Trends in horizontal periocular asymmetry

We placed negative electrodes on the body and positive electrodes at the medial and lateral canthi, measured their potentials separately, evaluated their characteristics, and analyzed cross-talk. We recorded EOG in 6 normal subjects and found the following. The potential at the medial was lower than that at the lateral canthus in the bilateral eyes. The polarity of waves at the lateral was reverse to that at the medial canthus in the bilateral eyes. We recorded EOG in 6 patients with unilateral anophthalmia and found the following. On the anophthalmia side, the potential at the lateral was considerably lower than that at the medial canthus. The polarity of the potential was the same between the medial and lateral canthi. The mean cross-talk to the medial canthus on the anophthalmia side was 8.7%-54.0% of the potential at the medial canthus on the normal side. The mean cross-talk to the lateral canthus on the anophthalmia side was 4.4%-16.9%. The influence of cross-talk of the other eye was marked at the medial but slight at the lateral canthus. In EOG recording, results with minimum errors due to cross-talk can be obtained by paying attention to the potential at the lateral canthus.

Patients often develop eyebrow drooping after blepharoplasty or ptosis repair. After aponeurosis advancement was performed in 53 patients (100 eyelids) with blepharoptosis, the eyebrow heights at the medial canthus, center of the pupil, and lateral canthus were measured using scanned photographs obtained preoperatively and 3 months postoperatively. In the 100 eyelids subjected to aponeurosis advancement, the eyebrow position was lowered at the medial canthus in 81 eyelids (81%), at the center of the pupil in 84 eyelids (84%), and at the lateral canthus in 80 eyelids (80%). The mean distance of eyebrow drooping in the 100 eyelids was 2.80 mm at the medial canthus, 2.87 mm at the center of the pupil, and 2.50 mm at the lateral canthus. The preoperative margin reflex distance (MRD) was significantly associated with the distance of eyebrow drooping at the medial canthus, the center of the pupil, and the lateral canthus in the 100 eyelids, but the postoperative MRD was not significantly associated with these parameters in the 100 eyelids. In conclusion, eyebrow drooping developed after aponeurosis advancement in most cases, and the distance of eyebrow drooping was associated with the severity of blepharoptosis.

The infrabrow blepharoplasty is a common surgical operation indicated in Asians for periorbital rejuvenation. This operation alone is difficult to achieve the correction of crow's feet. Therefore, the authors elucidate the authors' experiences of applying infrabrow blepharoplasty combined with the subcutaneous undermining of the lateral periorbital region to treat upper eyelid dermatochalasis with lateral hooding deformity and alleviate crow's feet, including its indications, operative procedures, and postoperative outcomes. Retrospective review of patients undergoing infrabrow blepharoplasty incorporated with subcutaneous undermining of the lateral periorbital region between January 2019 and December 2023. Thirty-nine patients who were well followed up were retrospectively reviewed. The surgical procedure is described in depth. Frontal and lateral view photographs were obtained to evaluate the curative effect. The following data were collected preoperatively and at postoperative 6 months: distance between the pupil centre and the supratarsal fold, distance between the pupil centre and lower margin of eyebrow, distance between the lateral canthus and the supratarsal fold, distance between the lateral canthus and lower margin of eyebrow, the rating of Crow's Feet Grading Scale (CFGS) at rest and at a maximum smile. The study included 78 eyelids of 39 patients ranging in age from 37 to 56 years, with a mean age of 46.25 years. The mean follow-up for the patients was 6.7 months. Compared with the postoperation with the preoperation, distance between the pupil centre and the supratarsal fold increased from 5.45 ± 1.31 to 5.98 ± 1.62mm, distance between the lateral canthus and the supratarsal fold increased from 3.93 ± 1.24 to 6.13 ± 1.87mm, no evidence of significant changes in distance between the pupil centre and lower margin of eyebrow and distance between the lateral canthus and lower margin of eyebrow. The average change in the rating of CFGS was -0.62 ± 0.11 at maximum contraction and -0.24 ± 0.08 at rest. No significant complications occurred in any patient postoperatively. The combination of infrabrow blepharoplasty with the subcutaneous undermining of the lateral periorbital region was effective in addressing moderate dermatochalasis with lateral hooding and improve crow's feet in middle-aged Chinese patients, resulting in a rejuvenated periorbital area and flattening of the eyebrow is not noted at the same time. The anthropometric measurement of the upper eyelid and CFGS facilitate operation outcome assessment.

