant differences between the BTX-A group and the HA group with a better result in BTX-A group in the first 8 weeks. Then the difference became insignificant till the 18th week. Then the difference became significant from the 19th till the 24th week with a better result in HA group. Conclusion: HA filler has better result in treating thyroid upper eyelid retraction than BTX-A due to its predictable controllable effect, also, due to the longer duration of action and fewer side effects.
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Ozturk Karabulut G, Fazil K, Saracoglu Yilmaz B, Ozturker C, Günaydın ZK, Taskapili M, Kaynak P. An algorithm for Botulinum toxin A injection for upper eyelid retraction associated with thyroid eye disease: long-term results. Orbit 2020; 40:381-388. [PMID: 32885692 DOI: 10.1080/01676830.2020.1814351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy and complications of transconjunctival Botulinum toxin A injections performed according to an algorithm, for the management of upper eyelid retraction associated with thyroid eye disease. METHODS Seventy one eyes of 60 patients at the inactive stage, who had undergone Botulinum toxin A injection were reviewed retrospectively. Botulinum toxin A was injected transconjunctivally, just above the superior tarsal border of the upper eyelid in doses between 2-15 units according to an algorithm, depending on the amount of retraction. Margin-reflex distances were measured according to the photographs taken under standard conditions before and after the injections at the tenth day, then the second month and the fourth month. Additional Botulinum toxin A injections were performed in patients who had an undercorrection on the tenth day. Complications such as diplopia and ptosis were recorded. RESULTS The study included 38 females, 22 males with a mean age of 43.3 ± 13.1. Normal margin-reflex distances (3-4 mm) were reached in the 58 of 71 eyes (81.7%). Additional injections were needed in eight eyes (11.2%) for residual retraction on the tenth day. Ptosis was the major complication in four eyes for 1-3 weeks after injection. Upper eyelid retraction recurred after 5.1 ± 0.9 months in all patients. CONCLUSION In the treatment of upper eyelid retraction due to thyroid eye disease, transconjunctival injection of Botulinum toxin A is an effective, safe, transient, and repeatable method with few complications in patients. The algorithm used in this study resulted in high success rate in long-term follow-up.
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Affiliation(s)
- Gamze Ozturk Karabulut
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Korhan Fazil
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Basak Saracoglu Yilmaz
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Can Ozturker
- Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Zehra Karaağaç Günaydın
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Muhittin Taskapili
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Pelin Kaynak
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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Grusha YO, Fedorov AA, Prause JU, Eksarenko OV, Sheptulin VA. [Experimental study of hyaluronic acid gel fillers biodegradation in orbit]. Vestn Oftalmol 2020; 136:13-19. [PMID: 32366064 DOI: 10.17116/oftalma202013602113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Recently, hyaluronic acid gel (HAG) fillers were proposed as an effective alternative treatment option for surgical orbital volume augmentation. Several authors reported about long-standing effect of the filler. PURPOSE To assess the features of HAG biodegradation after intraorbital injection in experimental environment. MATERIAL AND METHODS In the course of the experiment, 7 chinchilla rabbits (14 eyes) received a single 1ml intraorbital HAG injection (Restylane SubQ, Galderma, Sweden) using a cannula. The animals' orbits were examined by ultrasound scan after the injection and at 1, 3, 6, 9, 12 and 18 months. The animals were subsequently sacrificed for morphological study of orbital tissue containing the HAG filler. RESULTS The HAG filler persisted in the orbit of experimental animals during the whole follow-up period. The volume of HAG depot and its density diminished gradually till the 18th month, after which the particles of HAG could still be detected with the morphological study and ultrasound. CONCLUSION The HAG filler persisted in the orbit of experimental animals up to 18 months. Incomplete biodegradation explains the longstanding duration of the injection effect.
