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J Plast Surg Hand Surg 2019 Jan 24:1-5. Epub 2019 Jan 24.

f Department of Plastic and Reconstructive Surgery , Yokohama City University Hospital , Yokohama-shi , Kanagawa , Japan.

Patients often develop eyebrow drooping after blepharoplasty or ptosis repair. After aponeurosis advancement was performed in 53 patients (100 eyelids) with blepharoptosis, the eyebrow heights at the medial canthus, center of the pupil, and lateral canthus were measured using scanned photographs obtained preoperatively and 3 months postoperatively. In the 100 eyelids subjected to aponeurosis advancement, the eyebrow position was lowered at the medial canthus in 81 eyelids (81%), at the center of the pupil in 84 eyelids (84%), and at the lateral canthus in 80 eyelids (80%). Read More

Arch Craniofac Surg 2018 Dec 27;19(4):296-299. Epub 2018 Dec 27.

Department of Radiology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.

Xanthelasma palpebrarum is the most common cutaneous xanthoma found on the medial side of the eyelid. The typical lesion is usually a flat and yellowish plaque on the skin. However, we report on a unique case of intramuscular xanthoma found during blepharoplasty for the correction of ptosis. Read More

Aesthetic Plast Surg 2018 Nov 27. Epub 2018 Nov 27.

Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea.

Background: Postoperative eyelid asymmetry is the most common complaint of patients after undergoing blepharoplasty and ptosis correction surgery. Calibrating eyelid asymmetry during ptosis correction surgery is still difficult for surgeons despite the development of innovative procedures. Our levator pull-out suture technique for correcting postoperative eyelid asymmetry after ptosis surgery is introduced. Read More

J Craniofac Surg 2019 Jan;30(1):e62-e65

Department of Ophthalmology, Meir Medical Center, Kfar Saba.

The aim of this interventional, prospective study is to estimate the change in periocular cutaneous sensation after upper eyelid surgery. The trial included 48 eyes of 24 patients undergoing upper eyelid blepharoplasty or upper eyelid blepharoplasty and blepharoptosis repair. Eyelid sensation was measured using a Cochet-Bonnet filament-type esthesiometer at 4 predetermined anatomical locations in the upper eyelid. Read More

Aesthetic Plast Surg 2018 Nov 19. Epub 2018 Nov 19.

Department of Anatomy and Histo Embryology, School of Basic Medical Science, Peking University, Beijing, China.

Background: "European-style double eyelid" blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity.

Methods: During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. Read More

J Craniofac Surg 2019 Jan;30(1):235-236

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Upper blepharoplasty can be divided into incision and nonincision technique. Each has its advantages and disadvantages. The author innovated a method of modified upper blepharoplasty by taking advantage of both procedures' strengths. Read More

Korean J Ophthalmol 2018 Oct;32(5):344-352

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Purpose: The lower eyelid serves important roles in tear distribution and drainage. The purpose of this study was to measure the tear meniscus height (TMH) with anterior segment optical coherence tomography after lower blepharoplasty.

Methods: A total of 52 eyes from 26 patients treated between July 2012 and June 2015 were included in the study. Read More

Facial Plast Surg 2018 Oct 8;34(5):497-504. Epub 2018 Oct 8.

Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.

The periorbital region is a focal point on the face. Dermatochalasis, fat herniation, blepharoptosis, brow ptosis, deep tear troughs, and malar fat pad descent are all age-related changes that occur around the eyes, and successful rejuvenation involves addressing all of these changes. Restoring a youthful, vibrant appearance to the eyes and periorbital areas can often only be accomplished with a combination of surgical and nonsurgical interventions. Read More

Aesthetic Plast Surg 2019 Feb 23;43(1):133-138. Epub 2018 Aug 23.

Gangnam-Seoyon Plastic Surgery Clinic, 421 Samyoung Building, Gangnam-daero, Seocho-Gu, Seoul, 06614, Republic of Korea.

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. Read More

Aesthetic Plast Surg 2018 Dec 23;42(6):1565-1570. Epub 2018 Aug 23.

Department of Neurosurgery, Mackay Memorial Hospital, No. 45 Minsheng Road, Tamshui District, New Taipei City, Taiwan.

