Observations on the Tear Trough

2019 ◽  
Vol 40 (9) ◽  
pp. 938-947 ◽  
Author(s):  
Sathyadeepak Ramesh ◽  
Robert Alan Goldberg ◽  
Allan Edward Wulc ◽  
Alan Bart Brackup
Keyword(s):  
Lower Eyelid ◽  
Surgical Patients ◽  
Level Of Evidence ◽  
Erbium Laser ◽  
Laser Resurfacing ◽  
Men And Women ◽  
Lower Blepharoplasty ◽  
Tear Trough ◽  
Midface Lift ◽  
Topographic Structure

Abstract Background The tear trough is a prominent structure of the midface. Many surgical and nonsurgical techniques have been devised to efface this feature. Objectives The aim of this study was to define an aesthetically pleasing tear trough and understand the effect of various surgical procedures on its appearance. Methods 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. Level of Evidence: 4

scholarly journals Objective Comparison of Nasojugal Fold Depth and Lower Eyelid Length After Fat Excision Versus Fat Transpositional Lower Blepharoplasty

2019 ◽  
Vol 39 (10) ◽  
pp. 1048-1054 ◽  
Author(s):  
Sathyadeepak Ramesh ◽  
Robert A Goldberg ◽  
Allan E Wulc ◽  
Alan B Brackup
Keyword(s):  
Retrospective Review ◽  
Lower Eyelid ◽  
Level Of Evidence ◽  
Aesthetic Result ◽  
Lower Blepharoplasty ◽  
The World ◽  
Aesthetic Results ◽  
Compare And Contrast

AbstractBackgroundLower blepharoplasty is one of the most commonly performed aesthetic surgeries in the world. However, there are no studies to directly compare patients who had fat excision vs fat transposition.ObjectivesThe authors sought to compare and contrast aesthetic results of fat excisional and fat transpositional lower blepharoplasty.MethodsA retrospective review was conducted of 60 patients (120 eyelids) who underwent transconjunctival lower blepharoplasty, either with fat excision or fat transposition into a preperiosteal plane. Marginal reflex distance-2, lower eyelid length, nasojugal fold depth, and pretarsal orbicularis definition were measured.ResultsMean follow-up was 5.6 months. Mean marginal reflex distance-2 did not significantly differ after either fat excision or fat transposition. Mean lower lid length decreased after fat excision only (P < 0.001), and postoperative fat excision patients had a shorter lower eyelid length than patients who underwent fat transposition (13.5 ± 2.1 mm vs 16.1 ± 1.9 mm, P < 0.0001). Pretarsal orbicularis definition increased after both surgeries (P < 0.001), and the groups did not differ (1.0 ± 0.8 vs 1.1 ± 0.9, not significant). Mean nasojugal fold depth was effaced after surgery in both groups (P < 0.001), although the nasojugal fold was significantly more effaced after fat transposition (1.5 ± 0.7 vs 0.48 ± 0.6, P < 0.001).ConclusionsIn lower blepharoplasty, fat excision resulted in a shorter lower eyelid, and fat transposition resulted in a more effaced lid-cheek junction. Surgeons should be able to balance both techniques to deliver a customized aesthetic result.Level of Evidence: 3

Achieving a Youthful Midface: Examination of Midface Anatomy Improvement Following Lower Blepharoplasty With Fat Transposition and Transtemporal Midface Lift With Lower Lid Skin Pinch

2019 ◽  
Vol 39 (10) ◽  
pp. NP416-NP428 ◽  
Author(s):  
Catherine Weng ◽  
Vito Quatela
Keyword(s):  
Retrospective Cohort ◽  
Senior Author ◽  
Level Of Evidence ◽  
Lower Blepharoplasty ◽  
Surgical Methods ◽  
Significant Difference ◽  
Before And After ◽  
Midface Lift ◽  
Orbital Rim ◽  
Surgical Group

