Anatomy of the Forehead and Periocular Region
Neil S. Sadick in Illustrated Manual of Injectable Fillers, 2020
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
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in 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).
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].
Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations
Published in Seminars in Ophthalmology, 2021
Sirisha Senthil, Mamata Nakka, Virender Sachdeva, Shaveta Goyal, Nibedita Sahoo, Nikhil Choudhari
b) Dermatochalasis can also lead to apparent superior field defect: The defects are superior, with deeper defects in the superior-temporal quadrant. This occurs due to the excessive fold in the loose skin of the upper lid, and is more common on the temporal side.58 The temporal field defects may also extend below the horizontal midline, involving the inferior temporal field. This leads to mechanical obscuration of light causing a field defect. These defects disappear when the test is repeated with the skin on the upper lid taped or after surgical correction of the dermatochalasis. The optic disc evaluation in these eyes is normal, which indicates that the visual field defect could be due to a non-glaucomatous cause. Other less common causes that could lead to artifactual visual field defects in the superior field area are prominent nasal bridge or prominent brow.59
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
This study was approved by the ethics committee of Ankara Training and Research Hospital (Ankara, Turkey) and it conforms to the principles of the Declaration of Helsinki (2008). We performed histopathological evaluation of 70 eyelids of 35 patients who were admitted to our clinic’s Oculoplastic Surgery Division and underwent blepahroplasty surgery for dermatochalasis between 2010 and 2014. Ten eyelids of 10 patients who underwent eyelid surgery without showing any clinical signs of DC were enrolled as the control group. Four patients in the control group underwent lower eyelid neoplasm excision, three upper eyelid neoplasm excision, two lower eyelid ectropion, and one ptosis surgery. For the patients who underwent tumor excision, the histopathological examination was done at the areas of intact surgical borders. Patients with a history of congenital soft tissue disease, surgery, or trauma were excluded from the study. Eyelid samples were histopathologically evaluated for lymphatic vessel density, largest lymphatic vessel diameter, depth of collagen bed, inter-fibrillar edema, elastic fiber density, collagen fiber density, and number of macrophages. All eyelid samples were examined by a single pathologist.
Related Knowledge Centers
- Blepharitis
- Blepharoplasty
- Connective Tissue Disease
- Cutis Laxa
- Eyelid
- Meibomian Gland
- Orbital Septum
- Skin
- Entropion
- Ehlers–Danlos Syndromes