Lower eyelid blepharoplasty: An overview

We undertook a retrospective review of “ideal” subjects (ie, young men and women as well as male and female models) as well as surgical patients undergoing lower blepharoplasty with fat excision, fat transposition, erbium laser resurfacing of the eyelids and midface, or endoscopic midface lifting. Marginal reflex distance-2, lower eyelid length, and nasojugal fold depth were measured and analyzed for all patients.

Results

The nasojugal fold was significantly less prominent in ideal female models than in all other groups (P < 0.0001). Lower eyelid length was significantly shorter after fat excisional lower blepharoplasty, laser resurfacing, and midface lift (P < 0.0001), and did not change after fat transpositional lower blepharoplasty. Postsurgical reduction in lower eyelid length was significantly less with fat transpositional lower blepharoplasty than in all other groups (P < 0.0001). The nasojugal fold was significantly effaced after all types of procedures (P < 0.0001), but was significantly more effaced after fat transpositional lower blepharoplasty (P < 0.01) than after all other procedures.

Conclusions

A slight, medial tear trough is present in youth in many patients. The clinical tear trough is a virtual topographic structure distinct from the anatomic tear trough ligament and can be altered in a variety of ways.

https://academic.oup.com/asj/article-abstract/40/9/938/5639676?redirectedFrom=fulltext

COMMENTARY

Oren Tepper, MD

I commend the authors for their noteworthy contribution to our literature, titled “Observations on the Tear Trough,” ¹ which tackles an important and challenging area in facial aesthetic surgery. The tear trough, also commonly referred to as the nasojugal fold, is traditionally described as a deformity resulting from aging and the loss of ligamentous support at the lower eyelid-cheek junction. Through careful photographic analysis of “ideal” patients, and retrospective analysis of patients who underwent a variety of procedures to address the tear trough, the authors make a case for the novel concept of a “clinical tear trough,” defined as a virtual topographical structure.

In the initial part of their study, the authors set out to better define the aesthetic ideals…

https://academic.oup.com/asj/article-abstract/40/9/948/5775563?redirectedFrom=fulltext

Journal : Aesthetic Surgery Journal

Ref : Facial Aesthetics Fat transpositional blepharoplasty Fillers Lower blepharoplasty Tear trough rejuvenation

A Novel Way for Upper Eyelid Rejuvenation by Combination of Local Fat-Fascia-Muscle Flap Repositioning for Middle-Aged Asian Women

8 Aug 2020

Xiyuan Mao, Yunkun Pei, Lu Zhang, Ying Zhang, Rong Jin, Liying Cheng, Xiaoming Sun, Yuguang Zhang

Journal : JPRAS

Ref : Facial Aesthetics Sunken upper lid Upper blepharoplasty

Examining the Role of Retrobulbar Hyaluronidase in Reversing Filler-Induced Blindness: A Systematic Review

27 Jun 2020

Paap, Michael K.; Milman, Tatyana; Ugradar, Shoaib; Goldberg, Robert; Silkiss, Rona Z.

Journal : OPRS

Ref : Facial Aesthetics Hyalouronidase Hyaluronic acid fillers

The Anatomy and Clinical Application of Preorbital Septum Fiber

3 Jun 2020

Jingyi Zhao, MD, Xiaoshuang Guo, MD, Chenzhi Lai, MD, Dong Zhang, MD, Hong Du, MD, Changsheng Yang, MD, Yingying Yue, MD, Xiaolei Jin, MD

Background

In patients with mild superior sulcus deformity, pseudoptosis, or multiple eyelid folds, several bulky fibers can be found anterior to the orbital septum. These fibers, called preorbital septum fibers, may constrict protrusion of the fat pad and movement of the levator palpebrae muscle.

Objectives

In this study, the authors illustrated the anatomy of these fibers and described the double-eyelid procedure to correct pseudoptosis, mild superior sulcus deformity, and multiple eyelid folds, which may be caused by these fibers.

Methods

The bulky preorbital septum fibers were dissected and severed during upper blepharoplasty to release the orbital septum fat pad and levator palpebrae muscle. This procedure was performed between January 2016 and January 2018 in 56 patients with distinct preorbital septum fibers.

Results

Of the 56 patients, 38 displayed mild to moderate upper eyelid depression and multiple eyelids, and 18 displayed pseudoptosis. Bulky fibers that existed in the superficial layer of the orbital septum were all dissected and removed. After 6 months’ recovery, the superior sulcus deformity improved in all patients. No recurrence of multiple eyelids was observed. Patients with pseudoptosis showed a notable release of their upper eyelids.

Conclusions

This is the first time to our knowledge that the preorbital septum fibers are described as a distinct anatomical structure. They are clinically important in upper eyelid anatomy and the improvement of sunken upper eyelids or pseudoptosis. The combination of blepharoplasty with release of these fibers is easy to perform and promote.

https://academic.oup.com/asj/article-abstract/40/6/597/5588586?redirectedFrom=fulltext

COMMENTARY:

William P D Chen, MD

This paper “The Anatomy and Clinical Application of Preorbital Septum Fiber” 1 set out to attribute the finding of superior sulcal deformity, pseudoptosis, and multiple eyelid crease lines to the presence of bulky fibers within the superficial (front) layer of the orbital septum in the upper eyelid. It stated that in these cases, opening the orbital septum by severing this novel layer to allow repositioning of the orbital fat (preaponeurotic fat) appears to improve sunken sulcus deformity.

The authors cited papers dating as far back as 2010 that espoused the benefits of fat repositioning as well as fat grafting as methods to relieve sulcal deformity.2-6 This approach involves repositioning fat to the retro-orbicularis oculi space or the preaponeurotic space….

https://academic.oup.com/asj/article-abstract/40/6/603/5588585?redirectedFrom=fulltext

Journal : Aesthetic Surgery Journal

Ref : Facial Aesthetics Orbital septum