Background: Double eyelid surgery with a buried suture is a popular plastic surgery procedure in Asia owing to the relatively minor scarring and quick recovery associated with it. In this article, we present a new approach involving a continuous single-loop buried suture method, which expands the operating site to the conjunctiva and the aponeurosis-Müller's muscle complex.

Methods: The medical records of 42 patients (80 eyes) who underwent double-eyelid blepharoplasty were retrospectively reviewed. Read More

Ophthalmic Plast Reconstr Surg 2018 Aug 17. Epub 2018 Aug 17.

Wilmington Eye, Wilmington, North Carolina, U.S.A.

Purpose: To report a recent outbreak of atypical mycobacterial infection following upper eyelid surgery and the results of a prevention protocol that was successfully instituted to dramatically reduce the infection rate.

Methods: This is a multicenter retrospective nonrandomized comparative interventional case series. A chart review of 7 patients who developed atypical mycobacterium infection after undergoing blepharoplasty was conducted. Read More

Curr Opin Ophthalmol 2018 Sep;29(5):395-400

Billings Clinic, Billings, Montana, USA.

Purpose Of Review: Blepharoptosis is a common problem encountered in the pediatric ophthalmology clinic. The presentation is obvious to both parents and referring physicians and often prompts urgent consultation. The current classification and management of childhood ptosis will be reviewed. Read More

Korean J Ophthalmol 2018 08;32(4):249-256

Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea.

Purpose: To describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients.

Methods: This is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis. Read More

BMC Ophthalmol 2018 Jul 31;18(1):187. Epub 2018 Jul 31.

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.

Background: Direct damage to the superior rectus (SR) muscle insertion following upper lid blepharoplasty has not been reported. We document a rare case of vertical diplopia due to direct damage to the SR muscle insertion following cosmetic upper lid blepharoplasty.

Case Presentation: We describe a case of 24-year-old woman with Asian eyelid. Read More

Aesthet Surg J 2018 Oct;38(11):NP156-NP164

William Beaumont Hospital, Oakland University William Beaumont School of Medicine in Royal Oak, Michigan.

Background: In some upper eyelid blepharoplasties, maximal skin removal may not result in desired outcomes; raising crease height can therefore be considered. Currently, there is no method to determine the amount of skin to be excised and/or crease elevation required to achieve a specific outcome.

Objective: This study extrapolated an equation to determine amount of skin excision and/or lid crease elevation needed to achieve a specific eyelid margin to fold distance (MFD). Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):487-490

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: Undercorrected blepharoptosis can be encountered after frontalis sling operation. Revision surgery for undercorrection has commonly involved introducing a new sling material. We describe and evaluate a simple surgical technique to correct undercorrection by adjusting preexisting fascia. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017 Jul;31(8):996-998

Institute of Reconstructive Plastic Surgery, Weifang Medical University, Weifang Shandong, 261042, P.R.China.

Objective: To investigate the effectiveness of retro-orbicularis oculi fat resection in Park double eyelid surgery to correct the swollen upper eyelid.

Methods: Between September 2015 and July 2016, partial resection of the retro-orbicularis oculi fat was performed on 32 cases with bilateral swollen upper eyelids in Park double eyelid surgery. There were 10 males and 22 females with an average age of 25 years (range, 19-32 years). Read More

Orbit 2018 Jun;37(3):223-229

a Gwynedd District General Hospital , Gwynedd Health Authority , Bangor , UK.

The purpose is to present a new surgical technique using myotarsal (MT) flap for reconstruction of small to subtotal full thickness defects - up to 8 mm in height - of lower eyelids, without needing concomitant supplementary procedures. MT flap consists of a 3 mm tarsal strip with attached levator complex. It does not have conjunctival lining or pedicle. Read More

Curr Opin Otolaryngol Head Neck Surg 2018 Aug;26(4):221-226

Department of Ophthalmology, University of Illinois at Chicago, Chicago Illinois, USA.

Purpose Of Review: To review recent advances on the mechanisms and management of acquired aponeurotic blepharoptosis.

Recent Findings: Recent advances over the past year have focused on refining well known methods of ptosis repair, expanding and modifying techniques to treat difficult and more severe conditions, and uncovering the biomechanical and neurostimulatory mechanisms of ptosis and its repair.

