Publications by authors named "Francesco P Bernardini"

55 Publications

Oculoplastic Abstracts.

Ophthalmic Plast Reconstr Surg 2022 Jul-Aug 01;38(4):414-415. Epub 2022 Jul 5.

Ain Shams University, Cairo, Egypt.

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http://dx.doi.org/10.1097/IOP.0000000000002231DOI Listing
July 2022

Soft tissue filler augmentation of the orbicularis retaining ligament to improve the lid-cheek junction.

J Cosmet Dermatol 2021 Nov 22;20(11):3446-3453. Epub 2021 Oct 22.

Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Background: The orientation of facial ligaments changes with increasing age due to the loss of bony support. Soft tissue filler injections placed in close proximity to facial ligaments can alter their orientation to help achieve an improved and younger aesthetic appearance.

Objective: To assess the anatomic and aesthetic effects of a standardized injection with soft tissue filler placed directly inferior to the orbicularis retaining ligament in the infraorbital region.

Methods: A total of 163 patients with signs of infraorbital aging were treated with a standardized soft tissue filler injection into and in close proximity to the orbicularis retaining ligament (ORL). 2D frontal images of the infraorbital region were rated by eleven blinded and independent raters with regards to the aesthetic appearance of the infraorbital region before and after the standardized injection treatment.

Results: The aesthetic appearance of the entire infraorbital region (lid-cheek junction) was rated before and after the treatment. The severity of the tear trough (medial aspect of the infraorbital region) as well as the hollowing of the lateral aspect of the infraorbital region also was rated before and after the treatment. Aesthetic improvement was statistically significant when evaluated by the blinded raters, the treating physician, and the patients. All the results were "very much improved" compared to baseline.

Conclusion: The effectiveness of this injection technique is thought to be due to the strategic placement of soft tissue filler that helps to reposition facial ligaments that have changed their orientation during the aging process.
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http://dx.doi.org/10.1111/jocd.14495DOI Listing
November 2021

Comparing Water Absorption of Food and Drug Administration-Approved Hyaluronic Acid Fillers.

Dermatol Surg 2021 09;47(9):1237-1242

Aesthetic Oculoplastic Surgery, Private Practice, Boca Raton, Florida.

Background: To compare the water absorption of 12 FDA-approved hyaluronic acid (HA) facial fillers in vitro in conditions relevant to in vivo injection.

Objective: The goal of this study was to provide long-term insight into an improved, tailored facial rejuvenation approach and to understand sequelae that could affect preoperative surgical planning.

Methods: In 2 experiments, 12 FDA-approved HA fillers were loaded into test tubes with nonpreserved normal saline and then placed in a 94.5°F-96°F environment for 1 month to allow water absorption by passive diffusion. The test tubes were centrifuged so that the hydrated filler could pass to the bottom of the tube. The tubes were centrifuged for 12 minutes at 1,200 revolutions per minute in the first experiment and for 7 minutes in the second experiment. A blue dye was then instilled to demarcate the filler/saline interface.

Results: There was variation in the water absorption of different HAs. Low absorption occurred in non-animal-stabilized hyaluronic acid.

Conclusion: The pattern of water absorption was similar in the 2 experiments. The results inform us about in vivo conditions and provide guidance for filler selection.
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http://dx.doi.org/10.1097/DSS.0000000000003108DOI Listing
September 2021

Late-Onset Upper Eyelid and Brow Edema as a Long-Term Complication of Hyaluronic Acid Filler Injection.

Aesthet Surg J 2021 05;41(6):NP464-NP471

Department of Ophthalmology, Shamir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Late-onset upper eyelid edema is an uncommonly recognized complication of hyaluronic acid (HA)-based filler injection to the supraorbital area.

Objectives: The authors sought to report their experience in diagnosing and managing late-onset upper eyelid edema.

Methods: This was a noncomparative, retrospective study of a series of 17 consecutive patients who presented with upper eyelid edema 6 to 24 months after uneventful HA filler injection in the supraorbital area.