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Affiliation(s)
- Ya O Grusha
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Research Institute of Eye Diseases, Moscow, Russia
| | - A A Fedorov
- Research Institute of Eye Diseases, Moscow, Russia
| | - J U Prause
- Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
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The Injection for the Lower Eyelid Retraction: A Mechanical Analysis of the Lifting Effect of the Hyaluronic Acid. Aesthetic Plast Surg 2019; 43:1310-1317. [PMID: 31399822 DOI: 10.1007/s00266-019-01440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND It has been reported that the injection of the hyaluronic acid (HA) into the lower lid area could improve lower eyelid retraction. However, the published studies offered few insights into the mechanism of this treatment. When the underlying mechanism is not clear, many surgeons will not trust the method enough to apply it in their clinical practice. The purpose of this article was to propose a possible explanation for the underlying mechanism of the treatment and further verify the method by a series of cases. METHODS The authors performed a mechanical analysis on the physical impact of HA on the lower eyelid. In the clinical cases, we injected the fillers under the orbicularis muscle to correct lower lid retraction. The results were evaluated by the standardized marginal reflex distance 2 (MRD2) immediately and 9 months later. RESULTS From October 2013 to October 2015, the injections were carried out in 27 cases (14 post-blepharoplasty and 13 involuntary). In 26 cases (96.3%), the retraction was completely corrected and did not recur through the last follow-up. The average improvement of the standardized MRD2 was 0.84 mm immediately after the injection and 1.19 mm 9 months later. Complications were not reported. CONCLUSION Lower eyelid retraction could be treated by the injection of HA under the orbicularis muscle. The filler in this situation acted as a lifter because the filler changed the balance of force of the lower lid, forcing it to shift upward to gain the new balance. The 'lifter' mechanism could be applicable to other facial injections that generate elevating effects. 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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Hyaluronic Acid Gel Biodegradation After Intrapalpebral and Intraorbital Injection in Experimental Study. Ophthalmic Plast Reconstr Surg 2019; 35:558-561. [PMID: 30925540 DOI: 10.1097/iop.0000000000001374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Amid the increasing clinical application of hyaluronic acid (HA) fillers in the ocular adnexa is a paucity of histological data concerning the fate of the injected material. The current study documents the in vivo biodegradation of HA deposited in the eyelid and orbit. METHODS The study included 22 chinchilla rabbits. The right upper eyelid of 12 rabbits received a single 0.2 ml Restylane (Galderma, Uppsala, Sweden) subcutaneous injection. In 10 different rabbits, the right orbit was injected with 1.0 ml Restylane SubQ (Galderma, Uppsala, Sweden) in the extraconal space. The rabbits in the eyelid group were euthanized at 2 weeks, 1 month, 2, 4, 6, and 9 months, while the rabbits in the orbit group were euthanized at 1 month, 3, 6, 12, and 18 months. Histological analysis was performed on the harvested samples. RESULTS In the eyelid, the HA assumed a sponge-like structure that diminished gradually over time. At 9 months, the injected HA partially persisted, mainly in the peripheral areas of injection. A similar histologic pattern was observed in the injected orbits, with slow changes persisting at the eighteenth month. In both cohorts, clear signs of collagen deposition and pseudocapsule formation were observed around HA droplets, with no signs inflammation. CONCLUSIONS HA injected subcutaneously into the eyelid and orbit of rabbits undergoes slow and gradual biodegradation, with HA persisting to no less than 9 months in the eyelid and 18 months in orbit. Neocollagen synthesis and lack of hyaluronidase activity could explain the unexpectedly prolonged HA persistence.
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Grusha YO, Sheptulin VA, Prause JU, Danilov SS. [Hyaluronic acid gel implants for correction of pathological conditions of the orbit and eyelids]. Vestn Oftalmol 2018; 134:61-71. [PMID: 30499541 DOI: 10.17116/oftalma201813405161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of injectable implants made of hyaluronic acid gel (HAG) in ophthalmoplastics. MATERIAL AND METHODS The study included 57 patients (37 patients with lagophthalmos related to acute or chronic facial nerve palsy, endocrine ophthalmopathy; 20 patients with enophthalmos, anophthalmic syndrome). Depending on filler particle size, the patients received either intrapalpebral or intraorbital HAG injection. The biometric measures of palpebral fissure, the position of the eye/implant, and the condition of the cornea were evaluated during the follow-up period (12 months for eyelid and 18 for orbital injection). RESULTS In the course of the follow-up, all patients showed reliable reduction of lagophthalmos; additionally, improvement of the condition of the cornea was observed in patients after intrapalpebral injection; patients after intraorbital injection exhibited reduction in enophthalmos, upper orbital palpebral fold retraction and upper eyelid excursion. No serious complications have occurred after the injection. CONCLUSION As minimally invasive method of treating various pathologies of the orbit and eyelids, HAG fillers showed good clinical effectiveness and safety.
