• Archives of Plastic Surgery
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• v.50 no.2
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• pp.142-147
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• 2023

Some of Asian eyelids have double fold and some do not. Many people tend to prefer double eyelid in aesthetic and functional reasons. Since the mechanism of double eyelid is bonding the eyelid skin to the eye-opening tissue, the principle of double eyelid surgery is also connecting the eyelid skin to levator component. Double eyelids are differentiated by their shape according to the height and curvature. The double eyelid surgery procedure is divided into incision method and nonincision method. And the incision method is subdivided into double fold line design, skin and oculi muscle incision or excision, pretarsal or preaponeurotic soft tissue excision, fixation of posterior lamella to anterior lamella, and skin suture. The nonincision method is to connect the posterior lamella and the anterior lamella as a thread only without an incision. A successful double eyelid surgery creates a fold well-balanced in height, curvature, and depth of the fold based on patient's preference. In this article, the author's own methods of performing surgery are described, with a step-by-step guide and surgical tips.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.10
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• pp.4265-4269
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• 2015

Introduction: The aim of the study was to explore the distribution of eyelid tumors in Ankara, the capital city of Turkey, from a histopathological point of view. Materials and Methods: Medical records of 1,502 patients who had eyelid surgery because of tumoral lesions were retrospectively reviewed after obtaining institutional review board approval. A total of 1,541 lesions with histopathologic diagnosis were included. Inflammatory tumoral lesions were excluded. The lesions were categorized into three groups according to the origin: epidermal, adnexal tumors and 'others', including melanocytic, neural and vascular lesions. Results: Of the total of 1,541, 908 lesions were epidermal in origin. Only 22 (1.5%) were malignant, and 6.0% was premalignant lesions such as actinic keratosis and Bowen's disease. Twenty-one of 22 malignant lesions were basal cell carcinoma. There was only one patient with squamous cell carcinoma and no sebaceous cell carcinoma. Among the benign tumors (92.5%), squamous papilloma was the most frequent (21.8% of all lesions). The other frequent lesions were nevus (17.6%), seborrheic keratosis (17.3%), hydrocystomas (10.6%), xanthelasma (7.6%) and epidermal cysts (7.2%). Conclusions: The results of this study are in accordance with published literature. The absence of sebaceous cell carcinomas needs to be stressed.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.581-588
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• 2008

Purpose: It is generally accepted that anatomical structures of the soft tissue in Asian faces are quite different from those in Caucasian. It is presumed that these differences are due to collagen rich thick dermis and durable superficial musculo-apponeurotic system (SMAS) in Asian. We classified the aging lower eyelids and reviewed the operative procedures according to the types of aging lower eyelids in Asian. Methods: We compared preoperative and postoperative photos of 117 patients over 30 years of age, who underwent lower blepharoplasty at the Kyunghee Medical Center from January 2001 to April 2006. We classified the patients based on the degree of skin laxity, presence of nasojugal groove and malar bag, the extent of aging process. We also reviewed the operative procedures according to each type of classification. Results: We classified our patients into four types as following. Type I patients showed minimal skin-muscle excess confined to lower eyelids regardless of the facial line. For these patients, we performed only transcutaneous or transconjunctival blepharoplasty. In type II patients, nasojugal grooves were shown and skin- muscle laxity was limited to the medial side of imaginary vertical line at lateral margin of pupil. In these cases, we performed free fat graft or fat repositioning on nasojugal groove or fat removal and septal duplication confined to medial side. Type III patients displayed more advanced medial bulging and remarkable laxity over the lateral side, the same operation methods as those of type II were applied at the lateral side of the line. Type IV patients demonstrated extensive midfacial aging changes including malar bags and underwent superficial subciliary cheek lift. Conclusion: The lower eyelid aging of Asian is different from those of Caucasian. We think that our classification is useful in selection of appropriate operative procedure to address specific problems for Asian patients.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.7
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• pp.3643-3646
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• 2016