Results: The study group included 17 female patients. The average time of presentation was 13.9 months. Thirteen patients (76.4%) were satisfied after hyaluronidase and requested no further treatment (observation only); 4 patients (23.5%) elected to receive HA filler re-treatment, with satisfactory results. All patients were followed-up for at least 6 months after the re-treatment.

Conclusions: The incidence of late-onset upper eyelid edema is likely to increase as the number of patients undergoing HA filler injection to the supraorbital area increases. Our study emphasizes the importance of recognizing this condition and suggests a suitable noninvasive treatment with satisfying results for both the patient and the physician.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjaa126DOI Listing
May 2021

The "Eyelid Lift" Orbicularis Suspension Technique for Lower Blepharoplasty Surgery.

Facial Plast Surg Aesthet Med 2020 May/Jun;22(3):227-228. Epub 2020 Mar 30.

Oculoplastic Surgeon in private practice in Wagga Wagga, Australia.

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http://dx.doi.org/10.1089/fpsam.2020.0028DOI Listing
November 2020

Perioperative Prophylactic Antibiotics in 1,250 Orbital Surgeries.

Ophthalmic Plast Reconstr Surg 2020 Jul/Aug;36(4):385-389

Moorfields Eye Hospital, London, England.

Purpose: Intravenous antibiotic prophylaxis is used for many clean-contaminated surgeries or clean surgeries with an implant, but its value for clean orbital surgery has not been determined. This study investigated infection risks and adverse effects related to antibiotics in patients undergoing orbital surgery.

Methods: A prospective, nonrandomized comparative case series of all patients undergoing orbital surgery with participating surgeons between October 1, 2013, and March 1, 2015. Types of surgery, antibiotic regimens, corticosteroid use, antibiotic side effects, and surgical site infections (SSIs) were entered into an electronic database and subsequently analyzed. Cases in which patients received postoperative oral antibiotics were analyzed separately.

Results: Of 1,250 consecutive orbital surgeries, 1,225 met inclusion criteria. A total of 1208 patients were included in the primary analysis: 603 received no antibiotic prophylaxis (group A), and 605 received a single dose of intravenous antibiotic (group B). Five patients (0.42%) developed an SSI, 3 in group A and 2 in group B. The difference in SSI rates was not statistically significant between the 2 groups (p = 0.66). Antibiotic prophylaxis, alloplastic implants, paranasal sinus entry, and corticosteroid use were not associated with differences in SSI rates. All SSIs resolved on a single course of oral antibiotics; an implant was removed in 1 case. There were no complications associated with a single dose of intravenous prophylaxis. However, 12% of 17 patients (group C) who received 1 week of oral postoperative prophylactic antibiotics developed antibiotic-related complications (diarrhea, renal injury), yielding a number needed to harm of 8.5.

Conclusions: In this large series, antibiotic prophylaxis does not appear to have reduced the already low incidence of SSI following orbital surgery. Given the detriments of systemic antibiotics, the rarity of infections related to orbital surgery, and the efficacy of treating such infections should they occur, patients undergoing orbital surgery should be educated to the early symptoms of postoperative infection and followed closely, but do not routinely require perioperative antibiotics.
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http://dx.doi.org/10.1097/IOP.0000000000001565DOI Listing
March 2021

How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections.

J Cosmet Dermatol 2020 Feb 15;19(2):303-311. Epub 2019 Dec 15.

Division of Anatomy, Department of Medical Education, Albany Medical College, Albany, NY, USA.

Background: Recent advances in facial anatomy have increased our understanding of facial aging and where to best position facial soft tissue fillers.

Aim: Aim of this study was to investigate a novel injection protocol which makes use of concepts like the line of ligaments or the surface - volume coefficient.