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Affiliation(s)
- Y O Grusha
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - V A Sheptulin
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - J U Prause
- Eye Pathology Institute, University of Copenhagen, 10 Nørregade, Copenhagen, Denmark, 1165
| | - S S Danilov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Kim IA, Wu TJ, Byrne PJ. Paralytic Lagophthalmos: Comprehensive Approach to Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0219-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan P, Kwong TQ, Malhotra R. Non-aesthetic indications for periocular hyaluronic acid filler treatment: a review. Br J Ophthalmol 2017; 102:725-735. [PMID: 29146758 DOI: 10.1136/bjophthalmol-2017-310525] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/09/2017] [Accepted: 10/13/2017] [Indexed: 11/04/2022]
Abstract
Dermal fillers have been in use for many years for aesthetic rejuvenation of the face. More recently, however, fillers have been increasingly used as an alternative to traditional surgical procedures for non-aesthetic indications. These indications include lagophthalmos, eyelid malpositions and orbital volume deficiency. The advantages of these filler injections are multiple: minimally invasive, repeatable, titratable and even reversible (depending on the product used). We review the current literature of functional uses of filler injections as mentioned above and evaluate the safety profile and efficacy of filler injections for this purpose.
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Affiliation(s)
- Petrina Tan
- Ophthalmology, National University Health Systems, Ng Teng Fong General Hospital, Singapore, Singapore.,Corneo-plastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | - Raman Malhotra
- Corneo-plastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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Grisolia ABD, Couso RC, Matayoshi S, Douglas RS, Briceño CA. Non-surgical treatment for eyelid retraction in thyroid eye disease (TED). Br J Ophthalmol 2017; 102:bjophthalmol-2017-310695. [PMID: 28794075 DOI: 10.1136/bjophthalmol-2017-310695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 11/04/2022]
Abstract
Thyroid eye disease (TED) is an autoimmune condition with an unpredictable course that may lead to permanent facial disfigurement. Eyelid retraction is one of the most common findings, and frequently demands attention due to ocular exposure and impaired cosmesis. Surgical treatment remains the most effective option, but there is a role for temporary corrections during the active phase of the disease, as well as in patients who are poor surgical candidates. The aim of this review is to describe the non-surgical modalities currently available for treatment of eyelid malposition in TED. The authors have focused on the use of hyaluronic acid, triamcinolone injections and botulinum toxin type A as non-surgical treatment alternatives, paying special attention to dosing, technique, efficacy and duration of effect. Non-surgical treatment modalities may represent viable in cases where surgical correction is not an option. Although temporary, these modalities appear to be beneficial for ocular exposure remediation, improving quality of life and broadening our therapeutic arsenal.
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Affiliation(s)
- Ana Beatriz Diniz Grisolia
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ricardo Christopher Couso
- Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Suzana Matayoshi
- Division of Ophthalmology, University of São Paulo Medicine School, São Paulo, Brazil
| | - Raymond S Douglas
- Orbital and Thyroid Eye Disease Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - César Augusto Briceño
- Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Putterman AM, Liu CY. The Orbital Septum in Upper Eyelid Retraction and Ptosis Complicating Fat Injection. Aesthet Surg J 2017; 37:NP62-NP63. [PMID: 28510649 DOI: 10.1093/asj/sjx037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Allen M Putterman
- From the Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL
| | - Catherine Y Liu
- From the Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL
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Joseph SS, Joseph AW, Smith JI, Niziol LM, Musch DC, Nelson CC. Evaluation of Patients with Facial Palsy and Ophthalmic Sequelae: A 23-Year Retrospective Review. Ophthalmic Epidemiol 2017; 24:341-345. [DOI: 10.1080/09286586.2017.1294186] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shannon S. Joseph
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew W. Joseph
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jane I. Smith
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Christine C. Nelson
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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Massry GG. Commentary on: Lower Eyelid Retraction Surgery Without Internal Spacer Graft. Aesthet Surg J 2017; 37:137-139. [PMID: 27694455 DOI: 10.1093/asj/sjw157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guy G Massry
- Dr Massry is a Clinical Professor of Ophthalmology, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Joseph SS, Joseph AW, Douglas RS, Massry GG. Periocular Reconstruction in Patients with Facial Paralysis. Otolaryngol Clin North Am 2017; 49:475-87. [PMID: 27040589 DOI: 10.1016/j.otc.2015.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Facial paralysis can result in serious ocular consequences. All patients with orbicularis oculi weakness in the setting of facial nerve injury should undergo a thorough ophthalmologic evaluation. The main goal of management in these patients is to protect the ocular surface and preserve visual function. Patients with expected recovery of facial nerve function may only require temporary and conservative measures to protect the ocular surface. Patients with prolonged or unlikely recovery of facial nerve function benefit from surgical rehabilitation of the periorbital complex. Current reconstructive procedures are most commonly intended to improve coverage of the eye but cannot restore blink.
