Asian blepharoplasty, although a common procedure, has a relatively high rate of complications. Subtle imperfections and more serious iatrogenic complications often require immediate attention by the aesthetic surgeon. After attempted correction of the deformities, residual problems or new ones can arise. Blepharoptosis, supratarsal depression, an excessively high or low crease, a short or discontinuous crease, multiple creases, and asymmetric creases are the most commonly encountered complications that require special attention in this group, which has already undergone more than one surgical procedure. Between January of 1996 and December of 2002, 168 Asian blepharoplasty revisions were performed by one surgeon (S. H.-T. Chen); of these, 36 patients (21 percent) had previously undergone failed revisions. This subgroup of patients consisted of six with blepharoptosis, six with asymmetrical eyelid creases, three with supratarsal depressions, three with high creases, two with short creases, and 16 with combinations of these deformities. The results were graded as excellent, good, fair, or poor, based on the symmetry of the eyelids, palpebral fissures, crease heights, lengths, shapes, eyelid fullness, and overall aesthetics of the final outcome. A survey was performed of patient and surgeon satisfaction and factored into the grading system. With an average follow-up period of 16 months (6 to 60 months), 22 patients (61 percent) were found to have excellent results, 10 (28 percent) had good results, two (5.6 percent) had fair results, and two (5.6 percent) had poor results. Corrective procedures after failed revision Asian blepharoplasty require special strategic considerations because of the presence of extensive scarring and inadequate skin, muscle, and preaponeurotic fat and because of the occasional presence of dehiscence of the levator aponeurosis. By using careful preoperative evaluation, accurate measurements, precise preoperative planning, intraoperative fat repositioning or grafting, skin excision or redraping, and proper placement of anchoring sutures, successful outcomes can be achieved. The authors evaluate the outcomes and detail the surgical procedures that were used to achieve successful outcomes in this particularly challenging group of patients.
Nicotine-induced expression of P-selectin is implicated in endothelial cell damage related to smoking. Thirty male Sprague-Dawley rats were divided into three groups: two experimental and one control. Both experimental groups were exposed to cigarette smoke for four weeks, but one group was also given anti-P-selectin antibody (100 microg IgG per 100 g body weight) intravenously. Rolling and adhesion leucocytes within the microcirculation of the cremaster muscle were measured. The urine cotinine concentrations of rats exposed to smoke were 612 ng/ml higher than those of non-smokers. Both rolling and adherent leucocytes were highest and steady in the group given anti-P-selectin antibody at about 50 and 10, respectively. There was a significant drop in both rolling and adherent leucocytes (31 to 4 and 5 to 2) after the anti-P-selectin antibody had been given. However, this effect was short-lived as both increased above those at 35 minutes by 120 minutes (p<0.001). The increase in leucocyte rolling and adherence caused by smoking can be lowered by giving anti-P-selectin antibody. The effective period in rats was two hours, with the maximal effect one hour after injection.
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