Management of eyelid cancers is based on surgery and/or radiotherapy (RT). The treatment objective is to control tumors with acceptable functional and esthetic outcomes. The aim of this study was to evaluate the results of radiation therapy in management of epithelial eyelid cancers, reviewing retrospectively the clinical records of patients treated in our institution from January 1989 to December 2013. We focused on clinical and histological features, treatment characteristics, tolerance and disease control. One hundred and eight patients (62 men and 46 women) were enrolled, with a mean age of 61 years [ranges 15-87]. The most frequent tumor location was the inner canthus (42.6%). Median tumor size was 21 mm [ranges 4-70]. Histological type was basal cell carcinoma in 88 cases (81.5%), squamous cell carcinoma in 16 (14.8%) and sebaceous carcinoma in 4 (3.7%). Radiation therapy was exclusive in 67 cases (62%) and post-operative for positive or close margins in the remaining cases. Kilovoltage external beam radiotherapy (KVRT) was used in 63 patients (58.3%) and low-dose-rate interstitial brachytherapy in 37 (34.3%). Eight (7.4%) were treated with cobalt or with a combination of KVRT-cobalt, KVRT-electron beams, KVRT-brachytherapy or cobalt-electron beams. The total delivered radiation doses were 70 Gy (2 Gy/fraction) in 62 patients (57.4%), 66 Gy (2 Gy/fraction) in 37 (34.3%) and 61.2 Gy (3.4Gy/fraction) in 9 (8.3%). After a median follow-up of 64 months, we noted 10 cases of local recurrences(9.2%): 7 after exclusive and 3 after post-operative RT. No local recurrence occurred in patients treated with brachytherapy. Actuarial 5-year local recurrence-free rate, disease-free survival and overall survival were respectively 90%, 90% and 97%. T-stage was found to be a significant factor for recurrence (p=0.047). All acute radiation-related reactions were scored grade I or II. Delayed effects were eye watering in 24 cases (22.2%), eye dryness in 19 (17.6%), unilateral cataract in 7 (6.4%) and ectropion in 4 (3.7%). Radiation therapy and especially brachytherapy is an efficient treatment of eyelid cancers, allowing eye conservation and functional preservation with good local control rates and acceptable toxicity.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.299-303
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• 2005

The epicanthal fold is common natural finding in Asian eyes. It is very common that patients, who look for oriental blephaloplasty for double eye lid, request correction epicanthal fold. It is very often difficult to achieve satisfactory results if the correction of the epicanthal fold is not corrected concomitantly. Many authors described surgical procedures for correction of epicanthal folds. But most of them leave additional scars which tend to be hypertrophic and noriceable. We achieved satisfactory result in epicanthoplasty with invisible scar, using combination of procedures, such as upward incision, double eyelid operation, anchoring suture of the medial upper lid skin to the medial canthal tendon, trans-nasal root subcutaneous mattress suture of the epicanthal fold itself and combined rhinoplasty. For past six years (1998 to 2003) 17 patients have been operated with one of these mentioned procedures. The mean follow up was 4months (2weeks to 6months). All patients were satisfied and no major complication was noted. This method can be one of the effective procedures for correcting the Asian epicanthal fold for avoiding potential visible scar and ancillary procedure in double eye lid blephaloplasty.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.200-204
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• 2009

Purpose: The epicanthal fold is a unique finding in the medial canthal area of many Asians. Various methods have been developed to eliminate this fold. However, excessive and prominent scarring in the medial canthal and nasal area and recurrence restricted application of epicanthoplasty. The authors performed a epicanthoplasty using Y-V advancement flap method in order to obliterate the epicanthal fold without making incisions in the nasal area and as a result, to avoid postoperative scarring. Methods: Sixty one patients underwent epicanthal fold correction using Y-V advancement flap method from July 1999 to February 2005. There were 4 males and 57 females with ages ranging from 9 to 60 years. The epicanthoplasty was performed combined with double eyelid operation, ptosis correction, augmentation rhinoplasty, nasal alar reduction, and nasal tip-plasty. Results: There were few complications in our studies, and most of the patients were satisfied with the results. Conclusion: Remarkable advantages of our Y-V advancement flap epicanthoplasty are as follows: 1) minimal postoperative scarring in the medial canthal area, 2) application of modified double eyelid operation, 3) wider opening of the medial palpebral fissure, 4 the correction of entropion or epiblepharon, 5) no recurrence.