Materials And Methods: A total of 306 Caucasian patients (270 females, mean age 45.1 ± 11.4 years; 36 males, mean age 45.9 ± 11.6 years) were retrospectively investigated after the injection following a standardized protocol. This protocol comprised a total of six boluses and one retrograde fanning injections in the infraorbital area utilizing a 22G and a 25G blunt-tip cannula, respectively. Medial midfacial distances were measured using skin surface landmarks and compared after the injection of the partial and the total algorithm.

Results: Distances between the dermal location of the lateral SOOF and the dermal location of the mandibular ligament increased by 0.17 ± 0.11 mm with P < .001, to the corner of the mouth by 0.20 ± 0.09 mm with P < .001 and to the nasal ala by 0.20 ± 0.11 mm with P < .001. The repositioning of the facial soft tissues resulted also in a decrease of the height of the lower eyelid by 0.49 ± 0.13 mm with P < .001.

Conclusion: The results revealed that utilizing these novel anatomic concepts, a mean amount of 0.32 cc high G-prime soft tissue filler injected in the lateral SOOF can change midfacial distances by an average of 0.19 mm.
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http://dx.doi.org/10.1111/jocd.13245DOI Listing
February 2020

Is There a Role for a Noninvasive Alternative to Face and Neck Lifting? The Polydioxanone Thread Lift.

Aesthet Surg J 2019 07;39(8):362-363

Private practice in Genova, Italy.

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http://dx.doi.org/10.1093/asj/sjz132DOI Listing
July 2019

Supramaximal Levator Resection for Poor Function Congenital Ptosis.

Ophthalmic Plast Reconstr Surg 2019 Sep/Oct;35(5):e126

Oculoplastica Bernardini, Genova, Milano, Roma e Torino, Italy.

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http://dx.doi.org/10.1097/IOP.0000000000001341DOI Listing
January 2020

Minimal Incisions Vertical Endoscopic Lifting (MIVEL) for the Management of Lateral Canthal and Lower Eyelid Malposition.

Aesthet Surg J 2019 04;39(5):472-480

The purpose of this article is to describe the necessary steps to correct both primary and postblepharoplasty lateral canthal and lower eyelid malpositions at the time of endoscopic face lifting. Endoscopic surgery is traditionally considered only for brow and forehead lifting. However, in our practice we have successfully expanded the indications of the minimal incision vertical endoscopic lifting technique from being primarily indicated for forehead/brow elevation to also treating both primary and secondary lower eyelid and lateral canthal malpositions. This has eliminated the need for direct lateral canthal manipulation in primary cases and any need for open canthoplasty and posterior spacers in secondary cases. In our series of 63 patients with a mean age of 54 years, overall subjective satisfaction was high in 92% of patients, and there were no long-term side effects or complications.
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http://dx.doi.org/10.1093/asj/sjy244DOI Listing
April 2019

The Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for anterior approach ptosis surgery.

Orbit 2018 Dec 14;37(6):401-404. Epub 2018 Feb 14.

a Moorfields Eye Hospital , London , UK.

Purpose: The International Council of Ophthalmology (ICO) is currently developing a series of standardized, internationally validated, teaching tools for key ophthalmic surgical procedures called the Ophthalmology Surgical Competency Assessment Rubrics (OSCARs). This study aims to develop an OSCAR for anterior approach ptosis surgery.

Methods: An international panel of content experts, representing Australia, India, Iran, Italy, Turkey, UK, and the USA was established and worked to develop the rubric using a range of online collaboration tools. The team used the standardised OSCAR template as a baseline, developing explicit behavioural descriptors (the behaviour and performance expected for each step) that were reviewed and modified with successive models. Learners were scored a modified 4-point Dreyfus scale of skill acquisition (novice, beginner, advanced beginner, competent) with the removal of the expert domain.

Results: The final OSCAR ptosis tool was developed in alignment with the ICO-OSCAR standard. Seventeen agreed and weighted stems were produced. Domains such as communication and postoperative complications were removed from this rubric as they are evaluated in other spheres of residency training. Specific comments with regard to the parameters and wording were incorporated to formulate the final rubric, which was internationally agreed and demonstrated face and content validity.