Summary: Innovations in ptosis repair are discussed in the context of current treatment paradigms. Read More

J Pediatr Ophthalmol Strabismus 2018 Jul 1;55(4):229-233. Epub 2018 May 1.

Purpose: To demonstrate the benefits of using braided polyester in the management of severe or recurrent ptosis in children and young adults and to compare the efficacy of two surgical techniques.

Methods: Retrospective, non-randomized record review of 30 patients (43 eyelid procedures) affected by congenital or acquired severe ptosis who underwent frontalis suspension with braided polyester from 2008 to 2016. Two surgical techniques were compared: the base-down triangle and the Fox pentagon, both of which were performed using a closed technique. Read More

Facial Plast Surg 2018 Apr 9;34(2):183-193. Epub 2018 Apr 9.

Perth Facial Plastic and Cosmetic Surgery, Perth, Western Australia, Australia.

Upper blepharoplasty is one of the more common facial plastic procedures. The upper lid and brow complex are managed together. Whether upper blepharoplasty is performed for medical or cosmetic reasons, the aim is to improve appearance while retaining natural shape and maintaining (or improving) function. Read More

Facial Plast Surg 2018 Apr 9;34(2):164-172. Epub 2018 Apr 9.

Facial Plastic Surgery, Delray Beach, Florida.

Primary manifestations of facial aging are the reduction in subcutaneous tissue volume, especially the atrophy of fat as well as bone volume depletion which directly contribute to loss of support and laxity of the skin. Depressions and hollows develop with a visible disruption of the cosmetic facial aesthetic units resulting in harsh shadows. This is especially evident in the eyebrow and temporal regions which accentuate the appearance of brow ptosis and a hollow, almost cadaveric look to the temple. Read More

Facial Plast Surg 2018 Apr 9;34(2):150-154. Epub 2018 Apr 9.

Facial Plastic Surgery, Fedok Plastic Surgery, Alabama.

Rejuvenation of the upper face is a key component of overall facial rejuvenation. The upper face is probably the most important purveyor of our sense of well-being and our primary transmittal of nonverbal social interaction. There are many aspects to the aging changes in the area. Read More

Orbit 2018 Jun 15;37(3):215-222. Epub 2018 Mar 15.

a Gwynedd Health Authority , Gwynedd District General Hospital , Bangor , Wales , UK.

The purpose is to present a new refined surgical technique for mild-to-severe acquired myogenic ptosis correction under local anaesthesia (LA) as day cases with resection of myotarsal (MT) flap and demonstrate the safety and efficacy of the technique. MT flap consists of 2 mm tarsal strip with attached levator complex - levator muscle, its aponeurosis, and Müller muscle. This is a retrospective personal series of 400+ patients, who underwent surgical correction with MT flap resection of 8-24 mm under LA mostly as day cases. Read More

Exp Clin Transplant 2018 Mar;16 Suppl 1(Suppl 1):194-197

Department of Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Transplant patients, like the nontransplant population, can have surgical interventions for body shape disorders. Studies on aesthetic surgeries in transplant patients are scarce. Our aim was to share our experiences with various aesthetic procedures in solid-organ transplant recipients. Read More

Ophthalmologe 2018 04;115(4):266-274

Augenklinik der LMU, Klinikum der Universität München, Campus Innenstadt, Mathildenstr. 8, 80336, München, Deutschland.

Background: Upper eyelid blepharoplasty is among the most frequent oculoplastic surgical procedures. It is often performed as one of the first esthetic surgical interventions by surgeons of various disciplines. While there is a high probability of happy and satisfied patients postoperatively, there are important potential surgical complications that should be prevented. Read More

Aesthet Surg J 2018 Aug;38(9):941-948

University of Illinois at Chicago, Chicago, IL.

Background: Upper eyelid dermatochalasis often triggers frontalis hyperactivity in an effort to elevate the upper lids away from the visual axis. Similarly, prior neuromodulator treatment of the brow depressors may cause false elevation of the brows, diminishing the extent of preoperative brow ptosis or dermatochalasis. Studies have quantified postoperative brow ptosis and recurrent dermatochalasis following upper blepharoplasty, but a methodology to predict the postoperative brow position remains to be elucidated. Read More

Neuroophthalmology 2018 Feb 12;42(1):49-51. Epub 2017 Jun 12.