Abstract Background Numerous methods have been described to treat midfacial aging. The authors compared 2 surgical methods aimed to improve the appearance of midface aging via their ability to improve midface contour: the transtemporal midface lift (with lower lid skin pinch) and lower blepharoplasty with fat transposition. Objectives The authors conducted a retrospective cohort study of all patients who underwent transtemporal midface lift and lower blepharoplasty with fat transposition performed by the senior author (V.Q.) from January 2014 to December 2015. Preoperative and 6-month postoperative profile photos were objectively examined for both surgical groups and compared. A total of 16 patients underwent lower blepharoplasty with fat transposition and 15 patients underwent trans temporal midface lift. Methods For comparison 1, the authors compared the angle at the orbital rim within each surgical group before and after surgery. For comparison 2, the degree of improvement in the midfacial contour was quantitatively compared between the 2 surgical groups. Results This study demonstrated that both procedures achieved a statistically significant improvement in the midfacial contour. There was no statistically significant difference between groups in severity of deformity preoperatively (mean preoperative orbital rim angle 131.5° for lower blepharoplasty group and 132.2° for transtemporal midface lift group, P = 0.90). Degree of improvement between the groups also did not significantly differ (P = 0.28). Conclusions Both approaches (transtemporal midface lift and lower blepharoplasty with fat transposition) can successfully improve the lower lid midface contour, as the authors demonstrated statistically significant improvement at 6 months postoperatively. Level of Evidence: 4

Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty

2021 ◽  
Author(s):  
Per Hedén ◽  
Sebastian Fischer
Keyword(s):  
Online Survey ◽  
Study Groups ◽  
Fat Grafting ◽  
Fat Graft ◽  
The Novel ◽  
Level Of Evidence ◽  
Lower Blepharoplasty ◽  
Novel Technique ◽  
Tear Trough ◽  
Tear Trough Deformity

Abstract Background Lower blepharoplasty is one of the most challenging procedures in aesthetic surgery. In particular, blending the lid-cheek junction and correction of the tear trough are prone to failure and unsatisfactory outcomes. Objectives The aim of this study was to combine lower eyelid blepharoplasty with a novel technique of autologous fat grafting, commonly called segmental fat grafting, and to analyze the safety and efficacy of this approach. Methods A retrospective analysis of 339 lower blepharoplasties was performed to compare the novel technique of segmental fat grafting to traditional fat transposition during lower blepharoplasty. Outcomes were assessed objectively by several measurements as well as via online survey of 148 invited experts in plastic surgery. Statistical analysis included t test for unpaired and paired samples as well as 1-way analysis of variance for matched data. Results There were no differences in baseline characteristics and comorbidities between study groups. After a mean follow-up of 12.9 months (range, 5-120 months), the group that underwent segmental fat grafting had a significant reduction in tear trough width compared compared with the group receiving lower blepharoplasty with fat transposition. Based on an expert (blinded) online survey, segmental fat grafting was superior or equal in 47% and 35% of cases, respectively. Complications (4%) and revision surgeries (9%) did not differ significantly between study groups. Conclusions The novel technique of transplantation of a segmental fat graft during lower blepharoplasty is a safe and effective way to overcome tear trough deformity and blend the lid-cheek junction. Level of Evidence: 4

scholarly journals Lower Eyelid Blepharoplasty

2019 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Side Effects ◽  
Surgical Approach ◽  
Lower Eyelid ◽  
Facial Rejuvenation ◽  
Steady Increase ◽  
Operative Techniques ◽  
Lower Blepharoplasty ◽  
Midface Lift ◽  
Lower Lid Blepharoplasty

The eyelids and periorbital tissues undergo significant changes with aging and often constitute a major concern for those seeking facial rejuvenation. Over the last decade, there has been a steady increase in the demand for lower eyelid rejuvenation. Many techniques and approaches exist to address these concerns, including both noninvasive (filler, lasers, or chemical resurfacing) and invasive (Blepharoplasty or midface lift) procedures. The danger of side effects when performing lower blepharoplasty has kept many patients and physicians away from the surgery, yet advances in lower eyelid blepharoplasty techniques made this procedure more relevant. The exact surgical approach remains controversial and is largely dependent upon surgeon preference and a patient’s cosmetic desire. Here we review the aging changes in the lower lid, indications, preoperative considerations, operative techniques, and complications of lower lid blepharoplasty.

