Re: “Transconjunctival lower eyelid blepharoplasty with fat transposition above the orbicularis muscle for improvement of the tear trough deformity”

AbstractThere is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal filling material, and proper understanding of the anatomy of this unforgiving region will contribute to a safe, effective, and natural result. We aim to conduct a systematic review of published literature related to soft tissue fillers of the tear trough and infraorbital region. A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. The Medical Subject Headings (MeSH) terms used were “tear trough” OR “infraorbital” AND “dermal filler” OR “hyaluronic acid” OR “poly-L-lactic acid” OR “calcium hydroxyapatite” OR “Restylane” OR “Radiesse” OR “Perlane” OR “Juvéderm” OR “Belotero.” Different combinations of these key terms were used. The initial search identified 526 articles. Six additional articles were identified through references. Two-hundred twenty-five duplicates were removed. A total of 307 studies were screened by title and abstract and 258 studies were eliminated based on inclusion and exclusion criteria. Forty-nine articles underwent full-text review. The final analysis included 23 articles. Patient satisfaction was high, and duration of effect ranged from 8 to 12 months. Restylane was most commonly used. Injection technique varied, but generally involved placing filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim via serial puncture or retrograde linear threading with a 30-gauge needle. Topical anesthetic was most commonly used. Side effects were generally mild and included bruising, edema, blue–gray dyschromia, and contour irregularities. Nonsurgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with excellent patient satisfaction with long-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications.

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Filler Injection for Tear Trough Deformity

Cosmetic Injection Techniques : A Text and Video Guide to Neurotoxins and Fillers ◽

10.1055/b-0034-64052 ◽

2013 ◽

Keyword(s):

Filler Injection ◽

Tear Trough ◽

Tear Trough Deformity

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Lower Eyelid and Midfacial Rejuvenation

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0035 ◽

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.

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Management of Entropion and Trichiasis

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0012 ◽

2011 ◽

Author(s):

David H. Verity ◽

Geoffrey E. Rose

Keyword(s):

Ocular Surface ◽

Lower Eyelid ◽

Complete Loss ◽

Secondary Effects ◽

Orbicularis Muscle ◽

Eyelid Margin ◽

Ocular Irritation ◽

Age Related ◽

Causative Factors ◽

Gentle Traction

Entropion is a posterior rotation of the upper or lower lid margin against the globe; the causes include involutional changes within the eyelid tissues or cicatricial shortening of the posterior lamella of the eyelid. Congenital lower lid entropion is rare and results from an excess of skin and orbicularis oculi muscle being only loosely attached to the eyelid retractors. The symptoms of entropion—which include ocular irritation, lid spasm, pain, redness, and watering—are worse in the presence of a keratinized lid margin (occurring in cicatricial disease) and where the ocular surface is compromised. Discomfort may lead to secondary blepharospasm, which exacerbates the entropion by causing the preseptal part of the orbicularis muscle to override the pretarsal component. The eyelids and globe should be examined to identify underlying causative factors—in particular the degree and position of tissue laxity, the position of the eyelid margin and lashes, and the thickness of the tarsus. Any secondary effects of entropion, both within the lid and on the ocular surface, should also be noted. 7-1-1 Tissue Laxity. Aging of collagen and the force of gravity leads to eyelid laxity and an excess of tissues, particularly the anterior lamella of the lid. Stretching of the orbicularis muscle and canthal tendons results in horizontal laxity, and eyelid stability is further compromised by enophthalmos due to age-related fat atrophy. Where there is a relative dissociation between the anterior and posterior lamellae, the preseptal orbicularis muscle overrides the pretarsal muscle, leading to eyelid inversion, and this effect is exacerbated both by laxity of the lower lid retractors and age-related tarsal atrophy. Tissue laxity in the absence of orbicularis overriding tends to cause ectropion; with complete loss of retractor action, this can result in complete eversion of the tarsus (“shelf ectropion”). Horizontal laxity of the eyelid tissues is assessed by grasping the lid skin and applying gentle traction in the appropriate direction. The overall horizontal laxity is judged by the extent to which the eyelid can be parted from the globe—greater than about 6 mm is abnormal for a lower eyelid—and by the speed with which the retracted lid returns to the surface of the globe (the “spring-back” test).

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Facial Gender Differences in Nonsurgical Treatments and Treatment of the Tear Trough Deformity

Trends and Techniques in Aesthetic Plastic Surgery ◽

10.1016/b978-0-323-75710-2.00010-x ◽

2022 ◽

pp. 91-100

Author(s):

Lina Triana ◽

Fabian Cortinas

Keyword(s):

Gender Differences ◽

Tear Trough ◽

Tear Trough Deformity

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Successful treatment of lower eyelid epiblepharon by injection of botulinum toxin A in patients under two years of age

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i2.8709 ◽

2013 ◽

Vol 5 (2) ◽

pp. 177-181 ◽

Cited By ~ 7

Author(s):

CY Chen ◽

Angel Nava-Castaneda

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Clinical Signs ◽

Signs And Symptoms ◽

Type A ◽

Botulinum Toxin Type ◽

Lower Eyelid ◽

Rank Test ◽

Orbicularis Muscle

Introduction: Epiblepharon is characterized by a cutaneous horizontal fold adjacent to the lid margin. Some cases showed spontaneous resolution, others required surgical treatment. We propose a medical treatment with botulinum toxin type A (BTX-A). Objective: To provide clinical evidence of the usefulness of botulinum toxin type A (BTX-A) in patients with lower eyelid epiblepharon. Subjects and methods: This was a prospective, non-randomized, nonmasked study. Patients with lower eyelid epiblepharon with corneal eyelash contact were included in the study. The scale proposed by Khwarg & Lee (1997) was used to assess the epiblepharon clinical evaluation. A single dose of 12.5 IU of BTX-A (Dysport ®) was directly injected into the medial pre-tarsal orbicularis muscle region in the lower eyelid. Patients were evaluated before the injection and at 1, 4, 12 and 24 weeks after the injection. We performed descriptive statistics and Wilcoxon Signed Rank Test, comparing prior injection measurements to post injection measurements at the 24th week. A p < 0.05 was considered statistically significant. Each eye was separately analyzed. Results: Fourteen eyes of seven Hispanic patients were treated, five female and two male. The mean age was 8.4 months (4 - 14 months). The height of the skin-fold, the area of the cornea touched by the cilia and the symptoms score improved after the first week of BTX-A injection and remained so until the end of study (p < 0.05). No major complications were noted. Conclusion: The effect of a single 12.5 IU injection of BTX-A (Dysport ®) into the medial orbicularis muscle portion in the lower eyelid epiblepharon patients successfully improves the clinical signs and symptoms. Nepal J Ophthalmol 2013; 5(10): 177-181 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8709

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