the inferior-pedicled cheek rotation flap in reconstructing skin defects of the lower eyelid, particularly at the medial and lateral canthal regions - areas that present significant reconstructive and aesthetic challenges.Subjectsand methods: A case series of patients with lower-eyelid skin defects following tumor excision, trauma, or burn injury. Defects ranged from 1-3 cm and involved the medial or lateral canthus without full-thickness eyelid loss. Reconstruction was performed using either a lateral-pedicled cheek rotation flap based on branches of the facial artery or an inferior-pedicled cheek rotation flap based on the angular arterial system. Outcomes assessed included flap survival, eyelid position, contour, complications, and aesthetic satisfaction over a 1-3-month follow-up.Results: All flaps survived completely with good color and thickness match to the lower-eyelid region. No cases of ectropion, lid retraction, or flap necrosis occurred. Scars were well concealed within natural facial creases. Functional and aesthetic outcomes were rated as good to excellent in all patients.Conclusion: Lateral- and inferior-pedicled cheek rotation flaps provide a reliable, simple, and aesthetically favorable option for reconstructing lower-eyelid skin defects involving both the medial and lateral canthi. Their robust vascularity, tissue match, and minimal risk of eyelid distortion make them an effective method for periocular reconstruction.

Surgical approaches and complications

Vitiligo is an acquired depigmentation disorder characterized by loss of melanocytes, leading to milky-white macules on the skin.It is a common autoimmune skin disorder. Complete cure of this disease remains challenging [1].When occurring near the medial canthus of the eye and extending towards the lateral canthus, this cosmetic disfigurement can cause psychological distress and social stigma [2]. In Ayurveda, this condition is correlated with Shwitra, a subtype of Kustha, where Vata, Pitta, and Kapha along with Rakta are involved [3,4]. Ayurveda has good solutions when it comes to autoimmune disorders. Ayurveda approach to autoimmune disorder focuses on boosting natural immunity. In addition to this a customized panchakarma treatment, diet and lifestyle modifications work on overall disease management [5,6]. This case report presents the successful management of vitiligo starting near the medial canthus and extending towards lateral canthus, covering the complete under eye area, through Jalaukavacharan (leech therapy) as part of Raktamokshana.[7,8] The treatment Protocol was specifically designed with local panchakarma therapy with diet and lifestyle modification. Management of adverse effect of the leech therapy was also done successful. An attempt was made to assess the only effect of panchakarma treatment on shwitra through this case. This strategy could be useful in future by including other drug combinations and therapeutic methods to get quick relief.

OC65 Normative neonatal facial bio-metrics in the united arab emirates for non-invasive early detection of genetic disorder

Assessing Outcomes in Facial Reanimation: Evaluation and Validation of the SMILE System for Measuring Lip Excursion During Smiling

This study is to report the surgical outcome of lower lid epiblepharon repair with skin-only resection using a newly designed incision line. A retrospective, noncomparative, interventional case series analysis of 134 eyes of 67 patients, who underwent surgical correction of lower lid epiblepharon with skin-only resection using the new incision design, was performed. After marking the 4 vertical lines at the medial canthus, punctum, midpoint, and lateral canthus, the upper and lower incision lines were drawn from the medial canthus through punctum to the lateral canthus with novel design. After incising the skin along the marked line, gentle dissection of the skin flap from the underlying orbicularis muscle was performed. Only skin flap was excised and closed. The patients were followed up for more than 6months. The mean age of patients was 7.9 ± 3.7 years (range 4-13 years) and the mean follow-up period was 18.0 ± 5.7 months (range 13-31 months). During the follow-up period, recurrence of the epiblepharon was not observed. There was no occurrence of complications such as lower lid ectropion or retraction. Skin-only resection using a newly designed incision line is a simple and effective method to fully correct the medial portion of the lower lid epiblepharon and prevent dog-ear formation or overcorrection at the lateral portion, and prominent lid crease.

