上睑成形术治疗睑松弛症

目的　探讨睑松弛症与上睑皮肤松垂症的鉴别诊断与手术要点。方法　根据上睑解剖特点,利用改良的上睑成形术治疗睑松弛症。结果　手术治疗睑松弛症15例,随访2～5年,治愈率93%。结论　睑松弛症与上睑皮肤松垂症临床常易混淆,明确诊断后应用改良手术方法治疗,效果确切,复发率低。     

上睑成形术治疗睑松弛症

目的　探讨睑松弛症与上睑皮肤松垂症的鉴别诊断与手术要点。方法　根据上睑解剖特点 ,利用改良的上睑成形术治疗睑松弛症。结果　手术治疗睑松弛症 15例 ,随访 2～ 5年 ,治愈率 93 %。结论　睑松弛症与上睑皮肤松垂症临床常易混淆 ,明确诊断后应用改良手术方法治疗 ,效果确切 ,复发率低。     

The surgical management of childhood orbito-temporal neurofibromatosis.

PURPOSE: (1) To describe the natural history, changing manifestations and new signs of orbito-temporal neurofibromatosis (NF) during childhood and puberty. (2) To describe the surgical treatment and recommend guidelines for management of this condition in children compared to adults.Methods. Retrospective case note and serial photographic review. RESULTS: There were 9 patients (5M, 4F) with orbito-temporal NF who were children (<16 years) at the time of first presentation with a minimum of 5 years follow up. All the patients had unilateral periorbital neurofibromatosis with blepharoptosis, orbital enlargement and hypoglobus. All nine patients underwent blepharoptosis surgery. Eight patients underwent neurofibroma debulking (and lid shortening) and lateral canthal reattachment. Three had enucleation of their blind eyes. Seven patients had two or more operations for their orbito-palpebral deformities. New signs included conjunctival and lacrimal gland infiltration with a secondary dry eye. CONCLUSION: Blepharoptosis surgery is indicated if the visual axis is compromised and there is a chance of limiting amblyopia. Definitive surgery for appearance is best delayed until the age of 18 years, or when the disease progression has stabilised, unless there are compelling social reasons for earlier surgery.     

Blepharoplasty in Japan

About 90% of blepharoplasties performed in Japan include the double eyelid procedure. The reasons for the popularity of this procedure relate to changing concepts of beauty among the Japanese people. Facial anatomy contributes to the appearance of sleepiness and lethargy in the flat, monotone Japanese face. The narrower eye opening does not allow for the maximum viewing of the cornea. The shortened lateral canthus presents a facial balance that is not considered as attractive as one with an extended lateral canthus. The double eyelid procedure corrects these features, producing a face that is considered more beautiful.Presented at the 20th Instructional Course of International Society of Aesthetic and Plastic Surgery at Uppsala, Sweden, March, 15–17, 1983     

Celebrity Arcade Suture Blepharoplasty for Double Eyelid

Background In Taiwan, double-eyelid surgery is the most popular cosmetic surgical procedure. The technique preferred by plastic surgeons is the incision method because it is believed that this method can provide stable double-eyelid results. It is the authors’ observation that patients prefer an invagination fold rather than a significantly high fold. Suture blepharoplasty may create a relatively even and symmetric invagination fold. In the past, the major disadvantage of the suture technique has been the opinion that the double fold fades away. Methods The celebrity arcade suture (CAS) technique was applied in double-eyelid operations. The CAS technique includes three major techniques: stabbing incision, transtarsal suture, and bridge connection. The whole procedure can be completed in 15 min. From June 2001 to November 2004, 312 patients underwent the CAS technique. Results Of the 312 patients who underwent the CAS technique, 5 required a revisit, with 3 of these returning patients reporting fold disappearance. These three patients received repeat suture procedures. Conclusions The findings show that the CAS technique is a reliable method for establishing a smooth, constant, and symmetric double eyelid, and that CAS requires only a short recovery time.     

Peribulbar Anesthesia for Blepharoplasty

Background Peribulbar anesthesia for inferior blepharoplasty was used successfully in 788 selected cases over the past 9 years. This technique is largely accepted for ophthalmologic procedures, but is not yet specifically used for blepharoplasty. Methods In the past 9 years, 788 patients ages 36 to 77 years were submitted to inferior peribulbar anesthesia for blepharoplasty procedures. Of these patients, 623 (79%) were women and 165 (21%) were men. The anesthetic procedure is performed using a needle introduced at the junction of the medial two-thirds and the lateral third of the inferior orbital rim (point A). With the patient staring forward, the needle is introduced through the lid at point A. It enters the orbital cavity just above the orbital floor periosteum until the globe equator is minimally trespassed (depth, ∼31 mm). There, 3 ml of the local anesthetic solution (2% lidocaine + 0.5% bupivacaine) is slowly injected. Results None of our treated patients reported pain or discomfort during or after the surgical procedure. Immediately after inferior peribulbar anesthesia, chemosis was observed in 17 cases (2.2%) and orbital hematoma in 3 cases (0.4%). Diplopia, or a slight imaging distortion lasting a few hours may occur after inferior peribulbar anesthesia. Conclusion Inferior peribulbar anesthesia for blepharoplasty offers surprising results. The surgical procedures are performed pain free, leaving the patients completely relaxed and allowing an easier surgical procedure. This technique should be performed only by highly skilled anesthesiologists or surgeons with a perfect knowledge of the complex orbital anatomy.     