Changes to Eye Whiteness and Eyelid/Brow Position With Topical Oxymetazoline in Aesthetic Patients

2021 ◽  
Author(s):  
Shoaib Ugradar ◽  
Jane S Kim ◽  
Noelle Trost ◽  
Emanuil Parunakian ◽  
Erin Zimmerman ◽  
...  
Keyword(s):  
Color Change ◽  
Color Space ◽  
Ophthalmic Solution ◽  
The United States ◽  
Lower Eyelid ◽  
Secondary Outcome ◽  
Level Of Evidence ◽  
Upper Eyelid ◽  
Before And After ◽  
The Mean

Abstract Background Oxymetazoline hydrochloride 0.1% ophthalmic solution has recently been approved in the United States for the treatment of ptosis. Objectives The aim of this study was to assess the upper and lower eyelid position as well as the brow position and the color of the sclera following the ophthalmic administration of oxymetazoline hydrochloride 0.1%. Methods In this prospective cohort study, consecutive patients presenting with ptosis received topical oxymetazoline 0.1%. The primary outcome was measurement of the upper eyelid height (margin-to-reflex distance 1 [MRD1]) and lower eyelid height (MRD2) relative to the center of pupil, along with assessment of brow height, measured on photographs at baseline and 2 hours after instillation of oxymetazoline. The secondary outcome was the assessment of the color of the sclera (eye whiteness) before and after treatment with a novel color space algorithm. Results Twenty-nine patients participated in the study. The mean [SD] MRD1 at baseline was 2.3 [0.6] mm. At 2 hours following oxymetazoline treatment, the mean MRD1 significantly increased to 4.2 [0.9] mm (P &lt; 0.01). The mean MRD2 also significantly increased from 5.3 [0.9] mm to 5.7 [1.0] mm (P &lt; 0.01). Brow position did not change with treatment (P = 0.4). Following treatment, the eye sclera became significantly whiter, with a mean ΔEab (color change) of 9.7 [3.9], with 57 out of 58 eyes experiencing a significant change in color. A change of ΔEab ≥2 is considered visually perceptible to the human eye. Conclusions Within 2 hours of use, oxymetazoline significantly improves the size of the palpebral aperture (MRD1 + MRD2) and also makes the eye appear significantly whiter. Level of Evidence: 4

Subperiosteal Midface Lift: Its Role in Static Lower Eyelid Reconstruction after Chronic Facial Nerve Palsy

Orbit ◽  
2011 ◽  
Vol 30 (3) ◽  
pp. 140-144 ◽  
Author(s):  
Carlo Graziani ◽  
Claudio Panico ◽  
Giovanni Botti ◽  
Richard J. Collin
Keyword(s):  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Lower Eyelid ◽  
Eyelid Reconstruction ◽  
Lower Eyelid Reconstruction ◽  
Midface Lift

Lower Eyelid and Midfacial Rejuvenation

2011 ◽  
Author(s):  
Chun Cheng Lin Yang ◽  
Richard L. Anderson
Keyword(s):  
Lower Eyelid ◽  
Fat Pad ◽  
Tear Trough ◽  
Aesthetic Unit ◽  
Lateral Canthus ◽  
Age Related ◽  
Crow’S Feet ◽  
The Face ◽  
The Aesthetic ◽  
The Individual