Conclusions: The OSCAR for anterior approach ptosis is skill and behaviour-based, has ICO agreed standards for assessment and provides learners with specific targets for improvement. Although the OSCAR ptosis tool has face and content validity, further development could better elucidate its precise role.
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http://dx.doi.org/10.1080/01676830.2018.1437754DOI Listing
December 2018

Simultaneous Aesthetic Eyelid Surgery and Orbital Decompression for Rehabilitation of Thyroid Eye Disease: The One-Stage Approach.

Aesthet Surg J 2018 Sep;38(10):1052-1061

University of New South Wales Medical School and the University of Notre Dame Medical School, Wagga Wagga, Australia.

Background: Aesthetic rehabilitation of thyroid orbitopathy includes orbital decompression, correction of eyelid retraction, and aesthetic blepharoplasty, performed traditionally in separate stages.

Objectives: To report the results of orbital decompression surgery associated with aesthetic eyelid surgery in one stage for aesthetic rehabilitation of patients affected by thyroid eye disease.

Methods: Retrospective, multicentric study including 40 consecutive patients, who underwent orbital decompression surgery associated with aesthetic eyelid surgery in two centers: Genova (group 1) + Buenos Aires (group 2). Surgical techniques are described in detail.

Results: Mean patient age in the study group was 41.2, 85% of the patients were female, and minimum follow-up time was 12 months, with average follow up of 27 months. All patients underwent orbital decompression; at the same time, 26 patients (65%) underwent bilateral upper blepharoplasty and 32 patients (80%) underwent transconjunctival lower blepharoplasty. Associated upper eyelid procedures included 23 patients (58%) undergoing upper eyelid retraction repair, 9 patients (23%) undergoing associated inferior retractor recession, and 12 patients (30%) closed transcanthal lateral canthopexy. Seven patients (17%) needed strabismus surgery for the treatment of new-onset diplopia and none required further revision eyelid surgery.

Conclusions: Shorr and Seiff suggested 4 stages of surgical rehabilitation: (1) orbital decompression; (2) eye muscle surgery; (3) correction of eyelid retraction; and (4) removal of excess fat and skin. This is the first study to suggest single-stage aesthetic rehabilitation consisting of combined orbital decompression and aesthetic eyelid surgery. This approach has high patient satisfaction and significant reduction in direct and indirect healthcare costs.

Level Of Evidence 4:
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http://dx.doi.org/10.1093/asj/sjy014DOI Listing
September 2018

Comments on "Simplified Muscle-Suspension Lower Blepharoplasty by Orbicularis Hitch".

Aesthet Surg J 2017 04;37(4):NP43-NP44

Head of Oculoplastic and Orbital Surgery, Consultores Oftalmológicos, Buenos Aires, Argentina.

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http://dx.doi.org/10.1093/asj/sjw254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434493PMC
April 2017

Autologous Fat Grafting for Treating Blepharoplasty-induced Lower Eyelid Retraction.

Plast Reconstr Surg Glob Open 2016 Dec 23;4(12):e1190. Epub 2016 Dec 23.

University of New South Wales, Australia; Oculoplastica Bernardini, Genoa and Milano, Italy; Center for Sight, Sarasota, Fla.; Assof Harofhe Medical Center, Zerifin, Israel.

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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http://dx.doi.org/10.1097/GOX.0000000000001190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222676PMC
December 2016

Comparison of Colorado Microdissection Needle Versus Scalpel Incision for Aesthetic Upper and Lower Eyelid Blepharoplasty.