Most surgeons today advocate an endoscopic subperiosteal brow lift for surgical correction of the upper third of the face. At the author's clinic, this operation has been performed since 1994 and the subgaleal bicoronal brow lift is no longer used. In earlier investigations, the author showed that the subperiosteal approach (n = 60) gives a better result than the subgaleal method (n = 60) when compared 1 year after surgery. In the literature, however, there are no published data regarding the long-term results of subperiosteal brow lifts. The author took material from his earlier investigations and looked at the same patients 5 years postoperatively. He compared the subperiosteal approach (n = 30) with the subgaleal brow lift (n = 15) and found that after 5 years the brows of the subgaleal patients were on the same level as they were before surgery, but in the group of subperiosteal brow lifts, almost all of the brows were higher 5 years after surgery than they were 1 year after surgery, with a mean increase in height of 2.5 mm. These findings led the author to the question whether scalp fixation was necessary at all when performing a subperiosteal brow lift. He performed 20 subperiosteal endoscopic brow lifts where scalp fixation was not used at all, relying only on changing the balance of muscle vectors around the eyebrows. Using a computerized instrument, measurements were made of the distance between the medial canthus and the top of the eyebrow, the midpupil and the top of the eyebrow, and the lateral canthus and the top of the eyebrow. All patients were measured before and 1 year after surgery. The author found an increase of the vertical height from the midpupil to the top of the brow, with an average increase of 3.9 mm. There were no differences between patients who had only a brow lift and those who had a brow lift and an upper blepharoplasty at the same time. The author concludes that for most cases where an increased vertical height of the brows of more than 4 mm is not needed, it is not necessary to use scalp fixation to achieve a natural result.

To evaluate the design principles, clinical results and significance of hatchet skin flaps for repairing tissue defects in different parts of cheek. The area of cheek was divided into three parts, P(I), P(II) and P(III), with vertical lines through the medial canthus and lateral canthus. Different kinds of hatchet skin flaps were designed to repair tissue defects in different part of cheek. The hatchet skin flaps were performed in 29 cases with tissue defects in different part of cheek from August 2005 to August 2009. There were 17 male and 12 female, aged from 19 to 81 years, with a mean age of (45 ± 16) years. The size of tissue defect ranged from 1.5 cm × 1.5 cm to 2.5 cm × 3.5 cm. Patients' satisfactions were evaluated with a questionnaire in 5 aspects:color and texture match, scar, morbidity, and function after 6 months operatively. All the flaps survived completely with good color and tissue match. The facial contour was not altered obviously. Six to eighteen months later, all scars were almost invisible. All 29 patients were satisfied with their results. The hatchet skin flap is one of the versatile reconstructive methods for repairing of medium and small defects in the three parts of cheek. Defects in different part of cheek should be repaired individually with hatchet flap based on characters of natural lines.

The aim of this study was to assess clinical and histologic features of primary basal cell carcinomas of the periocular region and to calculate the rate of recurrence of these tumors after surgical excision without intraoperative frozen section control. All primary basal cell carcinomas of the periocular region which were treated by surgical excision at the University Eye Hospital and Clinic of Ulm between 1993 and 1998 were reviewed and special attention was paid to age and sex of the patient and localization and histology of the tumor. The recurrence rates were calculated depending on whether the margins were free or involved on histologic examination of the excised specimens. We could include 137 patients with 141 tumors into this study. In 92 patients with 95 tumors, follow-up data of at least 3 months was available with a mean follow-up period of 31.3 months. The mean age of the patients was 68.9 years, range 28.7-91.3 years. The tumor was located at the lower eyelid, medial canthus, upper eyelid and lateral canthus in 63.1%, 29.8%, 5.7% and 1.4%, respectively. The solid (53.9%) and the solid-cystic (17.7%) type were the most common encountered histology followed by the mixed type with sclerosing foci (12.1%) and the morphea or sclerosing type (10.6%). A free margin on histologic examination was achieved in only 47.6% of cases. The overall recurrence rate was 9.5% [definite recurrences: 6 cases (6.3%); questionable recurrences: 3 cases (3.2%)]. With histologically complete excision the recurrence rate was only 2.3% (1 case) and in the case of an incomplete excision definite recurrent tumors were observed in 11.8% (6 cases) and questionable recurrences in 3.9% (2 cases) of cases during the follow-up period. Surgical excision of basal cell carcinomas of the periocular region without utilizing intraoperative frozen section control or Mohs' micrographic surgery is associated with a high rate of positive tumor margin on histologic examination. However, our study showed that this is only infrequently followed by local recurrences. This result may raise the question whether simple surgical excision is still an option in the case that more cumbersome methods such as Mohs' micrographic surgery or intraoperative frozen section control are not available. However, with positive tumor margin on histologic examination of the excised tissue or with the presence of a sclerosing type regular follow-up is mandatory.