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Affiliation(s)
- Shannon S Joseph
- Division of Oculoplastic Surgery, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Andrew W Joseph
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Raymond S Douglas
- Division of Oculoplastic Surgery, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 150 North Robertson Boulevard, Suite 314, Beverly Hills, CA 90211, USA.
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Wolkow N, Chodosh J, Freitag SK. Innovations in Treatment of Lagophthalmos and Exposure Keratopathy. Int Ophthalmol Clin 2017; 57:85-103. [PMID: 28885249 DOI: 10.1097/iio.0000000000000185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Autologous Fat Grafting for Treating Blepharoplasty-induced Lower Eyelid Retraction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1190. [PMID: 28293531 PMCID: PMC5222676 DOI: 10.1097/gox.0000000000001190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 12/05/2022]
Abstract
Autologous fat grafting for blepharoplasty-induced lower eyelid retraction offers potential for a long-term solution while avoiding the morbidity associated with posterior lamellar spacer grafts. By combining traditional methods of lifting the retracted lower eyelid with autologous fat grafting, both functional and aesthetic concerns can be successfully addressed in these patients.
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Abstract
Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12–18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics.
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Affiliation(s)
- Milind Neilkant Naik
- Department of Ophthalmic Plastic Surgery, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Tear trough deformity: different types of anatomy and treatment options. Postepy Dermatol Alergol 2016; 33:303-8. [PMID: 27605904 PMCID: PMC5004220 DOI: 10.5114/ada.2016.61607] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/22/2015] [Indexed: 02/04/2023] Open
Abstract
Aim To explore the efficacy of tear trough deformity treatment with the use of hyaluronic acid gel or autologous fat for soft tissue augmentation and fat repositioning via arcus marginalis release. Material and methods Seventy-eight patients with the tear trough were divided into three groups. Class I has tear trough without bulging orbital fat or excess of the lower eyelid skin. Class II is associated with mild to moderate orbital fat bulging, without excess of the lower eyelid skin. Class III is associated with severe orbital fat bulging and excess of the lower eyelid skin. Class I or II was treated using hyaluronic acid gel or autologous fat injections. Class III was treated with fat repositioning via arcus marginalis release. The patients with a deep nasojugal groove of class III were treated with injecting autologous fat into the tear trough during fat repositioning lower blepharoplasty as a way of supplementing the volume added by the repositioned fat. Results Seventy-eight patients with tear trough deformity were confirmed from photographs taken before and after surgery. There were some complications, but all had complete resolution. Conclusions Patients with mild to moderate peri-orbital volume loss without severe orbital fat bulging may be good candidates for hyaluronic acid filler or fat grafting alone. However, patients with more pronounced deformities, severe orbital fat bulging and excess of the lower eyelid skin are often better served by fat repositioning via arcus marginalis release and fat grafting.
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Lee GHP, Ho SYM. Orbital Adherence Syndrome following the Use of Titanium Precontoured Orbital Mesh for the Reconstruction of Posttraumatic Orbital Floor Defects. Craniomaxillofac Trauma Reconstr 2016; 10:77-83. [PMID: 28210413 DOI: 10.1055/s-0036-1584398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/14/2016] [Indexed: 10/21/2022] Open
Abstract
Orbital blowout fractures are a common occurrence following orbital trauma. Depending on the size of the defect and the contents that have herniated or incarcerated, possible sequelae include enophthalmos, diplopia, dystopia, and entrapment. Surgical intervention aims to prevent or alleviate this through the use of a bone graft or an alloplastic implant to reconstitute the continuity of the orbit. However, in doing so, the implant itself may result in the unexpected adherence of the periorbita, resulting in orbital adherence syndrome. We present two cases of orbital adherence syndrome following the use of titanium mesh for orbital floor reconstruction. In both cases, we also delineate the management of this syndrome. Our first patient reported good recovery after surgical intervention to relieve the tethering to the titanium mesh and subsequent placement of a smooth interface implant. The other patient was managed nonsurgically with resolution of symptoms. We highlight possible signs that might suggest the need for early surgical intervention. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery.