Ophthalmic Plast Reconstr Surg 2017 Nov/Dec;33(6):430-433

*Department of Ophthalmology, Hacettepe University Hospital, Ankara, Turkey; †Department of Ophthalmology, Baskent University Hospital, Ankara, Turkey; ‡Oculoplastica Bernardini, Genova, Italy; §North Texas Ophthalmic Plastic Surgery, Ft. Worth, Texas, U.S.A.; ‖Department of Pathology, Baskent University Hospital, Ankara, Turkey; and ¶Section of Ophthalmology, Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A.

Purpose: Traditionally, eyelid skin incisions with electro-cautery devices have been avoided due to the concerns of aesthetically unacceptable scar formation. The purpose of this study is to compare ecchymosis, cosmesis, and histologic tissue damage of incisions made with a scalpel or Colorado needle in patients undergoing upper and lower aesthetic blepharoplasty. To the best of authors' knowledge, no previous study has been performed before to compare these 2 modalities in aesthetic blepharoplasty surgery.

Methods: This is a multicenter, prospective, interventional, comparative case series. The study protocol was approved by Institutional Review Board in each institution. Patients underwent bilateral upper and/or transcutaneous lower blepharoplasty with 1 side randomly selected for skin incision with the scalpel, the other side with the Colorado needle. Ecchymosis was evaluated using a 10-point Likert scale and the wounds using a Hollander score. The margins of excised tissues were evaluated histologically.

Results: A total of 254 eyelids of 101 patients were included in the study. No significant difference was observed in ecchymosis on postoperative day 1 and 7 and scar cosmesis on day 30 and 180 between the 2 techniques. Histologically, necrosis was noted only with the Colorado needle sides (p = 0.001). No adverse events occurred on the Colorado needle side at any time after surgery.

Conclusions: No clinical difference is noted between Colorado needle and scalpel incisions in terms of ecchymosis and scar cosmesis after aesthetic blepharoplasty.
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http://dx.doi.org/10.1097/IOP.0000000000000820DOI Listing
November 2017

Pediatric Orbital Osteoradionecrosis.

Ophthalmic Plast Reconstr Surg 2017 May/Jun;33(3):e54-e55

*Oculoplastica Bernardini, Genoa and Milan, Italy; †Neuroradiology Unit, ‡Pathology Unit, and §Department of Ophthalmology, Instituto Giannina Gaslini, Genoa, Italy.

Orbital osteoradionecrosis is a rare complication of orbital radiotherapy. It can occur in children, associated with orbital radiotherapy treatment, mimicking recurrence of malignancy and infection. In children, it is most likely to be associated with orbital malignancies treated with higher doses of radiotherapy, such as recurrent orbital rhabdomyosarcoma.
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http://dx.doi.org/10.1097/IOP.0000000000000729DOI Listing
September 2017

Skin Rejuvenation and Volume Enhancement with the Micro Superficial Enhanced Fluid Fat Injection (M-SEFFI) for Skin Aging of the Periocular and Perioral Regions.

Aesthet Surg J 2017 Jan 30;37(1):14-23. Epub 2016 May 30.

Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.

Background: Adipose-derived stromal and stem cells (ADSC) in autologous fat promises regenerative advantages, and injected into the dermal and subdermal layers, enhances rejuvenation and volume. However, extremely superficial fat injection with current techniques is limited.

Objectives: Efficacy and viability evaluation of fat harvested with extremely small side port (0.3 mm) cannulae without further tissue manipulation for the correction of aging/thin skin in the periocular and perioral regions.

Methods: Micro-superficial enhanced fluid fat injection (M-SEFFI) harvests adipose tissue with a multi-perforated cannula (0.3 mm), and autologous platelet rich plasma (PRP) is added. The tissue is injected into the dermal region of the periocular and perioral zones. Efficacy and viability were evaluated by histological and cell culture analysis. Clinical assessment included retrospective evaluation according to 1 = no effect, 2 = fair effect, 3 = good effect, 4 = excellent effect.

