Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Background: Traditional subciliary incision lower blepharoplasty (TSILB) is commonly used for improving aged lower eyelid. Fat grafting has been popularly performed to correct shortcomings of TSILB such as infraorbital hollowness and incomplete blending of lid-cheek junction (LCJ). LCJ has been known as an objective index to measure the aging of lower eyelid. However, there was no study on the changes of LCJ length and shape with complementary fat grafting.Objective: This study aimed to evaluate the effect of complementary fat grafting by observing the changes in length and shape of the LCJ. Methods:Between 2010 and 2016, the authors observed the change of LCJ in 33 patients who were followed-up for more than 3 months among patients who underwent TSILB alone (Group 1, G1) or TSILB combined with fat grafting (Group 2, G2). The fat graft was performed by sequential autologous fat injection method, having the concept of volumetric face lifting. The groups were further divided into subgroups G1p, G1n, G2p, and G2n according to positive (p) or negative (n) globe-to-skeletal rim relations. Suborbicularis oculi fat lifting and lateral retinacular canthopexy were mainly performed in patients who had negative vector. Results:The length of LCJ in G2 decreased significantly compared to that of G1. There was no significant difference between G1p and G1n, and G2p and G2n. The shape of LCJ changed diversely from V-shape to flat shape and was more dramatic in G2 than in G1. In G1, superolateral shifting in lateral points of LCJ was a typical change, but in G2, superolateral shifting and vertical shifting of LCJ were more prominently occurred at medial and middle points of LCJ, which were mainly induced by fat grafting. Conclusion:Complementary fat grafting showed better rejuvenation effect through further changes of LCJ in length (shortening) and shape (flattening) than that of TSILB alone. Level of Evidence: IV

Section: Tsilbmentioning

confidence: 99%

“…The complete shape of the LCJ was determined by connecting each of them, as shown in Fig. 2 [3]. The angle of bcd/ijk was measured using a protractor.…”

Section: Measurement Of Shape Changementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complementary effect of fat grafting on traditional subciliary incisional lower blepharoplasty: estimated by the change of lid-cheek junction

Kang¹,

Chai

2018

“…This was due to the differences of our high SMAS face lift from that of Barton [8]: 1. Suspension of midface and orbicularis oculi muscle through incising inferior palpebral margin [9] was not performed in our study. 2.…”

Section: Is There Anything High Smas Face Lift Fails To Achieve?mentioning

confidence: 99%

High SMAS face lift: clinical experience

Wang

Ma²,

Li-xiang³

et al. 2017

Background:The ultimate goal of facelift is to lift the sagging soft tissue as much as possible, so as to restore them to the original anatomical position for facial rejuvenation.Objective: In our High-SMAS facelift, the SMAS-platysma flap were tighten strongly, so as to obtain full and youthful facial morphologic characteristics. In addition, the effectiveness of high-SMAS was evaluated in this paper. Methods:A total of 86 cases of SMAS face lift were performed in 22 months from January 2015 to November 2016. High SMAS technique was applied in 39 cases of them. All the 39 patients were female averaged 44 (29-65) years old. Postoperative follow-up wascarried out in 18 cases for an average of 13 months (4-22 months). After the SMAS-platysma flap was dissected in the lower face and neck，the key point of operating is focus on：The middle temporal fascia and superficial temporal fascia flap was dissected carefully. Break off the ligaments medial to the zygomatic arch and on the malar process exactly, and pay attention to protect the facial nerve. So that the high-SMAS and even higher-SMAS flap can be dissected. Results:In all the 18 cases followed up, most (11/18) obtained a clear mandibular margin after operation and scored even full mark.Perfect nasolabial fold improvement was achieved in few (7/18). In terms of Ogee curve evaluation, most (15/18) made it to the level of "acceptable", which was shared by the evaluation of lower eyelid shortening effects (13/18). Very satisfied indicators as follow: the obtuse jowl line becomes clear, midface "ogee curve" is vary from linear to curves, and the nasolabial sulcus have been improved. Conclusion:High-SMAS Facelift is one of the most effective rhytidectomy, the most prominent parts of its effect including the improvement of midface and jowl line contour. Level of Evidence: IV

Quantitative analysis of polydioxanone thread effects on lid-cheek junction

Hwang¹,

Lee²,

Kang³

2018

Background: Polydioxanone (PDO) thread is commonly used as a skin rejuvenation material in the field of cosmetic medicine. Its usefulness in the aged eye area was described previously, but, to date, no clinical study has proven it. Objective: The purpose of this study was to investigate the rejuvenation effects of PDO thread on the aged lower eye area thorough quantitative and qualitative analysis. Methods: We examined the changes in the lid-cheek junction in 32 participants who underwent the PDO thread insertion. They were followed up during 12 weeks after PDO thread insertion into the orbital fat area. Participants were categorized into three groups by tear trough grade; the eyelid to junction distance (EJD)/eyebrow to junction distance (BJD) ratio was measured before and after the PDO thread insertion. Differences in EJD to BJD ratio after PDO thread insertion and post-procedural differences in EJD to BJD ratio by tear trough grade were compared by the paired t-test. Results: After PDO insertion into the infraorbital fat pad area, the overall EJD to BJD ratio significantly decreased from 0.35±0.03 to 0.33±0.04 (p=0.001). The significant post-procedural improvements in EJD to BJD ratio were found in grade 1 group and grade 2 group: 0.35±0.03 to 0.34±0.04 for grade 1 group (p=0.02), and 0.34±0.04 to 0.32±0.04 for grade 2 group (p=0.03); however, the changes were not found in the grade 3 group (p=0.21). Conclusion: PDO thread insertion into the aged lower eyelid may be an effective method for improving signs of lower aged eyelid particularly in individuals with tear trough group 1 and group 2.