Pigmented Lesions of the Eyelid Margin

The eyelid area poses a diagnostic and therapeutic challenge due to its specific anatomy. The eyelid is composed of skin, orbicularis muscle, tarsus, and the eyelid margin is continuous with palpebral conjunctiva. Among pigmented tumors, benign lesions such as epidermal or intradermal nevi, freckles, lentigo, or seborrheic keratosis are the most common. Melanoma is relatively rare in this location. A suspicious lesion may be biopsied or excised. Surgery in the eyelid area requires special considerations to maintain a safe surgical margin, vital function of the eyelid, and acceptable cosmetic effect due to the exposure of the eyelid region of the face.

Surgical correction of severe congenital ptosis using a modified frontalis muscle advancement technique: A single-arm trial

Purpose: To describe our experience with a modified frontal muscle advancement flap to treat patients with severe congenital ptosis. Methods: Analysis of the clinical charts of 154 patients who underwent a modified frontal muscle advancement flap. The FM was exposed by a crease incision. The FM flap was created by deep dissection between the orbicularis muscle and orbital septum from the skin crease incision to the supraorbital margin and subcutaneous dissection from the inferior margin of the eyebrow to 0.5 cm above the eyebrow. No vertical incision was made on the FM flap to ensure an intact flap wide enough to cover the entire upper tarsal plate. Contour, symmetry of height, marginal reflex distance (MRD1), and complications were assessed. Mean follow-up was 10 months. Results: The mean patient age was 7.6 ± 5.6 (range, 2–18) years. The mean MRD1 was 3.2 ± 1.3 mm after the operation. All bilateral cases achieved symmetry and optimal lid contour; 17 unilateral cases were under corrected, with a success rate of 89.0%. Complications such as entropion, exposure keratitis, FM paralysis, frontal hypoesthesia, severe haematoma, and entropion were not observed in our series. Conclusion: A modified frontal muscle advancement flap produced a high success rate with a clear field of vision, mild trauma, and few complications. This technique is relatively simple and should be considered for correcting severe congenital ptosis. Date of registration: 29-03-2020 Trial registration number: ChiCTR2000031364 Registration site: http://www.chictr.org/

A Novel Test of the Duchenne Marker: Smiles After Botulinum Toxin Treatment for Crow’s Feet Wrinkles

Smiles that vary in muscular configuration also vary in how they are perceived. Previous research suggests that “Duchenne smiles,” indicated by the combined actions of the orbicularis oculi (cheek raiser) and the zygomaticus major muscles (lip corner puller), signal enjoyment. This research has compared perceptions of Duchenne smiles with non-Duchenne smiles among individuals voluntarily innervating or inhibiting the orbicularis oculi muscle. Here we used a novel set of highly controlled stimuli: photographs of patients taken before and after receiving botulinum toxin treatment for crow’s feet lines that selectively paralyzed the lateral orbicularis oculi muscle and removed visible lateral eye wrinkles, to test perception of smiles. Smiles in which the orbicularis muscle was active (prior to treatment) were rated as more felt, spontaneous, intense, and happier. Post treatment patients looked younger, although not more attractive. We discuss the potential implications of these findings within the context of emotion science and clinical research on botulinum toxin.

Subbrow Lift Using Frontalis Sling to Correct Lateral Orbital Laxity

Background In order to correct upper lid laxity, upper blepharoplasty, subbrow excision, and forehead lift have been utilized. Our newly developed subbrow excision attaches the orbicularis oculi muscle to the frontalis muscle. This improves the longevity of the result without inhibiting the gliding plane of the periorbita. Method From January 2016 to July 2018, 564 patients were operated on using this technique. Among them, 41 were male and 523 were female with the average age of 59.5 years. The average size of the subbrow excision was 55 mm × 8 mm. From the upper skin incision site, the upper dissection proceeded cephalad in the subcutaneous plane just above the orbicularis oculi muscle to the point where the frontalis muscle was seen. The lower flap was created by incising the orbicularis oculi muscle 5 mm cephalad to the distal skin incision. From this 5-mm orbicularis muscle stump, the dissection proceeded caudally in a plane between the orbicularis muscle and the orbital septum. Once this flap was created, the 5-mm muscle stump was attached to the exposed frontalis muscle in a horizontal mattress fashion in three areas. The skin incision was then closed. Three months after the operation, a satisfaction survey was conducted using the Likert scale. Results The patients were followed postoperatively for at least 6 months. In all but two cases, the orbital laxity improved. However, in the brow’s lateral third where the frontalis muscle does not exist, a slight lowering of the brow had occurred. The incision healed well without any keloid or hypertrophic scars. There were no significant complications such as superior orbital nerve entrapment-related sensory problems. Conclusions Subbrow lift utilizing the frontalis muscle attachment to the lower flap orbicularis muscle is a novel method of correcting upper eyelid skin hooding. The technique does not rely on periosteal fixation. Therefore, the eyebrow gliding plane is not violated. Thus, the natural eyebrow movement is maintained. There were no cases of injury to the deep branch of the supraorbital nerve, poor wound healing, or other significant complications. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cleft Lip

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review. This review contains 16 figures, 3 tables, and 119 references. Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Treatment of Entropion – A modified Technique

Purpose: To study the results of a modified technique of Entropion correction at a Tertiary care hospital.Study Design: Quasi experimental study.Place and Duration of Study: Layton Rahmatullah Benevolent Trust (LRBT), a tertiary care teaching Eyehospital, Korangi, Karachi, for a duration of six months, from January 2018 to June 2018.Material and Methods: Patients with senile entropion were included in the study. Patients with recurrententropion, cicatricial entropion, chronic/acute ocular and adnexal infection were excluded. Three equally spaceddouble-armed 6–0 vicryl horizontal mattress sutures were used to close the skin and orbicularis muscle of thewound with a bite of the retractors in the center and a 5 mm silicone tube bolster place in the superior loop. Postoperativetreatment of antibiotics, anti-inflammatory drugs and topical lubricant eye gel were given. Patients wereexamined on 11stpost operative day and then weekly interval for up to one month and thereafter every month forup to six months.Results: There were 40 eyes of 30 patients with ages ranging from 50 to 65 years. Twenty (66%) patients hadunilateral repair and 10 (33%) had bilateral repair done. No recurrence was seen in 39 (97.5%) eyes at the endsix months after surgery. Out of the 40 patients, only 2 (5%) patients complained of heaviness which went awayeventually with the disintegration of the external tamponade.Conclusion: This modified technique of entropion repair using skin excision with retractor plication in the woundhas a favorable outcome with minimum recurrences and complications.

Effect of Orbicularis Muscle Resection during Blepharoplasty on the Position of the Eyebrow

Dermatochalasis is a skin excess in the upper eyelid which may be associated with either an aesthetic and functional defect, blocking the peripheral vision. Upper blepharoplasty is the gold standard procedure for correction of dermatochalasis and to restore youthful contours to the periorbita. It is one of the most commonly performed procedures in aesthetic plastic surgery; however, there is still a lack of consensus about this procedure. The excess skin is sometimes removed alone or in conjunction with a strip of orbicularis oculi muscle. The rationale for both muscle and skin resection or skin alone preserving the muscle is uncertain. Some authors have studied the aging influence in brow position, and a few studies pointed out the influence of the upper blepharoplasty on brow height. The true effects, regarding the position of the eyebrow, of both techniques, with or without resection of the preseptal orbicularis oculi muscle, are unclear. The authors present a review of the literature to find the rationale for resecting or preserving the orbicularis oculi muscle in upper eyelid blepharoplasty and its relation to eyebrow position.