Results: Between June 2014 and July 2015, 65 patients (7 men; mean age 49.7 years) were treated with M-SEFFI. No intraoperative complications or visible lumpiness were recorded. Analysis demonstrated mature, viable adipocytes with a strong stromal component. Following PRP addition, there was a greater proliferation noted in the M-SEFFI compared to the SEFFI (0.5 mm). Mean follow-up was 4.1 months. Clinical assessment by surgeons and patients at 1 month was 3.52 and 3.74, and 6 months 3.06 and 2.6 respectively.

Conclusions: M-SEFFI is effective and viable for lump free skin rejuvenation and volume enhancement, through the extraction of smoother ADSC rich, autologous fat tissue that does not require further tissue manipulation, to correct skin aging.

Level Of Evidence: 4 Therapeutic.
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http://dx.doi.org/10.1093/asj/sjw084DOI Listing
January 2017

Xanthelasma-Like Reaction to Filler Injection.

Ophthalmic Plast Reconstr Surg 2017 Jul/Aug;33(4):244-247

*Assaf Harofeh Medical Center, Tzrifin, Israel; †Chelsea Eye and Cosmetic Surgery, New York, New York, ‡University of Southern California, Los Angeles, California, U.S.A.; and §Oculoplastica Bernardini, Milan, Italy.

Purpose: The purpose of this study is to describe a new complication of a xanthelasma-like reaction which appeared after dermal filler injection in the lower eyelid region.

Methods: A retrospective case analysis was performed on 7 patients presenting with xanthelasma-like reaction after filler injection to the lower eyelids.

Results: Seven female subjects with no history of xanthelasma presented with xanthelasma-like reaction in the lower eyelids post filler injection. Fillers included hyaluronic acid (2 patients), synthetic calcium hydroxyapatite (4 patients), and polycaprolactone microspheres (one patient). Average time interval between filler injection and development of xanthelasma-like reaction was 12 months (range: 6-18 months). Treatment included steroid injections, 5FU injections, ablative or fractionated CO2 laser, and direct excision. Pathology confirmed the lesion was a true xanthelasma in one patient. In treated patients, there was subtotal resolution after laser. Xanthelasma-like reaction resolved completely after direct excision. Three patients elected to have no treatment.

Conclusions: Previously there has been one reported case of xanthelasma after filler injection. This case series is the largest to date. Furthermore, this series is notable because xanthelasma-like reactions appeared after injection with 3 different types of fillers. None of the patients had evidence of xanthelasma prefiller injection. The precise mechanism by which filler injection can lead to the formation of xanthelasma-like reaction is unclear. A possible mechanism may be related to binding of low-density lipoprotein and internalization by macrophages. Further investigation is required. Nevertheless, physicians performing filler injections should be aware of this new complication and treatment options.
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http://dx.doi.org/10.1097/IOP.0000000000000722DOI Listing
September 2017

Re: "Pediatric Acute Dacryocystitis".

Ophthalmic Plast Reconstr Surg 2016 Mar-Apr;32(2):155

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http://dx.doi.org/10.1097/IOP.0000000000000638DOI Listing
July 2016

The Revised Direct Transconjunctival Approach to the Orbital Floor.

Ophthalmic Plast Reconstr Surg 2017 Mar/Apr;33(2):93-100

*Oculoplastica Bernardini, Genova, Italy; †Cincinnati Eye Institute, Cincinnati, Ohio, USA; ‡Harvard Medical School, Boston, Massachusetts, USA; §Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

Purpose: To review common surgical approaches to the orbital floor and to evaluate the utility of canthal-sparing, single incision transconjunctival method.

Methods: A retrospective chart review of a consecutive series of patients who underwent transconjunctival, direct incision surgery without eyelid dissection or lateral canthotomy and inferior cantholysis and review of the literature were conducted.

Results: Twenty-three consecutive patients (33 orbits) were operated using a canthal-sparing direct single cut approach, including 10 unilateral pediatric orbital floor fractures, 1 orbital floor implant removal, 2 unilateral post-traumatic enophthalmos repairs, and 10 bilateral orbital floor decompressions. Surgical exposure was adequate to complete the surgical objective in each patient. Mean follow up was 13 months and no complications were observed.