• Archives of Craniofacial Surgery
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• v.20 no.3
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• pp.158-163
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• 2019

Background: Age-related changes in facial skin is a major concern in women. This study aimed to objectively evaluate normal skin elasticity and age-related differences in the faces of East Asian women. There are no standard values for data related to normal skin on East Asian women. Methods: We studied 129 healthy East Asian women without a history of cosmetic procedures or surgeries. Skin elasticity was assessed at the cheek and lower eyelid points, which were assessed on both the right and left sides of the face. Results: The age of the subjects showed significant negative correlations with the R2 and R7 parameters, which represent skin elasticity after deformation. Conclusion: We therefore concluded that the primary decrease in skin elasticity in East Asian women occurs in the midface region.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.521-524
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• 2006

Purpose: The history of biometry dates back to ancient Greek. The ideal body ratio from biometry is used as a guideline in many works of art. Biometry is also used as a medical standard to determine normal or abnormal. Since the biometry of face is so complicated, many surgeons tend to regard preoperative evaluation as a bother and substitute medical records with some photographs. We introduce a new method to measure $MRD_1$ and levator function using digital photographs, which becomes widely used lately. Methods: $MRD_1$ can be measured with the primary-gaze-view photo which is magnified by PhotoshopR 7.0.1. The distance from coneal reflex of ring flash to upper eyelid margin is converted to mm-unit using the piece of ruler attached on the patient's face. Levator function can be measured with up-gaze-view photo and down-gaze-view photo which are superimposed on another. The excursion distance of upper eyelid margin (a) and the excursion distance of eyebrow (b) are measured respectively. The levator function can be assessed through subtraction of two values (a-b). This method is simple and precise and can be applied directly to patient without photos. Results: Using magnified digital photos and computer, this method can reduce personal error and instrumental error. Taking some digital photos doesn't take long time, so it can reduce the effort of preoperative evaluation and discomfort of patients. Conclusion: Digital photo-biometry is useful for retrospective study. Especially reducing personal error, it is useful when the number of specimens is huge. New levator function test is much more useful for Asian-specific eyes than Berke's method allowing frontalis muscle compensation.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6761-6763
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• 2015

Aims: To investigate the role of swelling anesthesia in repairing facial soft tissue defects after tumor resection and temporal superficial artery frontal branch of narrow pedicle flap. Materials and Methods: From January 2008 to June 2008, 16 patients from Department of Ophthalmology with eye or eyelid tumors after eyeball removal of eye and part resection of surrounding soft tissue, undergoing postoperative swelling anesthesia with superficial temporal artery flap repair to prevent facial soft tissue defect formation and bone exposure, were recruited. Results: In all 16 patients facial soft tissue defect repair had good effects, with limited bleeding, and short operation times. Seven days after surgery, all flaps were in good repair. On postoperative follow-up after 3 months, flaps showed a similar appearance as with facial tissue. Conclusions: Swelling anesthesia for superficial temporoparietal artery frontal branch of narrow pedicle flap to repair soft tissue defect after facial tumor resection is feasible, and is linked with good analgesic effects, high postoperative survival of skin flaps, and good cosmetic effects.

• Asian-Australasian Journal of Animal Sciences
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• v.23 no.10
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• pp.1364-1368
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• 2010

Gnotobiotic piglets (n = 10) were hand-reared in conventional germ-free facilities. Piglet body temperatures were measured with rectal and non-contact infrared thermometry (NIFT) on the lower eyelid, auricular center and margin, parietal regions, axilla, central abdomen and dorsum, and the perianal region. Body temperature measurements at central abdomen, cranial dorsum, and perianal regions had NIFT values which had a significant linear relationship (p<0.0001) with rectal thermometry. The predicted equations of between-subject formulas were calculated as follows: rectal temperature, 28.07489+0.30372${\times}$central abdominal surface temperature; rectal temperature, 34.02799+0.15197${\times}$central dorsum surface temperature; and rectal temperature, 33.87937+0.15676${\times}$perianal temperature. These results suggested that NIFT could serve as a valid alternative to rectal thermometry in a portable germ-free facility without disturbing experimental animals. The development of a NIFT body temperature evaluation that does not require animal restraint is clinically advantageous, particularly in gnotobiotic piglets, and would be significantly less stressful for experimental procedures in germ-free facilities.