Blepharoplasty. Surgical versus chemical—Surgical plus chemical

The decision of whether to perform a blepharoplasty is based upon consideration of a number of physical characteristics, including the presence of excess eyelid skin, of thick rugal folds, and of pads of herniated periorbital fat. Patients whose problem is thick rugal folds wil benefit most from a facelift and chemical peel; for those with weathered skin alone, a chemical peel may be sufficient to improve the appearance. In the absence of significant herniated periorbital fat of the lower lid, lower blepharoplasty is rarely indicated. In most cases, an upper blepharoplasty with a face-lift provides a satisfactory solution.     

多点连续埋线法重睑成形术的临床应用

目的探讨多点连续埋线法重睑成形术的手术方法及优缺点。方法手术在局麻下进行,用6-0尼龙线从外眦向内眦,再由内眦向外眦连续多点缝合,线结埋于皮下隧道。结果本组150例患者,除2例线结外露,1例重睑线消失外,均效果满意。结论多点连续埋线法重睑成形术操作简单,术后恢复快,外形自然逼真,适应证广,并发症少,是一种较好的手术方法。     

重睑成形术后不对称的原因及修复策略

目的 探讨重睑成形术后不对称的原因及修复策略。方法 选取2013年8月-2021年12月常熟市第一 人民医院和常熟时代医疗美容门诊部收治的重睑成形术后两侧重睑不对称的78例患者为研究对象,分析重 睑成形术后不对称的出现原因,并行重睑修复术,由患者和手术医师分别于术前、术后12个月对重睑形态 评分。结果 78例患者中2例仍存在轻度不对称,其中1例因前次手术去除了过多的睑板前组织,导致下唇皮 下瘢痕粘连明显,影响了重睑线的流畅性,另1例因前次手术遗留的皮肤瘢痕,影响了重睑形态;其余76 例重睑修复术后均获得了满意的效果;修复术后12个月患者和手术医师评分均高于术前（ P ＜0.05）。结论 通过对重睑成形术后外形不对称的原因进行分析,并根据原因进行修复和矫正,能有效改善患者重睑形 态,提升美学效果。     

连续埋线法重睑术的临床评价

目的 探讨连续埋线法重睑术的适应证和手术要点.方法 手术在局部麻醉下施行,从外眦向内眦沿睑板上缘作连续缝合,然后折返,外眦缝合口打结.结果 本组132例患者术后随访形成良好重睑者为121例,占92%;两侧重睑皱襞高低不一的7例,占5%;重睑消失的4例,占3%,后两者均补充埋线法或者切开法重睑术修复.结论 连续埋线法重睑术除适用于上睑皮肤较薄的年轻患者,也可扩大到中等以下程度的上睑皮肤松弛患者,以及以外侧为主的上睑臃肿者.     

眉上提联合下睑袋整形矫治眶周区域老年样改变

目的探讨眉上提术联合下睑袋整形，矫治眶周区域老年样改变的疗效。方法采用眉缘切口，去除眉上松弛皮肤，固定眉脂肪垫，悬吊眼轮匝肌，治疗眉下垂及上睑松弛；同时，对下睑袋采用皮瓣、眼轮匝肌瓣分层剥离，将下睑轮匝肌瓣眶外侧缘骨膜悬吊，治疗下睑袋。结果本组36例患者，术后眉形、重睑外形恢复自然，下睑袋消失或明显减轻。随访21例患者3—12个月，术后效果满意。结论眉上提联合下睑袋整形，矫治眶周区域老年样改变，手术方法易掌握，手术效果良好且安全，术后瘢痕不明显。     

Blepharoplasty to form the orbitopalpebral sulcus and nasal bone graft in oriental subjects (Occidentalization)

The procedures of blepharoplasty and rhinoplasty have been applied successfully, alone or in combination, to the occidentalization of Oriental patients for aesthetic reasons. The blepharoplasty, using the Sayoc-Millard technique, and the rhinoplasty, using an autogenous osteoperiosteal graft from the crest of tibia, are described in detail.Work presented at the XVI Congresso Brasileiro de Cirúrgia Plástica (Brazilian Congress of Plastic Surgery), December 2–8, 1979, Guarujá, São Paulo, Brazil. Work performed at the Plastic Surgery Unit, Clínica de Cirúrgia Plástica Dr. Oswaldo de Castro, São Paulo, Brazil.     

An unusual presentation of neurofibromatosis of the breast

Patients with neurofibromatosis type I or von Recklinghausen disease develop neurofibromas in the subcutaneous tissues, including the breast. There are two German reports of massive neurofibromatosis of the breast, but few reports of massive neurofibromatosis of the breast in the English literature. We present an unusual case of neurofibromatosis of the breast with large neurofibromas predominantly noted protruding from both nipple-areolar complexes.     

