Electrosurgical modification of orbicularis oculi hypertrophy

Ultra-minimal pinhole blepharoplasty: A minimally invasive technique for the correction of eyelid bags

OBJECTIVE

The aim of the study was to investigate the efficacy and complications of ultra-minimal pinhole blepharoplasty in the treatment of eyelid bags.

METHODS

This retrospective study included patients with eyelid bags treated using a minimally invasive blepharoplasty technique between May 2018 and June 2021. The postoperative course and complications and patient satisfaction were analyzed.

RESULTS

A total of 460 patients (136 males and 324 females) were included with a mean age of 42.12 ± 9.76 years. The mean operative time was 24.3 min. After the operation, the patients had no infection, numbness, or lower eyelid varus, valgus, or withdrawal. Nine patients developed transient binocular diplopia, which disappeared 0.5-1 h after surgery. Two patients developed chemosis, which disappeared after therapy. Six months after the operation, 440 (95.65%) patients were satisfied with improvement in their fat bulge. A total of 434 (94.78%) patients were satisfied with improvement in their tear groove.

CONCLUSION

Ultra-minimal pinhole blepharoplasty is a safe, effective, and minimally invasive treatment for eyelid bags.

Comprehensive Evaluation of the Lower Eyelid Aging Process Among Asian Women

BACKGROUND

Lower eyelid aging is a complicated process, and for that reason, a comprehensive assessment of the lower eyelid is important before treatment.

OBJECTIVE

This study was conducted to analyze and assess the lower eyelid aging process between different age groups of Asian women.

METHODS AND MATERIALS

The authors developed the comprehensive lower eyelid age rating scale (CLEARS). The rating scale contains 3 domains and each composed of 3 items. Individuals were evaluated by the age group starting with the third decade (20-29 years) through the seventh decade (60-69 years) by 2 dermatologists working independently.

RESULTS

A total of 114 cases were evaluated. The total scores of CLEARS increased significantly between each adjacent age group. The scores of the snap test and the severity of fine lines, nasojugal groove, midcheek furrow, and eye bags increased significantly from the 3rd decade. The scores of the distraction test and the severity of palpebromalar groove and malar mound begin to increase with the 4th decade. Kappa coefficients of all items achieved moderate to substantial agreement.

CONCLUSION

This study describes the lower eyelid aging process among Asian women by CLEARS assessment. Lower eyelid aging becomes progressively more notable beginning with the third decade.

Anthropometry of pretarsal fullness and eyelids in oriental women

BACKGROUND

In Chinese physiognomy, lower-lid pretarsal fullness is considered a sign of beauty in women. However, there are no data regarding the normal measurements of pretarsal fullness. The purpose of this study was to evaluate the average appearance of lower-lid pretarsal fullness in oriental women of specific age groups with the intention of obtaining data that surgeons could use when performing lower blepharoplasty. The effects of the orbicularis oculi muscle on pretarsal fullness are also discussed.

METHODS

A total of 260 oriental women were included in this study. The parameters of the eyelid, including the size of lower-lid pretarsal fullness, upper-lid crease, and palpebral fissure, were measured. The changes in these parameters with age, the ratio of lower-lid pretarsal fullness to palpebral fissure height, and the effect of the orbicularis oculi muscle on pretarsal fullness were analyzed.

RESULTS

Two-hundred sixty women (520 eyes) were analyzed in the study. The average age of the participants was 39.3 years (range 21-60 years). The prevalence of static and dynamic pretarsal fullness was 19.2 and 74.0 %, respectively. The prevalence was higher in subjects in the fourth and fifth decades of their lives and lowest in subjects in their sixth decade. In the younger group, the average size of static pretarsal fullness was approximately 6.1-6.5 mm, and the static pretarsal fullness ratio was approximately 0.4. The vertical dimensions of static and dynamic pretarsal fullness increased with age. The changes were significantly higher in subjects over 20 years of age.

CONCLUSION

This study provided data about the size and prevalence of pretarsal fullness, and allowed us to provide reference data for doctors to utilize when treating patients seeking lower-eyelid pretarsal fullness. Patients may appear younger when their new static pretarsal fullness falls within the range of 6.1-6.5 mm in the vertical dimension and when the pretarsal fullness ratio is about 0.4.

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 .

What causes eyelid bags? Analysis of 114 consecutive patients

BACKGROUND

The purpose of this study was to identify the anatomical basis for perception of lower eyelid bags in patients seeking aesthetic surgery and to evaluate the cumulative contribution of different anatomic characteristics before surgery.

METHODS

The histories and photographs of patients whose motivation for aesthetic consultation was lower eyelid bags were analyzed. Six categories of anatomic basis for the lower eyelid bags were identified. For each patient, a score from 0 to 4 was given in each category. The cumulative contribution score for each category was calculated as total points for that category for all patients, divided by the 456 total available points. The authors also developed a "uniqueness score" to reflect the percentage contribution of the worst identified anatomic problem compared with the other problems. This was calculated for each patient as the maximum score in one category, divided by total points for that patient.

RESULTS

A total of 114 consecutive cases were evaluated (67 men and 47 women; mean age, 52 +/- 11 years; age range, 23 to 76 years). The cumulative contribution score for each anatomic variable was as follows: cheek descent and hollow tear trough, 52 percent; prolapse of orbital fat, 48; skin laxity and sun damage, 35; eyelid fluid, 32; orbicularis hyperactivity, 20; and triangular cheek festoon, 13. Prolapsed orbital fat and tear trough deformity both received the higher score and were more common in men as compared with women. The average uniqueness score was 38 percent, with a range of 20 to 75 percent. No one category played a dominant role for most patients. Tear trough depression, skin laxity, and triangular malar mound were significantly more common in patients older than 50 years. Linear regression analysis showed that recommendation for surgery is based on the extent of fat prolapse, skin elasticity, and midface descent. Significant positive correlations were found in all six categories and in uniqueness scores calculated by different observers (r values ranged from 0.31 to 0.73; p < 0.001, Pearson correlation), with the highest score in agreement with the contribution of eyelids fat (r = 0.73) and skin laxity (r = 0.66); the uniqueness score correlation was r = 0.45 (p < 0.001).

CONCLUSIONS

Eyelid bags do not have a single anatomic basis. For different anatomic problems, different treatments are recommended.

Lateral canthal anchoring

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand the principles involved in canthal support for patients undergoing cosmetic and reconstructive surgery. 2. Understand the variations in surgical techniques required to perform canthal anchoring in differing patients. 3. Describe the significance and techniques of canthal anchoring (canthoplasty and canthopexy) as they relate to cosmetic and reconstructive lower lid surgery. 4. Describe the effect of canthal anchoring on the function of the upper and lower lids and eyelid fissure shape. Any surgeon performing cosmetic or reconstructive surgery procedures on the lower lid or midface through the lower lid should be comfortable with canthal anchoring procedures. Appropriate canthal anchoring is effective in preventing postoperative lower-lid malposition, in ensuring eyelid closure, and in improving or maintaining proper eye shape. In many patients, a canthopexy (nonlysis canthal anchoring) is effective. However, in patients with significant horizontal laxity, cantholysis with appropriate lid shortening is required. It should be remembered that canthal anchoring, no matter how well performed, will not prevent severe lower-lid complications in cases of over-resection of lower-lid skin and of poorly performed midface procedures that do not support the lower lid and cheek.