Giovanni André Pires Viana

Treatment of the Tear Trough Deformity With Hyaluronic Acid

BACKGROUND Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. OBJECTIVE The authors evaluate the results of periorbital filling with hyaluronic acid (HA) in a small series of patients. METHODS Between June 2008 and December 2009, 25 patients were treated with HA to correct tear trough deformities. The HA was administered into the preperiosteal tissues with a serial puncture technique and approximately 0.1 mL was injected at each pass. Each patients before and after photographs were reviewed by three surgeons; to objectively assess the outcomes, a quantitative scale was used to grade the pre- and postinjection results. The significance of subjective aesthetic evaluation of the photographs was evaluated with the Mann-Whitney U-test. Differences were regarded as significant if probabilities were less than 0.05. RESULTS The mean (SD) volume per side needed to achieve correction was 0.54 (0.27) mL on the right and 0.61 (0.30) mL on the left. Complications included some degree of bruising, erythema, and local swelling. Most patients (88%) had cosmetic improvement according to the independent evaluation. CONCLUSIONS All patients were very satisfied with their results. During the course of the study, the authors determined that the ideal candidates for this treatment are young, with thick skin and a definite hollow.

Upper blepharoplasty with or without resection of the orbicularis oculi muscle: a randomized double-blind left-right study.

Purpose: To compare the aesthetic outcomes of the upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle. Methods: An interventional randomized double-blind left-right study was conducted in 15 consecutive patients with dermatochalasis of the upper eyelid. One side was randomly chosen for resection of the preseptal orbicularis oculi muscle (group 1). The orbicularis oculi muscle of the contralateral side was preserved (group 2). All patients scored differences between both sides on the seventh day, the thirtieth day, and the ninetieth day after the surgery regarding the following symptoms: edema, hematoma, itching, and pain. Three masked ophthalmic plastic specialists analyzed the aesthetic outcomes by the visual analogical scale. Results: The scoring of symptoms was significantly higher in group 1 than in group 2 on the seventh postoperative day. On the thirtieth and ninetieth days, there were no significant differences between groups 1 and 2. The analysis by 3 masked observers showed that the aesthetic result was worse in group 1 than in group 2 on the seventh postoperative day. There were no significant differences between groups 1 and 2 on the thirtieth and ninetieth days. Conclusions: Upper blepharoplasty causes more postoperative symptoms and presents worse initial aesthetic outcome when the preseptal orbicularis oculi muscle is excised. However, the final aesthetic outcome is the same when the preseptal orbicularis oculi muscle is excised or preserved.

Tratamento dos sulcos palpebromalar e nasojugal com ácido hialurônico

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. PURPOSE: The aim of this study was to evaluate the results of ten patients submitted to periorbital filling with hyaluronic acid gel filler. METHODS: Between June and August, 2008, 10 patients have had their tears troughs treated with hyaluronic acid gel filler. The filler was introduced by a serial puncture technique and approximately 0.1 ml was injected at each pass. The filler was placed in the pre-periosteal tissue. Patients photographs before and after the procedure were reviewed to assess the outcomes. RESULTS: The mean volume per side needed to achieve correction was on the right side 0.61 ml (SD=0.25) and on the left side 0.65 ml (SD=0.26). The most common complications were bruising, erythema, local swelling, and pain at the injection site. The effect of treatment lasted up to 12 months. CONCLUSIONS: This pilot study showed that the treatment of tear trough deformity with hyaluronic acid gel filler was feasible, predictable and effective. All patients were very satisfied with their results.BACKGROUND Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. PURPOSE The aim of this study was to evaluate the results of ten patients submitted to periorbital filling with hyaluronic acid gel filler. METHODS Between June and August, 2008, 10 patients have had their tears troughs treated with hyaluronic acid gel filler. The filler was introduced by a serial puncture technique and approximately 0.1 ml was injected at each pass. The filler was placed in the pre-periosteal tissue. Patients photographs before and after the procedure were reviewed to assess the outcomes. RESULTS The mean volume per side needed to achieve correction was on the right side 0.61 ml (SD=0.25) and on the left side 0.65 ml (SD=0.26). The most common complications were bruising, erythema, local swelling, and pain at the injection site. The effect of treatment lasted up to 12 months. CONCLUSIONS This pilot study showed that the treatment of tear trough deformity with hyaluronic acid gel filler was feasible, predictable and effective. All patients were very satisfied with their results.

Treatment of Tear Trough Deformity with Hyaluronic Acid Gel Filler

Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. Since January 2007, 150 patients have had their tears troughs treated with hyaluronic acid gel filler. Restylane® was used to treat all patients and it was injected in the preperiosteal tissues just inferior to the orbital rim. The mean volume per side needed to achieve correction was on the right side 0.63 ml (SD = 0.37) and on the left side 0.6 ml (SD = 0.3). Most common complications were some degree of bruising, erythema, local swelling, and pain at injection site. The effect of treatment has been lasting up to 18 months. All patients are very satisfied with their results.

Prolapsed orbital fat: 15 consecutive cases

Prolapsed orbital fat has rarely been described and is often confused with other conjunctival tumours, such as dermolipoma. We describe the clinical features and treatment of 15 patients with prolapsed orbital fat. We report here our experience in 15 consecutive patients who presented to the Vision Institute of Federal University of São Paulo, Brazil, between July 2004 and December 2007. Age, sex, presenting complaint, physical findings, associated local and systemic diseases, type of treatment, and complications were recorded. Ten patients were men, and ages ranged from 44–86 (mean 68). Eleven patients presented with unilateral disease. Thirteen had superotemporal prolapse, and two atypical superonasal prolapse. Two gave a history of trauma. All patients had the prolapsed fat excised for cosmetic reasons. There were no complications. Orbital fat prolapse is usually superotemporal, mainly in men, and is easily differentiated from other lesions, such as prolapsed lacrimal gland. Excision is always indicated, usually for cosmetic reasons.