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Affiliation(s)
- Geraldine Hwee Ping Lee
- Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Samuel Yew Ming Ho
- Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Park HJ, Son KM, Choi WY, Cheon JS, Yang JY. Use of Triamcinolone Acetonide to Treat Lower Eyelid Malposition after the Subciliary Approach. Arch Craniofac Surg 2016; 17:63-67. [PMID: 28913257 PMCID: PMC5556873 DOI: 10.7181/acfs.2016.17.2.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The subciliary approach is commonly used for reconstruction of orbital wall or zygomaticomaxillary fractures. However, this approach is associated with postoperative complications, especially lower eyelid malposition. We report the experience of managing postoperative lower eyelid malposition with triamcinolone acetonide. METHODS A retrospective review was performed for all traumatic facial fractures requiring surgery via the subciliary approach at Chosun University Hospital in 2014. For each patient meeting inclusion criteria, the medical chart was reviewed for demographic information and postoperative course, including the presence of postoperative eyelid malposition or scleral show. RESULTS The review identified 189 cases in which the subciliary approach was used, and postoperative lower eyelid malposition was found in 7 cases (3.7%). For these 7 patients, the mean therapeutic period (interval to correction of the malposition) was 10.5 weeks (range, 8 to 14 weeks). On average, patients received 3 injections of triamcinolone. In all cases, degrees of the malposition were improved, and none of the patients required an operative intervention to correct the malposition. CONCLUSION Triamcinolone injection is an appropriate treatment modality for lower eyelid malposition after subciliary approach. Treatment duration is relatively short, requiring fewer than 4 outpatient clinic visits, with relatively earlier recovery compared to conservative "wait-and-see" management.
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Affiliation(s)
- Hyun June Park
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Kyung Min Son
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Woo Young Choi
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Ji Seon Cheon
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Jeong Yeol Yang
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
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Hyaluronic Acid Gel Injection for Multiple Eyelid Folds in Asian Eyelids: A Novel Approach. Ophthalmic Plast Reconstr Surg 2016; 32:310-2. [PMID: 27065431 DOI: 10.1097/iop.0000000000000696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Upper eyelids of the Asian population have several unique anatomical characteristics that result in the characteristic absence of a native eyelid fold; however, 40% to 60% of the Asian population do exhibit a naturally occurring fold. Aging-associated soft tissue atrophy and loss of skin elasticity can lead to periorbital volume loss and subsequent development of multiple eyelid folds in patients previously with a native single-fold. The authors describe a nonsurgical technique for the management of multiple eyelid folds in Asian patients using hyaluronic acid gel (HAG) injection. METHODS In this retrospective review, 6 upper eyelids of 5 Asian patients who underwent HAG injection for multiple eyelid folds were identified. Patients were injected with HAG superior to the native eyelid fold in a superficial plane just deep to the orbicularis oculi muscle and in the suborbicularis oculi plane of the superior sulcus. RESULTS Five Asian patients with prior history of a single naturally occurring upper eyelid fold who developed age-related unilateral multiple eyelid folds underwent injection with HAG. All patients tolerated the procedure well and without complication. Restoration of a single-fold with bilateral upper eyelid symmetry was achieved successfully in all patients. CONCLUSIONS Multiple eyelid folds may occur in Asian patients with an established naturally occurring single eyelid fold as a result of periorbital volume loss. HAG injection in the periorbital region provides a nonsurgical solution to restore volume and reform a single eyelid fold.
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Litwin A, Kalantzis G, Drimtzias E, Hamada S, Chang B, Malhotra R. Nonsurgical treatment of congenital ichthyosis cicatricial ectropion and eyelid retraction using Restylane hyaluronic acid. Br J Dermatol 2015; 173:601-3. [PMID: 25639983 DOI: 10.1111/bjd.13710] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A.S. Litwin
- Corneoplastic Unit Queen Victoria Hospital NHS Trust East Grinstead West Sussex RH19 3DZ U.K
| | - G. Kalantzis
- The Leeds Teaching Hospitals NHS Trust St James University Hospital Beckett Street Leeds LS9 7TF U.K
| | - E. Drimtzias
- The Leeds Teaching Hospitals NHS Trust St James University Hospital Beckett Street Leeds LS9 7TF U.K
| | - S. Hamada
- Corneoplastic Unit Queen Victoria Hospital NHS Trust East Grinstead West Sussex RH19 3DZ U.K
| | - B. Chang
- The Leeds Teaching Hospitals NHS Trust St James University Hospital Beckett Street Leeds LS9 7TF U.K
| | - R. Malhotra
- Corneoplastic Unit Queen Victoria Hospital NHS Trust East Grinstead West Sussex RH19 3DZ U.K
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Abstract
PURPOSE To evaluate the effect of autologous periorbital fat injections on lower eyelid position. METHODS Retrospective review of patients treated with autologous periorbital (malar/eyelid tear trough) fat injections for aesthetic purposes by a single surgeon (S.N.) between March 2007 and June 2011. The primary outcome, lower eyelid position as defined by marginal reflex distance 2 and inferior scleral show, was measured by standardizing and comparing pretreatment and posttreatment follow-up digital photos. Photographs were randomized and measured by 2 masked investigators. RESULTS Seventy patients (5 male; mean age, 53; range, 33 to 77 years) were treated with autologous fat injections to the malar and lower eyelid tear trough for aesthetic purposes. A mean decrease in marginal reflex distance 2 of 0.5 mm in both OS and OD was found when pre- and posttreatment measurements were compared. Primary and secondary mean follow-up period was at 117 and 316 days, respectively. The effect of the autologous periorbital fat injection was not diminished (n=21) between follow-up periods. A mean change in scleral show of 0.5 mm was found when pre- and posttreatment measurements were compared. The overall mean follow-up period for scleral show was 125 days. Minor complications occurred in 7% (n=5) of patients who had postinjection subcutaneous induration. CONCLUSION Autologous fat injections are well tolerated and have potential to be an effective adjuvant or primary treatment for mild lower eyelid retraction.