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.

Brown syndrome is characterised by impaired supraduction worse in adduction due to a restricted superior oblique tendon passing through the trochlea. A few reports have previously described Brown syndrome after upper eyelid surgery, including blepharoplasty and ptosis repair. The authors describe two additional cases of Brown syndrome following ptosis repair. Read More

Facial Plast Surg 2018 Apr 21;34(2):230-234. Epub 2018 Feb 21.

Department of Ophthalmology, Albany Medical Center, Albany, New York.

The purpose of the current study was to analyze brow and ear position, and examine the relationship between these structures in patients presenting for blepharoplasty evaluation. A retrospective chart review was performed, which included all patients presenting to one oculoplastic physician for a blepharoplasty evaluation from November, 2012 to March, 2014. The prevalence of brow ptosis and brow and ear asymmetry was calculated; the proportional distribution was determined, and chi-square analysis and the z-test of proportions were used to calculate the significance. Read More

J Craniofac Surg 2018 May;29(3):747-750

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

Purpose: Change in eyelid position after upper blepharoplasty is an important factor that can affect postoperative patient satisfaction. However, no one has investigated eyelid changes during follow-up for upper eyelid surgery. Thus, the purpose of this study was to investigate position changes in the upper and lower eyelids during the follow-up period after upper blepharoplasty in Korean. Read More

Medicine (Baltimore) 2017 Dec;96(51):e9288

Eye Center, 2nd Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang, China.

Rationale: Ptosis is a rare complication of periocular steroid use. Studies report that local injections of steroids produce ptosis. We describe the first 2 cases of ptosis because of long-term treatment with topical steroid eye drops. Read More

Plast Reconstr Surg 2018 02;141(2):213e-219e

Bangkok, Thailand From the Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society.

Background: The purpose of this study was to compare the efficacy of external levator advancement and Müller muscle-conjunctival resection in aponeurotic blepharoptosis repair.

Methods: Mild to moderate blepharoptosis patients with good levator function and a positive phenylephrine test were randomized to upper blepharoplasty with either external levator advancement or Müller muscle-conjunctival resection. The primary outcome was marginal reflex distance 1 at 1 month after surgery. Read More

Ann Plast Surg 2018 Feb;80(2S Suppl 1):S40-S47

Background: Floppy eyelid syndrome (FES) is typically characterized by chronic eye irritation and an increased laxity of the upper eyelid that can be easily everted by applying minimal upward traction. However, it is a clinical entity that is less known to most plastic surgeons. Blepharoptosis is one of the most common features, which links to FES, for which a thorough differential diagnosis has become important in directing proper medical treatment. Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):460-462

Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, United Kingdom.

Purpose: The authors present a new series of our experience using posterior approach levatorpexy for congenital ptosis with poorer levator function (LF) in comparison with our first published report. This technique avoids a skin incision or any resection in addition to no excision of tissue.

Methods: A consecutive series of 16 patients. Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):483-486

Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, University of California, Los Angeles, California, U.S.A.

Purpose: This study aims to describe Müller's muscle-conjunctival resection surgery in terms of outcomes and potential factors that may predict final positions.

Methods: This cross-sectional cohort study included patients undergoing Müller's muscle-conjunctival resection surgery for involutional ptosis over a 15-year period. Success was defined in 2 ways: 1) final marginal reflex distance 1 (MRD1) ≥2. Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):436-439

Division of Oculoplasty and Orbit, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

Purpose: To analyze the upper eyelid contour of patients with unilateral congenital ptosis who underwent single-strip frontalis suspension.

Methods: The authors compared the upper eyelid shape of the right and left eyes of 10 patients who underwent unilateral frontalis suspension with a single strip of autogenous fascia. At a mean postoperative time of 10. Read More

Eye (Lond) 2018 04 12;32(4):757-762. Epub 2018 Jan 12.

Moorfields Eye Hospital, London, UK.