Involvement of spinal nerves in neurofibromatosis

Spinal tumors are a frequent form of manifestation of neurofibromatosis. Out of 171 patients, who have been operated on over a ten years period on spinal tumors, 7 patients had neurofibromatosis (4.1%). A total of 9 operations were performed, removing 20 spinal tumors. Three patients had multiple neurofibromas. Half of the neurofibromas had a dumbbell configuration with a larger extraspinal extension. In three patients a family history of neurofibromatosis and typical dermatological signs were evident. Two cases will be selected and the basic concept regarding treatment and the risks involved will be discussed.     

Hypophosphatemic osteomalacia in von recklinghausen's neurofibromatosis

a 56-year- old man with hypophosphatemic osteomalacia occuring in Von Recklinghausen's neurofibromatosis was treated orally with high-dose 1α-OH-D₃ (alphacalcidol), given in combination with a neutral phosphate mixture (equivalent to 1.2 g day of phosphorus) and calcium lactate (3 g day). Symptoms resolved together with normalization of the serum alkaline phosphatase actively. Subsequently, normal levels of the serum phophorus and serum calcium were recovered. The roentgenograms showed increased bone density after treatment. A decrease in oteoid coupled with an increase in mineralized bone was demonstrated when bone biopsy specimens were observed after preparation without decalcification.     

The Efficacy of Melilotus Extract in the Management of Postoperative Ecchymosis and Edema After Simultaneous Rhinoplasty and Blepharoplasty

BACKGROUND: Melilotus extract has been used as a folk medicine in inflammation-related therapy. This study was undertaken to determine the potential benefits of this herbal extract in treating postoperative ecchymosis and edema after simultaneous rhinoplasty and blepharoplasty. METHODS: Augmentation rhinoplasty and double-eyelid blepharoplasty were performed in one procedure by the same surgeon on 46 patients. RESULTS: Postoperative edema and ecchymosis were evaluated independently by two investigators checking the upper eyelid, lower eyelid, and paranasal area at postoperative days 1, 4, and 7. Our data showed that the patients receiving melilotus extract (n = 16) had lower scores not only in upper-eyelid and lower-eyelid ecchymosis, but also in paranasal ecchymosis at postoperative day 7 when compared with those in the control group. No significant difference in postoperative ecchymosis was detected in the group receiving dexamethasone treatment (n = 16) when compared with the control group (n = 14) at postoperative days 1, 4, and 7. The mean scores of upper-eyelid, lower-eyelid, and paranasal edema at postoperative days 1 and 4 were significantly lower in the group receiving dexamethasone treatment (n = 16) than that in the control group. Although the scores of eyelid edema reduction in the patients receiving melilotus extract showed no difference when compared with the control group, paranasal edema was reduced much more at postoperative days 4 and 7 when compared with the control group. CONCLUSION: We suggest the appropriate use of melilotus extract based on its beneficial effects on the postoperative results after simultaneous rhinoplasty and blepharoplasty.     

The neurosurgical aspects of neurofibromatosis 2: diagnosis and management

NF-2 is an extremely rare form of neurofibromatosis (NF) characterized by central nervous system (CNS) neural crest-derived tumors and frequently cafe an lait spots (CLS). The purpose of this study was to report the clinical and imaging findings of seven patients with this disorder and to stress the value of surgical treatment in its management. Seven patients between 8 and 32 years of age who had NF-2 were included in the study. Clinical charts, surgical and pathological findings, and imaging studies were reviewed retrospectively. Patients were followed up for 1 to 142 months. Clinical evaluation and neuroimaging studies detected the clinical criteria of NF-2 in all patients. Two deaths occurred after surgical intervention in our series. None of the patients suffered from recurrent tumor following surgery. Our results show that NF-2 is an uncommon entity which has a good prognosis after surgical intervention, in spite of the presence of multiple cranial and/or spinal lesions.     

Patient Satisfaction After Blepharoplasty Performed as Office Surgery Using Oral Medication with the Patient Under Local Anesthesia

Background: Blepharoplasty can be performed in the office setting using oral medication with the patient under local anesthesia. This article reviews the authors’ experience with this approach, evaluating patient satisfaction and demonstrating why this technique has become their procedure of choice for selected healthy patients. Methods: The authors conducted a retrospective review of the 86 patients who underwent office-based blepharoplasty and mailed surveys to assess patient satisfaction with the procedure. Results: Upper and lower blepharoplasties were performed with no major complications. The surveys were completed and returned by 83% of the patients. The survey results indicated that this procedure is well accepted and highly rated by patients. Many patients unwilling to undergo blepharoplasty outside the office were willing to have the procedure using this approach. A strong majority indicated that they would be referring friends and family for the procedure. Conclusions: The fact that blepharoplasty can be performed in the office using oral medication with the patient under local anesthesia proves to be a strong determinant toward the final decision of patients to undergo surgery. This procedure meets the safety requirements outlined by the American Society of Plastic Surgeons (ASPS) and is desired by our patients for its many obvious advantages. Recommendations are provided to assist others who desire to use this safe and cost-effective method. Presented at the Annual Meeting of the Texas Society of Plastic Surgeons in Frisco, Texas, 22 September 2006