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Effectiveness of the lower eyelid suspension using fascia lata graft for the treatment of lagophthalmos due to facial paralysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:759793. [PMID: 25821819 PMCID: PMC4364375 DOI: 10.1155/2015/759793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/17/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate of functional and cosmetic effectiveness of lower eyelid sling technique with fascia lata graft in patients with lagophthalmos due to facial paralysis. MATERIAL AND METHOD Ten patients with a mean age of 55.1 ± 19.77 years who underwent lower eyelid sling surgery with a fascia lata graft between September 2011 and January 2014 were included in this prospective study. Preoperatively and postoperatively patients were evaluated in terms of corneal epithelial defects, Schirmer's test, and tear break-up time (TBUT). Cosmetically, vertical eyelid aperture, margin reflex distances 1 and 2 (MRD1 and MRD2) and scleral show were evaluated preoperatively and postoperatively. RESULTS One patient had facial paralysis on the right side whereas the other 9 patients had facial paralysis on the left side. Preoperatively, 3 patients were detected with corneal ulcer, whereas 7 patients were detected with persistent corneal epithelial defects localized in the lower half of the cornea. In the 3 patients with preoperative corneal ulcer, the ulcer recovered with corneal opacity, whereas in the 7 patients with punctate epitheliopathy, postoperative corneal transparency was obtained. DISCUSSION Lower eyelid sling technique with fascia lata graft is an effective technique for the repositioning of the lower eyelid and preventing the corneal complications.
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Effect of double-fold surgery on spontaneous resolution of Graves' upper eyelid retraction. Can J Ophthalmol 2015; 50:49-53. [PMID: 25677283 DOI: 10.1016/j.jcjo.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/14/2014] [Accepted: 08/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect of previous incisional double-fold surgery on spontaneous resolution of eyelid retraction caused by Graves orbitopathy (GO) in Asian individuals. DESIGN Retrospective review of medical records. PARTICIPANTS Patients (N = 30; 39 eyes) with eyelid retraction associated with GO with symptom duration of less than 6 months. METHODS Patients who visited the Ophthalmology Department of Severance Hospital, Yonsei University, between January 2010 and December 2011, followed up for more than 6 months and in a euthyroid state with antithyroid drug treatment were included. Patients treated with steroids or who underwent surgery during follow-up were excluded. Upper scleral show was measured as the distance between the central upper lid margin and limbus at initial presentation and after 6 months. Comparative analysis was performed between the 2 groups delineated by history (n = 12; 16 eyes), or lack thereof (n = 18; 23 eyes), of incisional double-fold surgery before onset of GO symptoms and signs. RESULTS Patient demographics and initial upper scleral show were not significantly different between groups. In both groups, upper scleral show significantly decreased at 6 months of follow-up (p < 0.001 in both groups); however, improvement of upper scleral show was significantly reduced in patients who had undergone previous double-fold surgery (0.8 ± 0.5 mm) than in nonsurgical patients (1.8 ± 0.5 mm; p < 0.001). CONCLUSIONS Graves eyelid retraction resolves spontaneously over time, albeit not completely. Previous double-fold surgery hinders the degree of spontaneous resolution, probably because of the fibrosis and cicatrization between the skin, the subcutaneous layer, and the levator complex.