Over the past two and a half decades, techniques for midfacial rejuvenation have evolved. Midfacial rejuvenation has gained significant popularity among many aesthetic surgeons, including the ophthalmic plastic surgeon. Yet rejuvenation of the midface remains a challenge for the aesthetic surgeon who seeks facial harmony. A variety of techniques and approaches are available, yet no single approach is ideal for all patients. It is clear that the age-related anatomic alterations that cause patients to seek rejuvenation vary from patient to patient, and that many patients have more than one anatomic alteration that must be addressed to rejuvenate the lower lid. The surgeon must address the individual needs of each patient for optimal results. It has also become clear that the lower eyelid and midface form a continuum that needs to be addressed in its entirety for optimal rejuvenation. To achieve this, the surgeon must understand the basic concepts important to lower eyelid and midface rejuvenation, which include an understanding of eyelid and midfacial anatomy, an understanding of aging changes of the lower eyelid and midface, and surgical approaches and nonincisional options. A full understanding of aging changes in the lower eyelid and midface is essential to successfully address midfacial rejuvenation. A harmonious facial appearance consists of a balanced relationship among all tissues of the face. With age, disturbance of this harmony among midfacial tissues occurs. The aging process of the midface encompasses the lower eyelid, malar fat pad and associated structures, melolabial fold, and lateral perioral region. Hester describes four important features of midfacial aging: (1) baring of the inferior orbital rim with creation of a hollow valley at the junction of the lower eyelid and cheek; (2) descent of the malar fat pad, with loss of malar prominence; (3) deepening of the tear trough; and (4) exaggeration of the nasolabial fold. The midface represents a crucial aesthetic unit of the face. It is bordered by structures that play major roles in the overall appearances of the face. The lower eyelid and tear trough toward the nose and the lateral canthus and crow’s feet at the superior lateral aspect frame the midface superiorly.

scholarly journals Three Simple Steps for Refining Transcutaneous Lower Blepharoplasty for Aging Eyelids: The Indispensability of Micro-Autologous Fat Transplantation

2019 ◽  
Vol 39 (11) ◽  
pp. 1163-1177 ◽  
Author(s):  
Shu-Hung Huang ◽  
Yun-Nan Lin ◽  
Su-Shin Lee ◽  
Yu-Hao Huang ◽  
Hidenobu Takahashi ◽  
...  
Keyword(s):  
Long Term Results ◽  
Fat Transplantation ◽  
Autologous Fat ◽  
Orbital Fat ◽  
Lower Blepharoplasty ◽  
Tear Trough ◽  
Autologous Fat Transplantation ◽  
The Mean ◽  
Transcutaneous Lower Blepharoplasty

AbstractBackgroundLower blepharoplasty has been used for rejuvenating lower eyelids, and diverse modifications have been used to treat conjunct deformities at the tear trough/lid-cheek junction. Strategies for recontouring prominent tear trough/lid-cheek junctions, including orbital fat manipulation, have been reported with good results in the literature. Micro-autologous fat transplantation (MAFT) is a previously unevaluated, potentially advantageous approach to blending the prominent tear trough/lid-cheek junction.ObjectivesWe determined the long-term results after 3-step transcutaneous lower blepharoplasty with MAFT for patients with aging eyelids and prominent tear trough/lid-cheek junctions.MethodsWe evaluated 205 patients with aging lower eyelids who underwent transcutaneous lower blepharoplasty with MAFT between October 2010 and September 2016. The 3-step procedure involved a subciliary elliptical skin excision, resection of 3 orbital fat compartments, and MAFT for the tear trough/lid-cheek junction employing a MAFT-GUN under intravenous anesthesia.ResultsThe mean patient age was 52 years (range, 34-78 years). The mean operating time was 61 minutes. The mean fat volumes delivered to the tear trough/lid-cheek junctions were 2.80 mL and 2.76 mL for the left and right sides, respectively. The average weights of the 3 resected orbital fat compartments were 0.58 g for the left side and 0.56 g for the right side. Patients showed significant improvement and maintenance at an average follow-up of 60.2 months (range, 18-90 months).ConclusionsThree-step transcutaneous lower blepharoplasty with MAFT is an effective, reliable, and promising method with high patient satisfaction and minimal risk of complications. Long-term results demonstrated its utility for aging lower eyelid treatment.Level of Evidence: 4

Sign in / Sign up

Export Citation Format

Share Document