We found intraorbital gold weight implantation, without the use of a wrap, to be simple and effective, with adequate function, an acceptably low postoperative morbidity rate, and an excellent cosmetic outcome.
Compared with a standard Jones Pyrex tube, a frosted tube functions equally well and reduces the possibility of extrusion, which is the main complication of traditional conjunctivodacryocystorhinostomy. We have exchanged smooth tubes for frosted tubes in patients who have had extrusion of the original tube, and we are currently investigating primary placement of the frosted Jones Pyrex tube.
We find that a customized, single-incision, 3-wall orbital decompression provides adequate decompression and proptosis reduction while minimizing postoperative strabismus and providing an aesthetically desirable result.
trum of the impact of the incision from disfiguring (1) to imperceptible (10). The reviewers felt that the incision obtained 94% imperceptibility.Comment. Conchal cartilage is widely accepted for use during revision and reconstructive rhinoplasty, orbital wall reconstruction, and eyelid repair. The anterior approach to conchal cartilage harvest has become the most popular technique. After observing successful changes in the ear for anterior conchal cartilage harvest, some authors 10,11 have even developed new techniques for anterior approach otoplasty. Modest complication rates have been reported for both the anterior and posterior approaches, and complications including hypertrophic scarring, delayed wound healing, and asymmetry. Our patients underwent anterior approach only by a standardized method. Feared complications of any cosmetic surgery include hypertrophic scarring, postoperative hematomas or seromas, and infections. Fortunately, in our series of patients, there were no complications in the ears in which conchal cartilage was harvested, regardless of comorbidities, including tobacco and alcohol use, cardiovascular conditions, or diabetes mellitus. Use of perioperative antibiotics for cosmetic procedures is widely accepted and should be used in patients that are undergoing conchal cartilage harvest.Most of the patients underwent conchal cartilage harvest for Mohs micrographic surgical repair of facial malignancies. The morbidities of rhinoplasty, locoregional flaps, and tissue advancements, as well as staged procedures for repair of the nasal defects, would tend to distract the patient's attention from the less morbid conchal harvest. This, combined with the average duration of follow-up from surgery to telephone questionnaire, may have allowed some recall bias. Regardless, the rate of patient satisfaction with conchal cartilage harvest was very high. The only concerns reported were those of mild pain in the immediate postoperative period. There were no complaints of irritating dental roll bolsters, hearing changes, or problems that affected sleep positions.Most of the responses by the blinded reviewers who felt that they could make a distinction between the operated and nonoperated ear were incorrect. This may reflect the relative lack of knowledge by nonmedical personnel regarding the complex 3-dimensional auricular anatomies. After the reviewers were educated about basic auricular anatomy and conchal cartilage harvest, they felt that the incision was 94% imperceptible.Septal cartilage has proved to be the type most commonly used for autologous cartilage harvest and will likely remain that way owing to the robust nature of that type of cartilage and the indication for septoplasty associated with rhinoplasty. When septal cartilage is not available, however, conchal cartilage is a safe and cosmetically acceptable alternative for autologous cartilage harvest. Patients are very satisfied with conchal cartilage harvest.
The apocrine hidrocystoma is a benign adenomatous cystic proliferation derived from apocrine glands, which frequently occurs in periocular tissues. These cystadenomas may occur bilaterally, in multiple disfiguring confluent groups on both the upper and lower lids. Although these lesions have been treated successfully with meticulous surgical extirpation and electrosurgery, this report describes the successful treatment of two patients, each with multiple large (>7 mm) periocular apocrine hidrocystomas by either chemical ablation of the cystic epithelium with trichloroacetic acid (TCA) or surgical excision. Examination of the cysts at 1, 3, and 6 months after TCA treatment revealed well-healed lesions without cyst recurrence. Most of the TCA-treated cysts resolved completely, without leaving any trace to clinical examination. Treatment of cysts with TCA was technically simpler and much less time-consuming than surgical excision. The treatment of large apocrine hidrocystomas with TCA is an effective and expeditious method of treating these disfiguring and recalcitrant lesions.
Facial aesthetic surgeons are sometimes challenged by the predicament of diagnosing and managing patients with chronic eyelid edema. Herein we provide a brief review of some of the more common causes of pre- and postoperative eyelid edema, many of which have important systemic implications, and offer management suggestions.
In properly selected cosmetic patients, the endoscopic pretrichial brow lift is an effective method for rejuvenating the upper face. A more youthful appearance is achieved with the procedure, and it is easily combined with eyelid rejuvenation. We believe that this technique is the procedure of choice for addressing brow ptosis in patients with high hairlines.
A 42-year-old female with a remote history of a left maxillary sinus tumor treated with excision and radiation therapy was referred for dry eye symptoms. Ophthalmic examination revealed left-sided exposure keratopathy, lagophthalmos, lower eyelid retraction, and fat atrophy of inferior periorbital tissue with associated hollowing. Large particle hyaluronic acid gel was injected to expand and reinforce the lower eyelid. After treatment, there was significant improvement in lagophthalmos, inferior scleral show, and periorbital hollowing. Excellent symmetry with the fellow eye was achieved. The patient reported markedly reduced dry eye symptoms. No adverse side effects were observed. The use of large particle hyaluronic acid gel shows promise as a novel nonsurgical therapy in the management of lower eyelid retraction associated with radiation-induced lipoatrophy. Additionally, large particle hyaluronic acid gel may provide better soft tissue expansion and retention than small particle hyaluronic acid gel, increasing the longevity of treatment.
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