The Effect of Transconjunctival Blepharoplasty on Margin Reflex Distance 2

Segal, Kira L.; Patel, Payal; Levine, Benjamin; Lisman, Richard D.; Lelli, Gary Joseph

doi:10.1007/s00266-015-0583-8

Cited by 16 publications

(5 citation statements)

References 24 publications

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“…On the subcutaneous plane, this is the area where the junction of the palpebral-orbicularis oculi muscle and superior border of the malar fat pad meet. On the submuscular plane, it is fixed to the orbital rim by the orbital retaining ligaments, the protruded orbital fat placed on the ligaments, and the SOOF located beneath the ligaments [8][9][10]. LCJ descends gradually with aging, because the vertical length of the lower lid is increased by skin and muscle laxity, protruded orbital fat, and resorption of bone [2].…”

Section: Discussionmentioning

confidence: 99%

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

Kang¹,

Yang²,

Chai

2017

J Cosmet Med

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Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods:The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-toskeletal relationship. Results:The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n. Conclusion:Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.

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Section: Discussionmentioning

confidence: 99%

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

Kang¹,

Yang²,

Chai

2017

J Cosmet Med

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“…However, there was no significant difference in lower eyelid position after either technique ( p >0.5) [ 11 ]. Segal et al [ 12 ] reported that transconjunctival blepharoplasty did not induce lid retraction but rather elevated the lower eyelid in a majority of patients using MRD 2 measurement. Elevation of the lower eyelid can reduce or eliminate scleral show inferiorly, providing further cosmetic advantages.…”

Section: Discussionmentioning

confidence: 99%

The Reliability of the Transconjunctival Approach for Orbital Exposure: Measurement of Positional Changes in the Lower Eyelid

Yoon

Lee

2017

Arch Craniofac Surg

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BackgroundLower eyelid incisions are widely used for the orbital approach in periorbital trauma and aesthetic surgery. In general, the subciliary approach is known to cause disposition of the lower eyelid by scarring the anterior lamella in some cases. On the other hand, many surgeons believe that a transconjunctival approach usually does not result in such complications and is a reliable method. We measured positional changes in the lower eyelid in blowout fracture repair since entropion is one of the most serious complications of the transconjunctival orbital approach.MethodsTo measure the positional changes in the lower eyelids, we analyzed preoperative and postoperative photographs over various time intervals. In the analysis of the photographs, marginal reflex distance 2 (MRD2) and eyelash angle were used as an index of eyelid position. Statistical analyses were performed to identify the significance in the positional changes. All patients underwent orbital reconstruction through a transconjunctival incision by a single plastic surgeon.ResultsIn 42 blowout fracture patients, there was no statistical significant difference in the MRD2 and eyelash angle. Furthermore, there were no clinical complications, such as infection, hematoma, bleeding, or implant protrusion, during the follow-up periods.ConclusionThe advantages of the transconjunctival approach for orbital access include minimal scarring and a lower risk of eyelid displacement compared with other approaches. Based on these results, we recommend the transconjunctival approach for orbital exposure as a safe and reliable method.

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“…3 The ratio (R) of the values of MRD2/WTW was used to compensate for differences in scale inherent in photography; therefore the R reflects a "calculated" MRD2. 8 R was collected from all 74 eyes. It was averaged between the 3 different values collected by the 3 clinicians and then compared pre (R1) and post (R2) operatively to evaluate the efficacy of the muscular flap in preserving lower eyelid position after transcutaneous blepharoplasty.…”

Section: Exclusion Criteria Included: History Of Dry Eye Abnormal Snmentioning

confidence: 99%

Effects of orbicularis oculi flap anchorage to the periosteum of the upper orbital rim on the lower eyelid position after transcutaneous blepharoplasty: Statistical analysis of clinical outcomes

Innocenti

Mori

Melita

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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The Effect of Transconjunctival Blepharoplasty on Margin Reflex Distance 2

Abstract: This journal requires that the 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.

Cited by 16 publications

References 24 publications

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

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

The Reliability of the Transconjunctival Approach for Orbital Exposure: Measurement of Positional Changes in the Lower Eyelid

Effects of orbicularis oculi flap anchorage to the periosteum of the upper orbital rim on the lower eyelid position after transcutaneous blepharoplasty: Statistical analysis of clinical outcomes

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