Conclusions: The transconjunctival approach to the orbital floor can be performed using a pre- or post-septal dissection, with infratarsal or fornix incision commonly associated with lateral canthotomy and inferior cantholysis. The direct approach spares the lateral canthus, minimizes lower eyelid dissection, and provides rapid and effective access to the inferior orbital rim and orbital floor. It offers sufficient exposure to allow insertion of large floor implants even in children. Although apparently abandoned in the recent literature, canthal-sparing technique is a useful method for the management of orbital floor fractures, enophthalmos correction, implant removal, and orbital decompression.
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http://dx.doi.org/10.1097/IOP.0000000000000659DOI Listing
March 2017

Superficial Enhanced Fluid Fat Injection (SEFFI) to Correct Volume Defects and Skin Aging of the Face and Periocular Region.

Aesthet Surg J 2015 Jul 24;35(5):504-15. Epub 2015 Apr 24.

Drs Bernardini and Zambelli are oculofacial plastic surgeons in private practice in Genova, Milano, and Torino, Italy. Drs Gennai and Izzo are plastic surgeons in private practice in Bologna, Italy. Dr Repaci and Prof Dr Quarto are Researchers in the Department of Experimental Medicine, University of Genova, Italy. Dr Baldelli and Prof Dr Santi are Plastic Surgeons in the Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Italy. Dr Fraternali-Orcioni is a Pathologist in the Department of Pathology, University of Genova, Italy. Dr Hartstein is an Oculofacial Plastic Surgeon at Assaf Harofhe Medical Center in Zerifin, Israel.

Background: Although recent research on micro fat has shown the potential advantages of superficial implantation and high stem cell content, clinical applications thus far have been limited.

Objectives: The authors report their experience with superficial enhanced fluid fat injection (SEFFI) for the correction of volume loss and skin aging of the face in general and in the periocular region.

Methods: The finer SEFFI preparation (0.5 mL) was injected into the orbicularis in the periorbital and perioral areas, and the 0.8-mL preparation was injected subdermally elsewhere in the face.

Results: The records of 98 consecutive patients were reviewed. Average follow-up time was 6 months, and average volume of implanted fat was 20 mL and 51.4 mL for the 0.5-mL and 0.8-mL preparations, respectively. Good or excellent results were achieved for volume restoration and skin improvement in all patients. Complications were minor and included an oil cyst in 3 patients. The smaller SEFFI quantity (0.5 mL) was well suited to correct volume loss in the eyelids, especially the deep upper sulcus and tear trough, whereas the larger SEFFI content was effective for larger volume deficits in other areas of the face, including the brow, temporal fossa, zygomatic-malar region, nasolabial folds, marionette lines, chin, and lips.

Conclusions: The fat administered by SEFFI is easily harvested via small side-port cannulae, yielding micro fat that is rich in viable adipocytes and stem cells. Both volumes of fat (0.5 mL and 0.8 mL) were effective for treating age-related lipoatrophy, reducing facial rhytids, and improving skin quality.

Level Of Evidence: 4 Therapeutic.
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http://dx.doi.org/10.1093/asj/sjv001DOI Listing
July 2015

Orbital and Periorbital Extension of Congenital Dacryocystoceles: Suggested Mechanism and Management.

