• Archives of Plastic Surgery
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• v.33 no.3
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• pp.335-340
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• 2006

Lower palpebral bags and tear trough grooves are the common signs of aging. Weakness of the orbital septum, atrophy of the orbicularis oculi muscle, slackness and laxity of the lower lid skin are the main causes of these aging changes. Tear trough groove with skeletonization of the lower orbital rim can not be corrected easily by the conventional lower blepharoplasty, but the augmentation of the volume, can be an effective method. Lower lids provide a well vascularized recipient site, which is vital for proper grafting of fat to occur. We treated tear trough groove with free fat graft of surgically removed orbital fat. Surgical excision of the fat pad and septal reinforcement with free fat graft below the levator labii superioris alaeque nasi muscle were performed to correct tear trough groove. This technique was performed in 29 consecutive individuals from October, 2001 to January, 2005. Palpebral bags and tear trough groove were corrected concomitantly and obtained a youthful attractive midface with no secondary hollowness of lower lid and irregularity. The overall results obtained were satisfactory without any complications. Recurrence of tear trough deformity due to grafted fat absorption was not noted during the 7 months of the follow-up period. The authors conclude that the procedure is safe and effective in selected patients.

• Archives of Plastic Surgery
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• v.43 no.5
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• pp.483-485
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• 2016

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.3-9
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• 2019

Facial nerve palsy has an effect on a person's well-being functionally and psychologically. Therefore, comprehensive patient management is essential. One of the most common uncomfortable and potentially debilitating features is associated with the incapacity for eye closure. Restoration of eye closure is a key consideration during the surgical management of facial palsy. In this article, we introduce simple surgical methods-which are relatively easy to learn and involve the upper and lower eyelids-for achieving eye closure. Correcting upper eyelid function involves facilitating the component of eye closure that is in the same direction as gravity and is, therefore, less complicated and favorable outcomes than correction of lower lid. Aesthetic aspects should be considered to correct the asymmetry caused by facial palsy. Lower eyelid function involves a force that opposes gravity for eye closure, which makes correction of lower eyelid ectropion more challenging than surgery for the upper eyelid, particularly in terms of effecting a sustained correction. Initially, proper ophthalmic evaluation is required, including identifying the chronicity and severity of ectropion. Also, it is important to determine whether or not lateral canthoplasty is necessary. The lateral tarsal strip procedure is commonly used for lower lid correction. However, effective lower lid correction can be achieved with better cosmesis when extensive supporting techniques are applied, including those involving cheek tissue.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.304-310
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• 2005

Bulging of the lower eyelid & tear trough groove is regarded as a sign of aging. In the past, the surgical excision of the fat pad has been the mainstray of the management of lower palpebral bag in cosmetic blepharoplasty, Recently, fat pad sliding method has been introduced to make more attractive lower eyelids. We used the fat pad for covering the hollowness of the lower eye lid. And we use redundant fat pad for filling & augmentation of the lower eye lid by reflexion. Redraping of the orbicularis arc, with its accompanying midfacial fat repositioning, anatomically restores the cheek and lower lid to make more youthful contour. By redraping and fixing the orbicularis arc on the medial surface of the orbital rim, it becomes a more attractive midface and may prevent of ectropion. From August, 2002 to July, 2004 in correction of lower palpebral bulge & tear trough groove, these two technique were performed in 42 consecutive individuals (84 lower eyelid) for two-year period. Follow up ranged from 3 to 15 months. (an average of 9 months) Palpebral bulge & tear trough groove were corrected and obtained a youthful midface. Complication was rare. The advantages of these techniques are that: prevent in of secondary palpebral bulge and irregularity of lower eyelid by using of reflexed fat fad; prevent in of ectropion. Thus an attractive midface is obtained by redraping of orbicularis arc.

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.777-784
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• 2007

Purpose: For a minor degree of mandibular prognathism, mandibular anterior segmental osteotomy (ASO), usually extracting the bilateral premolars, has been performed frequently to correct malocclusion of the anterior teeth. Preoperative planning using cephalometry and a dental model is very important for such a orthognathic surgery. Depending on the specific preoperative mock surgery with the dental model, ASO, with ipsilateral unitooth extraction, is defined to be feasible and performed for ten patients. The comparisons of its preoperative and postoperative analysis of clinical photographs, dental casts, and lateral cephalograms, for soft tissue profiles, skeletal and dental relationships are described in the following, and its clinical applications are noted. Methods: From March 1, 2004, to March 31, 2006, We performed 10 mandibular ASO by extraction of ipsilateral unitooth to improve their lower facial profiles and the lip relationships. Patient age ranged from 19 to 33 years, with a mean age of 25.6 years. Two were males and eight were females. Results: All patients were satisfied with aesthetic and occlusal changes postoperatively. Significant and persistent decrease in the SNB and interincisal angle were observed in the postoperative cephalometries. The soft tissue profiles also were improved and near Ricketts's esthetic line. Other combined procedures include nine genioplasties, two rhinoplasties, and one blepharoplasty. One patient complained of transient unilateral inferior mental nerve paresthesia. There were no other significant complications or relapses throughout the follow-up period(6-20 months). Conclusion: Mandibular ASO, extracting the ipsilateral unitooth, was performed for ten patients to correct mild mandibular prognathism. The amount of setback of the mandibular anterior portion was 2 to 3 mm, and satisfactory results were obtained combined with genioplasties.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.603-609
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• 2013

Background Although the conventional direct brow lift operation provides a simple means of managing lateral brow ptosis, the scars produced have been unacceptable. However, using the modifications proposed here, scarring showed remarkable improvement. This article reviews our experiences with the presented technique, mainly with respect to postoperative scarring. Methods Measured amounts of supra-eyebrow skin and subcutaneous fat were excised en bloc in the conventional manner under 'hyper-hydrated' local infiltration anesthesia. The lower flap and the edge of the upper flap were undermined above the muscular plane, and the orbicularis oculi muscle was directly suture-plicated and suspended upward to the distal frontalis muscle. Skin closure was performed in a basic plastic surgical manner. Results From April 2007 to April 2012, a consecutive series of 60 patients underwent surgery using the above method. The average width of the excised skin was 8 mm (range, 5-15 mm) at the apex of the eyebrow. Preoperative complaints were resolved without occurrence of significant complications. The surgical scars showed remarkable improvement and were negligible in the majority of the cases. Conclusions The direct brow lift operation combined with plication/suspension of the superior and lateral portion of the orbicularis oculi muscle provides a simple, safe, and predictable means of correcting lateral brow ptosis. The scars were acceptable to all of the patients. For proper management of the frontalis tone, upper blepharoplasty and/or repair of eyelid levator function must be considered in addition to brow lift procedures.