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Kotlus B, Schwarcz RM. Management of Postblepharoplasty Lower Eyelid Retraction. Clin Plast Surg 2015; 42:73-7. [DOI: 10.1016/j.cps.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Grusha YO, Fedorov AA, Prause JU, Sheptulin VA. [Histopathological study of experimental intrapalpebral injection of hyaluronic acid gel]. Vestn Oftalmol 2015; 131:69-74. [PMID: 25872389 DOI: 10.17116/oftalma2015131169-74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Hyaluronic acid gel (HAG) fillers are successfully used in the treatment of many eyelid disorders. It is considered that the effect of HAG injection lasts for 6 months on average. However, in our experience volume augmentation persists longer, suggesting that the presence of the filler in the eyelid may be associated with certain tissue reactions. The objective of the study was to investigate morphological features of HAG biodegradation. MATERIAL AND METHODS Seven adult Chinchilla rabbits (14 eyes) received a single 0.1 ml HAG (Restylane, Q-Med AB, Sweden) subcutaneous upper eyelid injection followed by contouring of the skin for 1.5 mm on average. Tissue samples containing HAG were collected for histopathological examination with morphometric analysis on day 0, week 2, months 1, 2, 4, 6, and 9. RESULTS HAG persisted subcutaneously in the eyelid during the 9 months of the study in the form of a sponge-like structure with compartments of varying shape and size. Its total volume diminished gradually, nevertheless at the end of the study the filler could still be found in some compartments, mainly peripheral. In the central area of the depot residual HAG was surrounded by optically transparent spaces. CONCLUSION After being injected subcutaneously into the eyelids of experimental animals HAG formed a sponge-like structure causing a significant increase in eyelids volume. Gradual biodegradation of HAG was accompanied by neocollagenogenesis and 9 months later the process was still ongoing.
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Affiliation(s)
- Y O Grusha
- I.M. Sechenov First Moscow State Medical University, Ophthalmology Department, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991; Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Fedorov
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - J U Prause
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Frederik V's Vej 11, 1., Copenhagen, Denmark, 2100
| | - V A Sheptulin
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
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Yoo DB, Griffin GR, Azizzadeh B, Massry GG. The minimally invasive, orbicularis-sparing, lower eyelid recession for mild to moderate lower eyelid retraction with reduced orbicularis strength. JAMA FACIAL PLAST SU 2014; 16:140-6. [PMID: 24434916 DOI: 10.1001/jamafacial.2013.2401] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Identifying a procedure to address lower eyelid retraction (LER) in the presence of an orbicularis deficit is a useful tool for aesthetic and reconstructive eyelid surgery. OBJECTIVE To describe and evaluate a surgical technique consisting of a closed canthal suspension and true lower eyelid retractor recession to address LER in the setting of orbicularis weakness. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of patients who underwent the minimally invasive, orbicularis-sparing, lower eyelid recession from January 1, 2010, to October 1, 2012, by one of us (G.G.M.) in an ophthalmic plastic surgical practice. We included 29 patients with reduced orbicularis strength and LER resulting from eyelid paresis related to facial nerve disease, surgical trauma (after blepharoplasty), involutional change, or idiopathic causes. INTERVENTIONS Surgical intervention consisting of closed canthal suspension and lower eyelid retractor recession. MAIN OUTCOMES AND MEASURES Surgical results, complications, and patient satisfaction. RESULTS The 29 patients included 18 women and 11 men. The mean patient age was 52 (range, 6-72) years; mean follow-up, 11 (range, 6-21) months; and mean preoperative orbicularis strength, 2.7 (on a scale of 0-4, where 0 indicates no function and 4, normal function). The causes of orbicularis weakness included eyelid paresis related to facial nerve disease (11 patients), surgical trauma (13 patients), involutional change (4 patients), and an isolated idiopathic finding (1 patient). In 12 patients, the eyelid retraction was unilateral; in 17, bilateral. A small tarsorrhaphy was added to the surgery in 6 patients with facial nerve disease. The mean eyelid elevation after surgery was 1.80 mm, with only minor complications. Patient and surgeon satisfaction were high. CONCLUSIONS AND RELEVANCE Recent publications have demonstrated the utility of closed canthal suspension and true lower eyelid retractor recession as separate procedures. In the setting of LER with reduced orbicularis strength and/or tone, the techniques can be combined to recess the lower eyelid without disturbing the already compromised lower orbicularis muscle (minimally invasive, orbicularis-sparing, lower eyelid recession). The combination technique is safe and effective and yields excellent results. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Donald B Yoo
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Garrett R Griffin
- Facial Plastic and Reconstructive Surgery, Spalding Drive Cosmetic Surgery and Dermatology, Center for Advanced Facial Plastic Surgery, Beverly Hills, California
| | - Babak Azizzadeh
- Facial Plastic and Reconstructive Surgery, The Facial Paralysis Institute, Beverly Hills, California4Facial Plastic and Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California5Department of Facial Plastic and Reconstr
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, The Facial Paralysis Institute, Beverly Hills, California7Ophthalmic Plastic and Reconstructive Surgery, Beverly Hills Ophthalmic Plastic Surgery, Beverly Hills, California
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Nonsurgical periocular rejuvenation: advanced cosmetic uses of neuromodulators and fillers. Curr Opin Ophthalmol 2014; 25:461-9. [PMID: 24926573 DOI: 10.1097/icu.0000000000000074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the current literature regarding aesthetic enhancement using facial neuromodulators and fillers and to present advanced techniques using facial injectables for periocular rejuvenation. RECENT FINDINGS The authors provide a summary of traditional periocular locations for the injection of neuromodulators and dermal fillers. The authors also present novel and advanced techniques utilizing injectables in the periocular region. SUMMARY Minimally invasive procedures with little-to-no recovery time are continuing to increase in popularity. Neuromodulators and hyaluronic acid gel fillers have been shown to be well tolerated and efficacious nonsurgical alternatives in periocular rejuvenation.
