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Anatomy of the Forehead and Periocular Region
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Marcelo B. Antunes, Stephen A. Goldstein
The anterior hairline is also aesthetically important. The ideal hairline creates a balanced face when it is divided into horizontal thirds. A naturally low hairline will shorten the upper third and is best addressed surgically. A receding and thinning hairline tends to lengthen the forehead and contribute to the perception of aging. An increasing distance between the hairline and eyebrows is a visual sign of aging. The earliest signs of an aging eyebrow include glabellar and horizontal rhytides typically starting in the early thirties. As people age, actinic skin changes in combination with weakening support of the soft tissue of the upper face continue to contribute to the visual signs of aging. Clinically, this presents as dermatochalasis of the upper eyelids. The forehead rhytides become more defined as the frontalis muscle attempts to compensate for progressive descent of the eyebrows. Eyebrow descent adds to excess skin and lateral hooding of the eye (1). The orbital fat then breaks through the orbital septum in the upper eyelid causing mechanical eyelid descent and fat pad herniation. The combination of these age-related changes creates a tired or angry appearance.
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Dermatochalasis describes a common, physiologic condition seen clinically as sagging of the upper eyelid skin. It is typically bilateral and most often seen in patients over 50 years of age, but it may occur in some younger adults. Examination of these patients’ eyelids reveals redundant, lax skin with poor adhesion to the underlying orbicularis oculi muscle. An excess fold of skin in the upper eyelid is characteristic, which obscures the normal upper eyelid skin crease which may be lost (Figure 87.24). This patient complained of visual field limitation and headaches towards the evening (due to frontalis muscle fatigue).
How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
In epiblepharon there is excess pre-tarsal skin and orbicularis oculi. This can cause misdirection of the eyelashes, resulting in corneal irritation and punctate keratitis. Dermatochalasis is seen in the elderly due to excess upper lid skin. Overhanging of the skin can cause superior visual field defects. Blepharochalasis affects younger people with recurrent inflammation and swelling of the upper lid. This can lead to loosening of the skin and levator dehiscence. It is not caused by allergy. Floppy eyelid syndrome typically affects middle-aged overweight males. The upper lid everts easily during sleep, causing mechanical irritation. Chronic papillary conjunctivitis and punctate keratitis are common. Brow ptosis can be involutional or the result of facial nerve palsy.
Upper blepharoplasty: advanced techniques and adjunctive procedures
Published in Expert Review of Ophthalmology, 2023
Parya Abdolalizadeh, Mohsen Bahmani Kashkouli, Vahid Khamesi, Nasser Karimi, Hossein Ghahvehchian, Leila Ghiasian
Dermatochalasis refers to loose and redundant eyelid skin. Upper blepharoplasty (UB) procedure is the gold-standard procedure to correct dermatochalasis [1]. It includes excision of excess eyelid skin in conjunction with orbicularis oculi muscle (OOM) and orbital fats. The procedure is performed at different ages, for either esthetic or functional purposes [2]. According to the Esthetic Society 2019 statistics, blepharoplasty is the fifth most commonly performed esthetic surgery and the most common cosmetic surgery among patients older than 65 years in the United States [3]. A survey of American Society of Ophthalmic Plastic and Reconstructive Surgery showed that only 30% of blepharoplasty cases are purely esthetic and 70% of the patients underwent surgery due to functional problems in the United States [2]. This is in contrast to Iran (with a younger population pyramid), for example, where most blepharoplasty and eyebrow procedures are esthetic [4–9].
The Histopathological Findings of Patients Who Underwent Blepharoplasty Due to Dermatochalasis
Published in Seminars in Ophthalmology, 2018
Ali Karnaz, Yasemin Aslan Katircioglu, Evin Singar Ozdemir, Pınar Celebli, Sema Hucumenoglu, Firdevs Ornek
The dermatochalasis group included 24 (68.6%) females and 11 (31.4%) males with an average age of 55.4 ± 9.248 (37–76) years; the control group included four (40%) females and six (60%) males with an average age of 61.80 ± 12.96 (44–82) years. There were no significant differences between the groups in terms of demographic characteristics (gender: p = 0.170; age: p = 0.139). The number of dilated lymphatic vessels, largest lymphatic vessel diameter, depth of stromal collagen bed, interfibrillar edema, number of elastic fibers, and number of macrophages between the study and control groups are shown in Table 1.
Efficacy of tarsoconjunctivomullerectomy in adults with acquired aponeurogenic blepharoptosis: a large single-surgeon case-series
Published in Orbit, 2023
Hrvoje Kovacic, René J Wubbels, Dion Paridaens
We included 243 patients, of whom 178 were treated with unilateral and 65 with bilateral TCM. Baseline demographics are summarised in Table 1. Of the 243 patients, 44 had undergone previous ptosis surgery elsewhere. Of these patients, four had been treated with a TCM, 27 with an anterior levator reinsertion (ALR), and 13 with a combination of ALR and blepharoplasty. Another 22 patients had either developed or been diagnosed with ptosis after upper eyelid dermatochalasis correction. Since we presumed no causal relation between dermatochalasis correction and the occurrence of ptosis, they were not included as reoperation.