Reconstrução palpebral com retalho de Fricke: relato de dois casos

O câncer de pele e o tumor mais comum na especie humana, sendo o carcinoma basocelular o de maior prevalencia. Este trabalho relata dois casos recentes deste tipo de tumor, envolvendo tanto a palpebra superior quanto a inferior em duas mulheres. O primeiro caso e de uma mulher de 72 anos de idade, amaurotica do olho direito, com comprometimento de aproximadamente 80% da palpebra superior esquerda, 70% da palpebra inferior esquerda e comprometimento da parede lateral da orbita, comprovado pela tomografia computadorizada. O exame anatomopatologico da peca cirurgica revelou a presenca de carcinoma basocelular invasivo, com margens livres. Foi feita reconstrucao imediata com retalho de Fricke. O segundo caso e de senhora de 68 anos de idade, com historia previa de trauma na regiao periorbitaria esquerda, apresentando edema e hiperemia palpebral, com aspecto brilhante, com perda dos cilios e pequena ulceracao central, envolvendo aproximadamente 90% da palpebra superior e 65% da palpebra inferior esquerda, com comprometimento da parede lateral da orbita evidenciado na tomografia. O exame anatomopatologico da peca cirurgica revelou a presenca de carcinoma basocelular invasivo, com margens livres. Foi optado pela reconstrucao imediata com retalho de Fricke. Os autores acreditam que apesar deste tipo de retalho nao ser a primeira escolha na maioria das reconstrucoes palpebrais, nao deveria ser negligenciado, pois em certos casos, tornar-se-ia a unica opcao viavel.

Standardized clinical photography: the role of flash.

Medical photographic documentation is important for professional, research, and ethical concerns. This study analyzed the possible interference that the flash could cause on evaluation of lower eyelid cosmetic results. Standardized photographs with and without flash were taken of 10 patients with dermatochalasis. The photographs were evaluated by 3 independent observers, as before (without flash) and after (with flash) an alternative esthetic treatment of the lower eyelid. The observers rated the overall cosmetic improvement of the lower eyelid photographs on a visual analog scale. The 3 surgeons believed that there was improvement in cosmetic outcome from the first (without flash) to the second (with flash) picture. The results indicate that a simple flash addition in one of 2 consecutive photographs, taken seconds apart, could influence the impression of experienced surgeons on the final outcome of oculoplastic surgeries and may constitute a bias in observer-dependent studies.

Assessment of self-esteem and psychological aspects in patients undergoing upper blepharoplasty

Objective: To evaluate the self-esteem and quality-of-life outcomes in patients undergoing upper blepharoplasty. Methods: A cross-sectional study was performed at Federal University of São Paulo. The self-esteem and quality-of-life of 29 patients undergoing upper blepharoplasty were compared with 20 age-matched volunteers from the general population. During preoperative assessment, the patients and volunteers underwent complete ophthalmological examinations and answered two questionnaires: the Rosenberg self-esteem scale (RSES) and the World Health Organization quality of life assessment (WHOQOL-BREF). The RSES is a ten-item questionnaire developed to measure self-esteem that are answered using a four-point scale. The scores range from 0 to 30, and lower scores indicate higher self-esteem. The WHOQOL-BREF is composed of 26 questions divided into four domains. Mean values greater than 5 are considered indicative of very good quality-of-life. Data from the RSES and quality-of-life scores were compared between the two groups using an unpaired ttest. Results: The mean self-esteem scores for the patients and volunteers were 10.31 ± 0.71 and 6.9 ± 0.99, respectively (p < 0.001). The mean response scores for the WHOQOL-BREF questionnaire for the patients and volunteers were 3.67 ± 0.08 and 3.76 ± 0.08, respectively (p = 0.449). For the psychological subscale of the WHOQOL-BREF questionnaire, the results for the patients and volunteers were 3.52 ± 0.09 and 3.78 ± 0.08, respectively (p = 0.041). Conclusions: Subjects who underwent upper blepharoplasty exhibited worse self-esteem based on the RSES. Regarding quality-of-life, as assessed using the WHOQOL-BREF questionnaire, significant differences between the groups were evident in the psychological aspects subscale. Our study confirms the importance of subjecting patients to psychological evaluation prior to upper blepharoplasty.

A Minimally Invasive Approach for Apocrine Hidrocystomas of the Eyelid.

Univ Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Div Ophthalm Plast & Reconstruct Surg, Sao Paulo, Brazil

Cicatricial Ectropion Secondary to Psoriatic Arthritis

Ectropion is characterized by the eversion of the eyelid margin and the consequent exposure of the conjunctiva and cornea. The shortening of the anterior lamella of the lid causes cicatricial ectropion. We described a case of skin pathology causing cicatricial ectropion. The case is about a 68-year-old woman with a 2-year history of psoriatic arthritis. She complained of eyelid tearing and redness for two years. Due to the psoriasis, she presented a very dry skin, also in the periocular region, resulting in cicatricial ectropion. A skin graft was indicated to correct the eyelid malposition. Careful investigation should be performed in patients who have a skin disease that can lead to cicatricial ectropion.