To evaluate the demographic features, location, and histopathologic results in primary eyelid tumors. We retrospectively reviewed the records of patients with primary eyelid tumor diagnosed and treated between November 1997 and June 2016 on our service. Nine hundred and eleven lesions from 874 patients were included in this study. Four hundred and forty-six (51.0%) of the patients were females and 428 (49.0%) were males. The mean age was 51.0y (range: 3mo-94y). The lesions were located in the upper eyelid (418 cases, 45.9%), lower eyelid (378 cases, 41.5%), medial canthus (89 cases, 9.8%), and lateral canthus (26 cases, 2.8%). Four hundred and seventy (51.6%) lesions were located on the right side and 441 (48.4%) on the left. Of the eyelid lesions, 666 (73.1%) were benign, 230 (25.2%) malignant, and 15 (1.6%) premalignant. When the eyelid tumors were classified according to their tissue or cell of origin, 527 (57.8%) of the lesions were found to be epidermal, 171 (18.8%) adnexal, 131 (14.4%) inflammatory and infectious, and 65 (7.1%) stromal. The most common benign lesions were squamous cell papilloma (139 lesions, 15.2%), intradermal nevus (97 lesions, 10.6%), epidermoid inclusion cysts (78 lesions, 8.6%), seborrheic keratosis (60 lesions, 6.6%), and inflammatory masses (59 lesions, 6.5%). Basal cell carcinoma was the most common malignant tumor (191 lesions, 21.0%) followed by squamous cell carcinoma (16 lesions, 1.8%), sebaceous carcinoma (14 lesions, 1.5%), and malignant melanoma (5 lesions, 0.5%). In this study, 73.1% of eyelid lesions are benign and the remaining 26.9% are premalignant and malignant. Basal cell carcinoma is the most common tumor among all histopathological diagnosis followed by squamous papilloma.

To investigate the facial aging analysis of 1200 Han adult people in Dalian with iris diameter, so as to provide reference for facial rejuvenation in Han people. 1200 facial digital photographs from the second-generation ID card of China were stratified randomly selected as the research sample, excluding facial deformity, tattooing eyebrow, tattooing lid margin, ptosis, lip grain and eyebrow deformity cases, as well as the cases whose join point of upper eyelid and lower eyelid not exposed at the nasal side. These photos were divided into six cohorts: female aged 18, 38, and 68 years old; and male aged 18, 38, and 68 years old, with 200 cases in each cohort. The individual iris diameter was divided into 20 equal parts in each photograph, with each part marked one unit as individual iris diameter ruler. Ten values were made from a horizontal plane between the medial canthus to ten points at one face ( the line between two medial canthus is used as the horizontal line, circumocular and facial soft tissue were measured with individual iris diameter ruler on the photographs), then the results were analyzed with Adobe Photoshop software. There are statistically significant differences in eyebrow height (36.42 ± 4.22 unit in 18 years old male group, 40.22 ± 6.90 unit in 38 years old male group, 34.83 ± 9.39 unit in 68 years old male group; 37.59 ± 6.72 unit in 18 years old female group, 41.09 ± 5.15 unit in 38 years old female group, 36.84 ± 9.45 unit in 68 years old female group), palpebral fissure height, physiognomic external canthus height, palpebral fissure width, pupil height and other items (P < 0.05). (1) The brow position rises to the peak level at middle age (38 years old group), then drops down gradually with aging. (2) The physiognomic external canthus moves towards the nasal side and caudal side with aging. (3) Eyeball moves towards caudal side with aging. (4) The soft tissue around bilateral angle of mouth, nasal tip and submaxilla moves towards caudal side with aging. (5) The measurement of individual iris diameter ruler can apply to analyze the aging changes of facial soft tissue, and is more suitable for the case when facial photographs are taken at different distances.

Pretarsal fullness of the lower eyelid has recently gained popularity in the Asian population. Hyaluronic acid injection is a simple, nonsurgical method for creating pretarsal fullness of the lower eyelid, but the effects last only 6-12months. A need exists for a surgical procedure with long-term effects. We describe the use of a deep temporal fascia graft for subciliary augmentation of the lower eyelid. Between September 2009 and October 2011, seven Japanese patients underwent subciliary augmentation of the lower eyelid. This retrospective study was conducted on four of the seven patients who were followed for more than 1year. A skin incision of approximately 1cm was made at the lateral canthus along the subciliary crease of the lower eyelid and the skin was undermined to create a subcutaneous tunnel. A stab incision was then made 2mm below the ciliary margin near the level of the lower lacrimal punctum. The orbicularis oculi muscle was incised under the skin incision at the lateral canthus, and the stump of the incised muscle was suspended to the periosteum of the lateral orbital rim. A deep temporal fascia graft was placed in the undermined subcutaneous plane of the lower eyelid. Lower-eyelid pretarsal fullness was maintained at more than 1year after surgery. The eyelids regained a natural appearance, and the patients were highly satisfied. Morphometric measurements demonstrated increased projection and width of the lower-eyelid pretarsal fullness. Deep temporal fascia grafting is safe and reliable for subciliary augmentation of the lower eyelid. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .