Blepharoplasty in senile blepharoptosis: preoperative measurements and design for skin excision

A Novel Preoperative Design to Address Dermatochalasis in Asian Upper Blepharoplasty

BACKGROUND

The preoperative design for the amount of skin excision of the upper eyelid is a common procedure in Asian blepharoplasty, but there lack of an effective method addressing dermatochalasis to acquire esthetically pleasing results. Our aim was to propose an alternative technique to determine the skin excision combined with the esthetics of eyes for correcting skin laxity and therefore to create attractive double eyelids.

MATERIALS AND METHODS

The preoperative invaginating-simulating design combined with esthetic criteria for determining the amount of excised skin were performed during blepharoplasty. The Strasser grading system and the Global Aesthetic Improvement Scale were evaluated by analyzing the preoperative and 6-month-postoperative photographs.

RESULTS

One hundred forty-two patients were included. The general outline of the "optimal incision" took on a knife in shape with a mean of 2.2±3.32 points of Strasser grading score. A total of 130 of 142 patients (91.5%) were judged as "good results" and 12 of 142 patients (8.5%) were judged as "mediocre". The Global Aesthetic Improvement Scale showed a significant cosmetic improvement with the result of 89.4%(127 of 142 patients) for "very much improved", 7.8% for "much improved" and other patients for "improved". No severe complications were observed.

CONCLUSIONS

This preoperative design approach has been proven to be effective to address dermatochalasis (especially for lateral hooding) by simulating the expected appearance of a double eyelid combined with esthetic criteria of eyes simultaneously, which can contribute to achieving upper-lid rejuvenation and beautiful and natural outcomes.

A New Preoperative Upright Design for Dermatochalasis Correction

BACKGROUND

Conventional assessment of the height of upper eyelid skin excision in dermatochalasis correction is performed with patient's eyes closed in supine position. It is not able to consider the effects of gravity on the upper eyelid, thus may lead to asymmetric postoperative appearance. The authors herein report a novel preoperative upright design (PUD) that can accurately determine the amount of skin excision with patients' eyes open in dermatochalasis correction.

METHODS

Patients with dermatochalasis underwent PUD during blepharoplasty were enrolled and were followed-up for 9 to 15 months.

RESULTS

A total of 116 patients (mean age 55.1 ± 6.1 years, range 46-78 years) successfully underwent the surgery. Using the PUD, the vertical height of skin excision was 8.2 ± 2.4 mm (6-19 mm), the preoperative margin fold distance was -0.5 ± 1.0 mm (-4 - 1 mm), which improved to 2.1 ± 0.6 mm (1-3 mm, P < 0.05) at the last follow-up visit. A total of 107 of 116 patients (92.2%) were judged as "good" (natural double eyelid folds with symmetric margin fold distance), 9 patients (7.8%) were judged as "fair" (natural double eyelid folds with the differences of margin fold distance between fellow eyelids within 2 mm), and no one was judged as "poor" (unsmooth double eyelid folds or the differences of margin fold distance between fellow eyelids is more than 2 mm).

CONCLUSION

Preoperative upright design is a simple and effective method to accurately determine the amount of skin excision in blepharoplasty, and help to achieve symmetric double eyelids.

Strategies of upper blepharoplasty in aging patients with involutional ptosis

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.

Incisional Ptosis Correction with Hidden Double Fold in Asian Patients

BACKGROUND

Korean males and a few females desire to have larger eyes; however, they often wish to enlarge their eyes and conceal their double eyelids. This paper attempts to describe how to make the eyes bigger and brighter without showing double-fold eyelids.

METHODS

The authors performed cosmetic ptosis correction in 121 cases from April 2013 to December 2017. All patients enrolled in this retrospective study underwent surgical procedures at the author's institutions. Patients were included that had mild-to-moderate degrees of ptosis and levator function greater than 5 mm, ages greater than 16 years, and no prior ptosis surgery.

RESULTS

A successful outcome was achieved with this surgical approach in 113 (93.4%) patients. Complications potentially associated with ptosis surgery were not observed.

DISCUSSION

A refined method of preoperative evaluation for incisional ptosis correction to conceal a double fold with no visible signs of surgery is described. Ptosis correction without the formation of double eyelids will result in skin hooding and visible scarring, and thus, it is recommended to lower the height of the double eyelids. The lower height of double eyelids can cover the incisional scar and make it appear there are no double eyelids.

LEVEL OF EVIDENCE IV

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Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis

AIM

To assess the effects of upper lid blepharoplasty on visual quality.

METHODS

Seventy-three eyelids of 39 patients were subjected to upper lid blepharoplasty. Pre- and post-operative contrast sensitivity, visual acuity, vertical palpebral aperture and the degree of lash ptosis were measured.

RESULTS

The mean log contrast sensitivities under photopic (P=0.017) and scotopic conditions (P=0.009) were improved after surgery, and these differences were significant. The degree of lash ptosis was also decreased after blepharoplasty (P<0.001).

CONCLUSION

In our study, a significant increase in contrast sensitivity was found after surgery. These results suggest that upper lid blepharoplasty can be helpful for improving visual quality.

Tear condition following unilateral ptosis surgery

PURPOSE

To evaluate changes in tear film condition following unilateral ptosis surgery.

METHODS

This interventional case series includes patients with unilateral blepharoptosis scheduled for ptosis surgery with no prior history of eye disease and surgery over a 2-year period. Tear film evaluation before surgery were performed, which included Schirmer test with and without anesthesia, and tear break up time (TBUT). Ptosis surgery included levator resection and frontalis sling. The previously mentioned tests were repeated 1, 3, and 6 months after surgery. Subjective symptoms related to dry eye also evaluated before and after surgery.

RESULTS

A total of 83 patients including 46 (55.4%) male subjects with mean age of 26.2 ± 16.2 years were enrolled in the study. The most common cause of ptosis was congenital in 77 (92.8%) patients. Surgical intervention included levator resection in 56 (67.5%) cases and frontalis sling procedure in 27 (32.5%) cases. The result of surgery was good in 47 (56.6%) patients while under- and overcorrection were observed in 32 (39.8%) and 3 (3.6%) patients, respectively. Schirmer's test with and without anesthesia and TBUT after surgery revealed a decrease in tear quantity and quality after surgery with time. Patients who had subjective complaints from dryness after surgery only had shorter TBUT among the objective signs.

CONCLUSIONS

Ptosis surgery can decrease the quantity and quality of tears in operated eyes. Since some of these patients may need other types of operations in future, such as refractive or cataract surgery, evaluation of the tear condition before further surgery is prudent.