To address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (B.A.) has offered "modified selective neurectomy" of lower division facial nerve as a long-term solution. This article examines technical considerations outcomes this procedure.A retrospective review was conducted patients who underwent modified neurectomy buccal cervical branches performed by single surgeon over 4½-year period. House-Brackmann grading scores, electronic...

Differences in technique and outcome between fat transposed to the subperiosteal supraperiosteal planes during transconjunctival lower blepharoplasty remain be elucidated.To provide a single-surgeon comparison of with repositioning (TCBFR) vs plane.A retrospective medical record review patients who underwent TCBFR or plane by single surgeon from January 1, 2009, through December 31, 2011. surgical technique, postoperative course, complications, patient satisfaction, aesthetic results (by...

Traditional upper blepharoplasty is a subtractive form of surgery that involves the excision variable amounts skin, muscle, and fat from eyelid. The goal to improve field vision and/or appearance. While surgical debulking eyelid may appearance early on, volume loss inherent this process (especially excision) can contribute hollowed with an associated deep sunken superior sulcus. This skeletonized look be mitigated by repositioning prominent nasal pad, if present, central eyelid.The charts...

Postblepharoplasty lower eyelid retraction (PBLER) has been linked to anterior lamellar shortage, unaddressed laxity, and middle scarring. The authors believe there are other, less-appreciated physical findings (orbicularis weakness, negative-vector eyelid, inferior eyelid/orbit volume deficit) that also influence the development potentially management of this complex type malposition.To better understand PBLER, prevent its development, improve treatment options, determined incidence various...

To assess current practice patterns for management of upper and lower eyelid blepharoplasty by active American Society Ophthalmic Plastic Reconstructive Surgery members.An invitation to participate in a web-based anonymous survey was sent the membership via email. The consists 34 questions, both multiple choice free response, regarding surgery. Practice aesthetic functional are assessed.Thirty-four percent (161/472) members polled responded survey. Members perform an average 196 eyelid, 46...

Historically, lower eyelid blepharoplasty has been a challenging surgery fraught with many potential complications, ranging from ocular irritation to full-blown malposition and poor cosmetic outcome. The prevention of these complications requires detailed knowledge anatomy focused examination the factors that may predispose A thorough preoperative evaluation skin, muscle, tone, laxity, fat prominence, tear trough deformity, vector are critical for surgical planning. When analyzed...

Traditional functional blepharoplasty has focused on the excision of variable amounts skin, muscle, and fat, with little attention given to finding lacrimal gland prolapse (LGP). The reported incidence LGP found clinical examination, patients all ages presenting for blepharoplasty, is 15%. author's experience procedure in older age group (older than 60), that this percentage much lower at surgery. To verify whether correct, author evaluated position intraoperatively a undergoing upper...

Periorbital aging is a multifactorial process involving volume loss (bone and soft tissue), tissue decent, cutaneous degenerative changes. Traditional approaches to surgery on this area of the face have been subtractive in nature, focusing excision skin, muscle, fat. This has frequently led gaunt or hollowed postoperative appearance. Contemporary aesthetic eyelid periorbital rejuvenation undergone paradigm shift from an excisionally based surgical approach one that prioritizes preservation...

In Brief Purpose: To evaluate a series of patients who underwent combined lower transconjunctival blepharoplasty with fat repositioning and orbicularis muscle suspension, "The Lift Fill Lower Blepharoplasty," as means improving eyelid, eyelid/cheek interface aesthetics after surgery. Methods: The authors retrospectively reviewed the charts both suspension over 4-year period (2007–2010) from 2 authors' practices. All history previous eyelid surgery or trauma, orbital inflammatory disease,...

The purpose of this study is to describe a new complication xanthelasma-like reaction which appeared after dermal filler injection in the lower eyelid region.A retrospective case analysis was performed on 7 patients presenting with eyelids.Seven female subjects no history xanthelasma presented eyelids post injection. Fillers included hyaluronic acid (2 patients), synthetic calcium hydroxyapatite (4 and polycaprolactone microspheres (one patient). Average time interval between development 12...

To describe an evisceration technique that combines scleral modification with optic nerve release for coverage of any sized orbital implant.The medical records 70 patients who underwent the described procedure were reviewed.The average implant was 20 mm in diameter, 50 (71%) receiving a solid polymethylmethacrylate sphere. Fifty-eight (83%) had history at least one previous ocular surgery, and 12 (17%) phthisical eyes preoperatively moderate to severe cicatrization. Postoperatively, there...

In Brief Purpose To evaluate the tarsal strip procedure in treatment of tearing related to lacrimal pump failure. Methods A retrospective chart review all patients undergoing was done. Patients with ectropion, nasolacrimal duct obstruction, and punctal eversion stenosis were excluded. Data collected included patient age, sex, procedures performed, follow-up, resolution tearing. The main outcome measure is Results Thirty-four eyelids 21 underwent a for correction Complete noted 14 eyes....

Purpose: To introduce and describe the author's experience with external browpexy, a minimally invasive transcutaneous variant of trans-blepharoplasty temporal brow suspension (internal browpexy). Methods: The charts patients who underwent an browpexy over 2-year period by author are reviewed. Excluded from study history previous forehead/eyebrow or eyelid surgery. surgical procedure is described in depth, representative patient photographs presented to assess outcome, results complications...

To identify if isolated surgical violation of the orbital septum predisposes to "middle lamellar" scarring and subsequent postblepharoplasty lower eyelid retraction.A retrospective review patients who underwent transconjunctival blepharoplasty in either a postseptal (orbital undisturbed) or preseptal (septal incision required) plane was performed. Patients undergoing skin excision, orbicularis muscle plication, canthal suspension were excluded. The presence clinically apparent postoperative...

A numerical measurement of the length lower eyelid is valuable in understanding aging process lid. This study recorded multiple values for lid to provide average each age group. will allow surgeons better assess and treat lid.Female patients were studied groups every decade starting 20- 29-year-old group ending 90- 99-year-old Twenty assessed a total 160 patients. In group, an was length.The 10.4 mm increased 18.6 steady increase measurements numerically confirms that increases with age. For...

The authors describe their experience with postoperative injectable 5-fluorouracil (5-FU), or without added low-dose and concentration steroid, in the particular patient subset undergoing eyelid skin grafting surgery.A retrospective chart review (2011-2013) of patients who underwent for various etiologies adjunctive 5-FU (50 mg/ml) injections (with kenalog 5 was performed. Injections were given 2 to 3 weeks postsurgery as frequently every a total up 4 injections. At each visit, evaluated...

To evaluate the safety, subjectively assess outcome, and emphasize surgical pearls critical clinical observations of upper blepharoplasty performed in conjunction with brow fat pad suspension suture procedure, previously referred to as a "browpexy variant" or "brassiere procedure."A retrospective 4-year analysis patients who underwent was performed. Adjunctive procedures (brow lift ptosis repair) were categorized. The technique is detailed emphasis placed on nuances aid optimal outcome.Two...

Skype video telemedicine consults are gaining popularity to evaluate patients from distant locations. No study has analyzed the utility of this means patient evaluation in a cosmetic oculoplastic population.The authors sought provide an evidence-based analysis surgery population with regards demographics, reasons for consult, and procedural conversion rate.A 1-year retrospective chart review (May 2016 May 2017) who underwent aesthetic 2 authors' practices was performed. The referral source,...