Objective: To compare the efficacy of tranexamic acid (TXA) versus etamsylate (ETM) in reducing postoperative ecchymosis in upper blepharoplasty. Introduction: With an increase in demand for shortened recoveries after facial aesthetic surgery, various optional approaches have been sought out. In terms of ecchymosis, TXA and ETM have been most commonly used. Method: A prospective, intrapatient split face study was conducted from January 2020 to January 2021 in 40 patients who underwent upper blepharoplasty under local anesthesia. Two equal anesthetic solutions were prepared; Solution A contained TXA and solution B contained ETM. Solution A was injected in the right eyelid and solution B in the left eyelid. Postoperative ecchymosis was assessed by 2 blinded evaluators, the assisting surgeon (Observer 1) and an external surgeon (Observer 2) at 48 h and on the seventh day using a scale published by Sagiv et al. Results: Postoperative ecchymosis was found to be less at 48 h by both observers with TXA solution. Moreover, at the seventh day, no ecchymosis was found in 32.5% with TXA solution compared to 2.5% with ETM solution. Kappa analysis showed concordance between observers. Conclusion: In our study, TXA solution was a more effective therapy when compared to ETM solution for reducing ecchymosis. Larger case studies are required to prove the difference for validation.
Brow position is a key feature to define a fresh and youthful appearance of the periorbital region. Frontotemporal brow lift implies the elevation of both the medial brow and lateral brow and can be performed through an open (coronal), endoscopic, or combined approach. While endoscopic brow lift has the advantage of minimal incisions compared with the open coronal approach, it requires specific equipment, a longer learning curve, and has been associated with high recurrence rates. Herein, the authors’ technique for frontotemporal brow lift is presented, an approach that includes complete access under direct vision to the lateral brow and glabellar area, through 2 limited frontotemporal incisions and a novel method of 3-vectoring suspension to the frontal bone. It has proved to be predictable with long-lasting results.
Brow ptosis is one of the earliest signs of periorbital aging. To surgically correct the aging brow, several brow lift procedures have been documented with varying amounts of success. Direct brow lift is regaining its popularity as it is a simple direct surgery that allows the surgeon a precise positioning, elevation, and shaping of the brow. However, unaesthetic scarring is a potential handicap of this technique. To reduce scarring, many methods have been proposed from different design markings, beveling the incision, and tissue suspension. The versatility of direct brow lift lies in its design, execution, tissue management, and reduction of tension in the scar. In this article, we present a refined modification of the classic direct brow lift technique. The procedure is based on anatomical landmarks with a versatile and reproducible design, a 20° beveled incision, and periosteal suspension of the orbicularis muscle. In our experience, the use of this technique has enabled us to attain long-term stable aesthetic results.
The objective of the study was to compare wound dehiscence in upper blepharoplasty between the traditional suturing technique and the modified suturing technique in split-face study. A prospective, intrapatient split-face study was conducted from October 2019 to August 2020 in 40 patients who underwent upper blepharoplasty. The incision was made on both eyes, where the left eye received 3 subcutaneous buried sutures (6-0 polyglactin) before interrupted 6-0 nylon skin closure (modified technique), and the right eye underwent skin closure only (traditional technique). At 3 months, the aesthetic results using Hollander wound scale were evaluated by patients and an independent surgeon blinded to the method of closure. The study included 40 patients with an average age of 45 years. At 3 months, 39 patients (97.5%) recorded lateral wound dehiscence on the right eye and 0 patients (0%) on the left eye. The patient was scored 2 on the right eye and 5 on the left eye by the surgeon, whereas the patient scored 3 on right eye and 5.5 on left eye on Hollander wound scale. The modified technique in upper blepharoplasty proved to be a more aesthetically appealing and effective method to achieve a better scar in inverted canoe-shaped incisions with high-tension closure in well-positioned eyebrow.
Pollybeak deformity is a postoperative nasal deformity. This occurs when the lower third of the dorsum is more projected than the tip. Several etiologies due to primary and secondary rhinoplasty have been described in the literature. Some of these are preventable, while others are postoperative. We designed a convenient technique to correct fibrous pollybeak deformities presented in revision surgeries. The procedure is performed under tumescent local anesthesia. An open technique was used to expose the supratip deformity. A flap is designed and elevated anatomically from the supratip area and then divided into 2 halves, resulting in a forked flap joined at the vertex resembling a “V.” Then both flaps are overlapped to project the tip to the desired position. The V-shaped flap is fixed in its position by simple sutures to the underlying cartilage. A significant improvement in correcting fibrous supratip deformity was noted in postoperative evaluation. All our patients were satisfied with the result and healed uneventfully with no significant complications. This alternative technique is simple and practical for correction of fibrous pollybeak deformity over traditional techniques. The V-shaped flap can be addressed with 1 maneuver, both the pollybeak deformity and the nasal tip projection.
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