• Archives of Plastic Surgery
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• 제45권3호
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• pp.214-221
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• 2018

Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.

• 대한기관식도과학회지
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• 제12권2호
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• pp.19-25
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• 2006

There have been numerous modalities to recover blink function of orbicularis oculi muscle in patients with facial paralysis. However, there is still no optimal method for reanimation of eyelid. In this study, we tried to recover blink function of paralyzed rabbit's eyelid with the ion polymer metal composite (IPMC) which is one of the electroactive polymers that is spotlighted as artificial muscle. We manufactured IPMC by plating the platinum over perfluorosulphonic acid polymer ($Nafion^{(R)}$). IPMC was coated by Norland optical adhesive for the purpose of insulation and keeping it from dry. IPMC modifications by roughening the surface of Nafion, repetitive plating (maximum 4 times) with platinum, and lengthening the width of IPMC were done. The facial paralysis was induced in the rabbit by sectioning of facial nerve at the main trunk. After minimum period of 4 weeks, IPMC was inserted in the paralyzed rabbit's eyelid. By modification, the force generated by IPMC was enhanced. Restoration of blink function in paralyzed rabbit was achieved on electrical stimulation of the IPMC by 5 voltage direct current. IPMC can be promising option for facial reanimation, but further studies are needed to enhance the efficiency of IPMC.

• Archives of Plastic Surgery
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• 제33권3호
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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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• 제33권1호
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• pp.87-94
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• 2006

This study is to investigate the patients who had blepharoplasty for cosmetic purposes or facial nerve disorders. 21 patients were examined with an age from 17 to 63 years. Sixteen cases were classified as a normal group for investigation of the histopathologic change according to the age. The rest were patients of Bell's palsy(2), $Botox^{(R)}$ injection(2) and blepharospasm (1). We measured a mean diameter of myofiber and dimension's proportion of muscluar tissue per regular visual field. First, we measured a statistical significance according to the age in normal cases by grouping them into younger than 30-year-old, 30's, 40's, 50's and 60's. Second, we divided normal cases(16) into Group A and B by two bases for statistical analysis. In conclusion, although there were several differences as vacuolation, internalization of sarcolemnic nuclei between 35-year-old and 62-year-old patients in simple comparison, there was no uniform decrease according to the age. There were also no significant statistical changes in the value of a diameter of myofibers and dimension's proportion of muscular tissue according to the age in any of the two normal groups. But in $Botox^{(R)}$ injection and Bell's palsy, blepharospasm patients, two values showed remarkable difference compared to the normal group of same age.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.455-460
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• 2008

Purpose: We have classified blepharoptosis into the categories including pseudoptosis in Koreans and compared with other previous studies. Methods: Total of 250 patients(398 eyes) who underwent surgery for blepharoptosis from 1987 to 2006 were studied. By classification of Beard, patients were categorized into congenital, acquired and pseudo blepharoptosis and later they were reclassified by their etiologies. Also addition of pseudoptosis to the classification of Frueh, blepharoptosis were categorized into neurogenic type, myogenic type, aponeurotic type, mechanical type and pseudoptosis. And we divided these cases by the degree of blepharoptosis, levator function and the operation methods. Results: Out of the 250 patients, 175 patients were congenital type, 49 were acquired type and 26 were pseudoptosis. According to the mechanistic classification, 177 myogenic type, 30 aponeurotic, 7 mechanic, 8 neurogenic and 28 pseudoptosis were categorized. Regarding severity of blepharoptosis, there were 29.2% of mild, 40% of moderate, and 30.8% of severe cases. Out of the 398 cases, in terms of the operation methods, there were 39 aponeurosis plication, 184 levator resection, 5 Muller tucking, 60 Orbicularis oculi muscle flap, 66 frontalis transfer, and 21 blepharoplasty. Conclusion: The cause and degree of ptosis, and levator function are very important when considering the amount of resected muscle. There were only a few studies about blepharoptosis classification including pseudoptosis category. Therefore, through this study, we can investigate the relationship between the pseudoptosis and the others. This study could be useful for the making future management plans of blepharoptosis in Korean patients.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.48-52
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• 2011

Purpose: Microfat graft is a common procedure for correcting tear trough deformity and dark circle. Because the tissue in this area is very thin, the grafted fat, sometimes, induces palpable lumps and uneven skin contour. When it happens, the surgical removal of the grafted fat is often needed. The authors made attempt of transconjunctival approach for removal, and this made infraorbital fat repositioning possible at the same time. Methods: 15 female patients with history of microfat graft on lower eyelid, got operation for the grafted fat removal with transconjunctival approach from April of 2009 to July of 2010. The dissection was performed in accordance with infraorbital fat repositioning surgery. Through the transconjunctival incision, knotted fat on orbital septum and orbicularis oculi muscle was removed without damage on skin. After grafted fat removal, subperiosteal space was made 1~2 mm below the inferior orbital rim by elevating periosteum. With preserving orbital septum, infraorbital fat was repositioned and anchored to subperiosteal space. Finally, transconjunctival incision was closed with absorbable suture material. Results: 14 patients in the study showed satisfactory results. The problems like uneven skin contour and knotted fat mass, were all solved. In only one patient, incomplete correction was observed, as bulging on her right lower eyelid still remained. One patient complained of transient numbness on lower eyelid, but there was no specific complication other than this. Conclusion: The authors attempted the method of transconjunctival approach to remove former grafted fat in lower eyelid and reposition infraorbital fat simultaneously. Since the study brought great results, the method would be helpful to patients and surgeons.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.409-413
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• 2013

Background Buried non-incisional double-eyelid blepharoplasty is a popular aesthetic procedure. Although various modified continuous suture techniques have been used to create a more natural appearance and to reduce downtime, complications such as loosening of the double fold, asymmetry, and foreign body reactions have been observed. Methods This study included 250 patients who underwent double-eyelid blepharoplasty between March 1997 and November 2012 using a modified single-knot continuous buried non-incisional technique. With 4 stab incisions in the upper eyelids, one of two needles loaded with double-armed 7-0 nylon was passed in one direction alternately through the dermis and the conjunctiva, while the other needle was passed subconjunctivally in the opposite direction. Both ends of the sutures were knotted within a lateral stab incision of the upper eyelids and were buried in the orbicularis oculi muscle. Results Most patients displayed satisfactory aesthetic results, and no significant complications occurred. There was no obvious regression of the double fold; however, 3 patients required reoperation to correct loosening of the fold on one side during the follow-up period. One patient presented with the suture knot subcutaneously, and the knot was removed in the clinic. Conclusions The modified single-knot continuous buried non-incisional technique is a simple and less time-consuming method for a durable double fold and provides satisfactory aesthetic results.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.398-402
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• 2014

Background Non-incisional blepharoplasty is a simple, less invasive method for creating a more natural-appearing double eyelid than classical incisional blepharoplasty. However, in aging patients, non-incisional blepharoplasty is not effective due to more severe blepharochalasis. Traditionally, incisional blepharoplasty is a common surgical method used for older patients, but blepharoplasty in elderly patients typically results in prolonged recovery times, and final blepharoplasty lines may be located in unintended or asymmetrical positions. Here, we introduce a new modified combination technique for geriatric blepharoplasty. Methods A total of ten patients were treated from July 2010 through July 2012 using the combination method. First, we performed non-incisional blepharoplasty using tarsodermal fixation. Then, incisional blepharoplasty with additional elliptical excision of the upper eyelid skin was performed. We removed pretarsal tissue, fat, the orbicularis oculi muscle, and orbital fat. Telephone surveys were administered to all patients for follow-up. The questionnaire was composed of eight questions that addressed recurrence and satisfaction with aesthetics and the procedure. Results A total of nine patients (90%) responded to the telephone survey. All cases of moderate to severe blepharochalasia were corrected and there were no major complications. Patients who underwent blepharoplasty had higher satisfaction scores. All patients were satisfied with the postoperative shapes of their eyelids. Conclusions The advantages of the proposed technique include: ease of obtaining a natural-looking fold with symmetry at the desired point; reproducible methods that require short operation times; fast postoperative recovery that results in a natural-appearing double-eyelid line; and high patient satisfaction.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.471-479
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• 2008

Purpose: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. Methods: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. Results: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33 mL in right eyelid, 1.31 mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. Conclusion: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.

• Archives of Plastic Surgery
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• 제37권6호
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• pp.801-807
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• 2010

Purpose: Facial rejuvenating surgery has become a challenge to most plastic surgeons. Patients are demanding fewer complications, a prompt recovery, and more natural results. Current trend of the face lift surgery has been developed into less invasive procedures. Every aging patient in Asia wants to look younger without obvious evidence of surgical correction. Methods: The authors performed the limited dissection face lift with PDS quilting suture on twenty five patients. These five quilting sutures consist of sutures at 1~2 cm posterior to the prominent point of zygoma to the periosteum of the zygomatic arch, at the lateral border of Bichat's fat pad area to the zygomatic arch, at the lateral border of the orbicularis oculi muscle to the deep temporal fascia, at the upper lateral border of the platysma to the periosteum of the mastoid, and at the anterior lower margin of the earlobe to the deep temporal fascia by quilting suture technique to achieve rejuvenation. Results: These procedures could produce a balanced volumetric rejuvenation. This method gave considerable benefit of stable and satisfactory results. It provides reduced operative time, well corrected nasolabial fold and neck wrinkle, and swift recovery with minimal complications. Conclusion: Although it could not replace the classic facelift, this technique can be recommended as an option for patients who do not present with advanced facial aging or not want a more extensive procedure.