Ophthalmic Plast Reconstr Surg 2016 Sep-Oct;32(5):e101-4

*Department of Ophthalmology, Ospedale Gaslini, Genova, Italy; †Department of Ophthalmology, Dünya Göz Hastanesi, Ankara, Turkey; ‡Department of Neuroradiology, Ospedale Gaslini, Genova, Italy; §Department of Ophthalmology, Istanbul Beyoğlu Eye Research Hospital, Istanbul, Turkey; ‖Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia; ¶Scheie Eye Institute; and #Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

Orbital and periorbital extension of congenital dacryocystoceles is rarely observed in neonatal infants. The authors describe 4 cases of congenital dacryocystocele that presented with extension to the orbital and periorbital regions. The first 3 newborns underwent marsupialization of the orbital and periorbital dacryocystoceles with aspiration of the purulent material followed by nasolacrimal duct probing after radiographic evidence of diffuse orbital or periorbital expansion. The fourth patient was successfully treated with an external dacryocystorhinostomy with excision of the enlarged cystic walls. Transconjunctival orbitotomy with sac marsupialization followed by nasolacrimal intubation can provide immediate and permanent resolutions of this unusual complication in most instances. External dacryocystorhinostomy may be required, however, when the orbital or periorbital dacryocystocele is complicated by acute or recurrent dacryocystitis.
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http://dx.doi.org/10.1097/IOP.0000000000000278DOI Listing
March 2017

Calcium hydroxyl-apatite (Radiesse) for the correction of periorbital hollows, dark circles, and lower eyelid bags.

Ophthalmic Plast Reconstr Surg 2014 Jan-Feb;30(1):34-9

*Oculoplastica Bernardini, Genova, Italy; †Ophthalmology Department, Dunyagoz Ankara Hastanesi, Ankara, Turkey; and ‡Consultores Oftalmológicos, Buenos Aires, Argentina.

Purpose: To describe the authors experience with calcium hydroxyl-apatite (CaHa) injections for the aesthetic correction of tear trough, infraorbital hollows, deep upper sulcus, dark circles and lower eyelid bags.

Methods: The records of 63 patients (127 eyelids) injected with CaHa for aesthetic rejuvenation of the periocular region between March 2012 and March 2013 were retrospectively evaluated. All injections were carried out using a 25-gauge cannula after adding 0.5 ml of 2% lidocaine to 1.5 ml vials of the original product. Postoperative visits were scheduled at 1 week and 1 month. Any previous treatment was recorded, and necessity of retreatments and side effects was evaluated. Patient satisfaction was recorded at 1 month with self-evaluation of the treatment result as "worsened," "unchanged," or "improved." Standard pre- and postinjection photographs were taken and compared to analyze the success of the procedure. Pictures were retrospectively graded by the authors on a similar improvement scale of 1 (worse), 2 (no change), and 3 (improvement).

Results: Fifty-eight/sixty-three patients were women (92%), with an average age of 42 years (range; 18-57 years). Chief complaints were "hollows" in 94% of patients, "dark circles" in 33%, lower eyelid "bags" in 17%, and deep upper sulcus in 4.7%. Twenty-three patients (36.5%) required an additional correction 1 month after the primary treatment. Satisfaction was as high as 98% among patients treated primarily for hollowness, and the overall satisfaction rate was 92%. Associated dark circles were satisfactorily treated in 68% of the patients. Temporary side effects involved mild erythema and swelling for 2 to 3 days and pseudoxanthalesma effect in 22 eyelids (17.4%) lasting <6 weeks. In 2 patients, erythema lasted longer than 4 weeks. The 2 worse complications in this series were migration of the product above the medial canthal tendon in 1 patient and overcorrection in another patient. These complications were all managed conservatively and resolved spontaneously within 6 to 8 weeks. No case of irregular contour, palpable lumpiness, or unevenness were encountered. In the end, only 1 patient thought she was worsened after the treatment.

Conclusions: Treatment of the periocular region with CaHa injections is a safe and effective treatment with high patient satisfaction and low complication rate. Advanced technical skills may have to be acquired for the specific treatment of this area using this particulate material.
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June 2014

Improvement from no light perception after orbital decompression for graves' optic neuropathy.

Ophthalmology 2014 Jan 20;121(1):431-432.e1. Epub 2013 Nov 20.

Department of Ophthalmology, Hospital Felicio Rocho, Belo Horizonte, Brazil.

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January 2014
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