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Griffin G, Azizzadeh B, Massry GG. New insights into physical findings associated with postblepharoplasty lower eyelid retraction. Aesthet Surg J 2014; 34:995-1004. [PMID: 25168805 DOI: 10.1177/1090820x14544306] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Postblepharoplasty lower eyelid retraction (PBLER) has been linked to anterior lamellar shortage, unaddressed eyelid laxity, and middle lamellar scarring. The authors believe there are other, less-appreciated physical findings (orbicularis weakness, negative-vector eyelid, and inferior eyelid/orbit volume deficit) that also influence the development and potentially the management of this complex type of eyelid malposition. OBJECTIVES To better understand PBLER, potentially prevent its development, and improve treatment options, the authors determined the incidence of various physical findings present on initial examination of patients referred for PBLER revision. METHODS The medical charts of patients referred for PBLER revision over a 21-month period were reviewed. The presence of anterior lamellar shortage, lower eyelid laxity, and a middle lamellar (internal eyelid) scar was documented. Orbicularis weakness, negative-vector eyelid topography, and volume deficiency of the lower eyelid/inferior orbit also were noted. The incidence of each finding was calculated. RESULTS Forty-six patients (35 women, 11 men) were included. All patients had undergone primary transcutaneous surgery, which led to the eyelid retraction. Orbicularis weakness, anterior lamellar shortage, inferior eyelid/orbital volume deficit, negative-vector eyelid topography, and eyelid laxity were common. A middle lamellar scar of significance was found in only 17% of eyelids. CONCLUSIONS The data suggest that the aforementioned underappreciated findings are common in patients with PBLER. Evaluating these factors when planning primary blepharoplasty may reduce the incidence of PBLER. Awareness of these findings when planning revisional procedures may improve surgical outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Garrett Griffin
- Dr Griffin is a facial plastic surgeon in private practice in Woodbury, MinnesotaDr Azizzadeh is a facial plastic surgeon in private practice in Beverly Hills, CaliforniaDr Massry is an ophthalmic plastic surgeon in private practice in Beverly Hills, California
| | - Babak Azizzadeh
- Dr Griffin is a facial plastic surgeon in private practice in Woodbury, MinnesotaDr Azizzadeh is a facial plastic surgeon in private practice in Beverly Hills, CaliforniaDr Massry is an ophthalmic plastic surgeon in private practice in Beverly Hills, California
| | - Guy G Massry
- Dr Griffin is a facial plastic surgeon in private practice in Woodbury, MinnesotaDr Azizzadeh is a facial plastic surgeon in private practice in Beverly Hills, CaliforniaDr Massry is an ophthalmic plastic surgeon in private practice in Beverly Hills, California
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Hyaluronic Acid Gel Injection for Upper Eyelid Retraction in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2014; 30:400-4. [DOI: 10.1097/iop.0000000000000130] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mancini R. Nonsurgical considerations for addressing periocular aesthetics: a conceptual dimensional approach. JAMA FACIAL PLAST SU 2014; 16:451-6. [PMID: 25144216 DOI: 10.1001/jamafacial.2014.498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ronald Mancini
- Section of Oculoplastic and Orbit Surgery, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
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Use of Hyaluronic Acid Gel in the Treatment of Lagophthalmos in Sunken Superior Sulcus Syndrome. Ophthalmic Plast Reconstr Surg 2014; 30:175-9. [DOI: 10.1097/iop.0000000000000040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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