PurposeCorrection of upper eyelid ptosis is one of the most commonly performed oculoplastic procedures on the NHS but there is currently no data in the literature informing the surgeon of the optimal time for the first postoperative review. Our aim was to investigate how often a complication that warranted intervention occurred in the first 6 weeks after surgery and whether such a complication could have been predicted preoperatively.Patients and methodsA retrospective review was performed of 300 operations in 239 patients over a 9-month period at Moorfields Eye Hospital, London. Read More

Vestn Oftalmol 2017;133(6):69-75

Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogriazskaya St., Moscow, Russian Federation, 105062.

Aim: to develop a modified implant to correct ptosis through brow suspension and to evaluate its effectiveness.

Material And Methods: The clinical group consisted of 20 patients (29 eyes) aged 23 to 69 years (45±5.3 years on the average) and the comparison group - of 20 patients (33 eyes) aged 19 to 77 years (47±9. Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):432-435

Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, California, U.S.A.

Purpose: The purpose of this study was to determine whether advancement of the levator aponeurosis in external levator resection surgery or Mueller's muscle and conjunctiva in Mueller's muscle conjunctival resection (MMCR) surgery has a differential effect on variation in eyelid position during the postoperative period.

Methods: In this retrospective observational cohort study, 2 groups of patients were defined. The first underwent MMCR surgery without tarsectomy by surgeon 1. Read More

Ophthalmic Plast Reconstr Surg 2018 Jan/Feb;34(1):90-92

Am J Ophthalmol 2018 03 23;187:xiv-xvii. Epub 2017 Dec 23.

The Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address:

J Pediatr Ophthalmol Strabismus 2018 Mar 19;55(2):117-121. Epub 2017 Dec 19.

Purpose: Congenital ptosis is a troubling eye condition for pediatric ophthalmologists. There are many considerations to contemplate when deciding when to operate and which technique to use.

Methods: A retrospective chart review of 69 pediatric patients treated for congenital ptosis using a double rhomboid frontalis sling with a nylon suture at a single tertiary care center. Read More

J Craniofac Surg 2018 Mar;29(2):482-485

Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City.

Background: Some fordless-eyelid patients with moderate upper lid ptosis characterize in a higher eyebrow position which leads to an increased midfacial ratio. Apart from performing blepharoplasty to create dynamic folds, additional procedures such as folding aponeurosis of levator palpebrae superioris muscle were effective to revise the enlarged ratio of midface through lowering eyebrow, which gains good aesthetic results. However, the specific changes in the proportion of facial aesthetics and the importance of these change were serious lack in the literature as far as the authors know. Read More

Facial Plast Surg 2017 Dec 1;33(6):627-638. Epub 2017 Dec 1.

Department of Otolaryngology, Otolaryngology and Facial Plastic Surgery Associates.

Semin Ophthalmol 2018 22;33(3):429-434. Epub 2017 Feb 22.

c Ophthalmology Department , New Stobhill Hospital , Glasgow , UK.

Introduction: Medical management can have limitations in improving ptosis in patients with myasthenia gravis (MG). We present our experience of ptosis surgery in MG.

Materials And Methods: Clinical records of all patients with MG undergoing ptosis surgery from September 2007 to November 2013 in a single center were retrospectively reviewed. Read More

Orbit 2018 Jun 17;37(3):191-195. Epub 2017 Oct 17.

d Oculoplástica , Consultores Oftalmológicos , Buenos Aires , Argentina.

Purpose: To evaluate the aesthetic and functional outcomes of autologous fat transfer using the SEFFI (superficial enhanced fluid fat injection) technique for reconstruction of the periocular area.

Methods: Autologous fat injections prepared with the 0.5 mL and 0. Read More

J Pediatr Ophthalmol Strabismus 2017 Oct 9;54:e63-e66. Epub 2017 Oct 9.

A case of dissociated vertical deviation, ptosis, and juvenile glaucoma is described. J deformity anteriorization of the normally acting inferior oblique muscles was chosen to preserve the superior fornix for glaucoma surgeries by avoiding superior rectus recession and to prevent narrowing of the palpebral fissure by avoiding an inferior rectus tuck. [J Pediatr Ophthalmol Strabismus. Read More

J Plast Reconstr Aesthet Surg 2018 02 25;71(2):279-280. Epub 2017 Sep 25.

Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: