John G. Rose

Histologic comparison of autologous fat processing methods.

Purpose: To perform a quantitative analysis of adipocyte viability after fat processing during autologous fat transfer, comparing the processing methods of washing, centrifuging, and sedimentation. Methods: An experimental study was conducted in which 24 fat samples were obtained after processing from 22 patients undergoing autologous fat transfer. Histologic analysis of periodic acid-Schiff–stained specimens was then performed. Results: Cell counts per high-powered field of intact adipocytes and nucleated adipocytes and adipocyte cross-sectional area were significantly greater in samples processed by sedimentation, compared with those by centrifuging or washing. Conclusions: Of the various processing techniques currently used during autologous fat transfer, sedimentation appears to yield a higher proportion of viable adipocytes than does washing or centrifuging.

Periorbital Edema Following Hyaluronic Acid Gel Injection: A Retrospective Review

Introduction: The purpose of this study is to investigate the incidence, clinical features, and treatment of prolonged periorbital edema following the injection of hyaluronic acid gel to the infraorbital hollows. Materials and Methods: Retrospective descriptive study. The medical records of patients from 4 physician practices with prolonged (≥1 month) periorbital edema following the placement of hyaluronic acid gel to the infraorbital hollows, diagnosed between January 1, 2008 and December 31, 2011, were reviewed. Results: A total of 51 charts were reviewed, of which 12 (24%) patients were diagnosed with prolonged periorbital edema with a mean follow-up time of 7.1 ± 4.2 months (range, 1.5–15.3 months). The mean patient age was 50.4 years (range, 36.4–64.9 years), and the edema lasted an average of 5.4 months (range, 2.7–5.3 months). A minority of patients had a preprocedural history of fluid retention (17%), seasonal allergies (25%), previous lower eyelid or midface surgery (25%), or festoons on examinat...

Anatomy of Facial Recipient Sites for Autologous Fat Transfer

Introduction: Autologous fat transfer is an increasingly popular treatment for the aging face. Recently, studies have suggested increased duration of effect with the injection of fat into or adjacent to muscles. Subcutaneous depths of facial muscles have been demonstrated using cadaver dissections, but to our knowledge this is the first study to use radiologic measurements in living subjects in order to quantify muscle depths in the face. Materials and Methods: Forty computed tomography (CT) scans were reviewed retrospectively using digital radio imaging software with a calibrated digital measurement tool that was used to measure the depths of the muscles of facial expression corresponding to fat-grafting sites. Correlation was made to formalin-preserved cadaver dissections. Results: Subcutaneous depths of facial muscles are listed as measured radio graphically and on cadaver sections. Discussion: The depths of the muscles of facial expression are more accurately measured using digital radiographs; these depths are important landmarks for facial cosmetic surgeons performing an autologous fat transfer. To our knowledge, this is the first study to characterize the anatomic depth of the facial muscles in the living human.

Surgical Anatomy of the Eyelid

Proper diagnosis and management of eyelid disorders, both functional and cosmetic, hinge upon a thorough understanding of the location of critical eyelid structures and the anatomic relationships between them. Accurate intraoperative identification of anatomy is fundamental in performing eyelid surgery and preventing complications.

Patient-reported outcomes: comprehensive analysis for the oculofacial clinician.

C know how to evaluate clinical outcomes in their daily practice. Some outcomes are easy to assess and are mutually exclusive (e.g., dead vs. alive). Others may have very small margins of error (e.g., biometric measurements like the margin reflex distance or degree of proptosis). Neither do all such metrics translate into clinically meaningful outcomes nor are they all meaningful to patients. Other outcomes exist— like patient-reported outcomes (PROs)—that may capture the patient’s point of view on health-related satisfaction and quality of life. These outcomes, arguably, are best assessed by asking the patient directly; they have the potential to provide rich and practical information to clinicians. Exploring the patient’s perception of their outcomes can fundamentally strengthen the patient-doctor relationship, improve delivery of care, and help clinicians predict their patients’ treatment responses. PRO can also differentiate or prove superiority of medications and surgeries that have otherwise equivalent safety and efficacy profiles. The modern PRO movement has been evolving for over 2 decades. It may be considered a product of the interplay among increasing costs of medical care, geographic practice variations, and efforts to establish standards of care. The resulting emergence of patient-centered research is apparent in the steady annual growth of related published medical literature from about 1,000 articles in 1990 to >8,000 articles in 2010. Quality measures have proven important for all sectors of the health-care market. This movement has contributed to the modern-day emphasis of large clinical databases and registries, establishment of national practice guidelines, and a national focus on “a cycle of continuous improvement.” Despite the growth and broad impact of PRO, the topic is rarely explored in the oculofacial literature. Is this underutilization of PRO the result of a lack of valid or reliable measures (also known as instruments or questionnaires) or perhaps difficulty deriving meaning from measures and their scores? If clinicians agree that evidence-based practice and the patient’s perspective matter, then PRO-based research will facilitate evidence-based, patient-centered care. This study analyzes PRO in oculofacial surgery by systematically evaluating the development and psychometric properties of all available outcome measures and characterizing the health-related domains explored in diseasespecific instruments. With this analysis, the topic is then placed into a broader perspective that examines the relevance of PRO for oculofacial clinicians. The supplemental digital content provides detailed guides to understanding, using, and producing PRO research for evidence-based daily practice (Supplemental Digital Content 1, Appendix, available at http://links.lww.com/IOP/A76).

Patient-Reported Outcomes in Cosmetic Oculofacial Plastic Surgery: A Systematic Review:

Introduction: This work reviews the current state of patient-reported outcomes research in periocular cosmetic plastic surgery. Materials and Methods: A systematic review of the English-language medical literature from January 1946 through March 2013 was conducted for patient-reported outcomes measures used in periocular cosmetic plastic surgery patient populations. These measures were assessed for adherence to minimum standards recommended by the International Society for Quality of Life Research. Results: Thirteen outcome measures were identified. Upper-lid blepharoplasty was the only procedure for which an instrument, the Blepharoplasty Outcomes Evaluation, had been formally developed in the target patient group (periocular cosmetic surgery), and that met or exceeded minimum standards of reporting. Nine formally developed instruments were identified in the following applications: general facial cosmetic surgery (instruments that may be applied to periocular surgery, which are not restricted to any single facial intervention or anatomic region), chemodenervation, filler, and skin treatment. Of these, 5 instruments met minimum standards. Conclusions: Few well-developed, patient-reported outcomes measures targeted at periocular cosmetic patients exist at this time.

Modified Short-Scar Face-Lift: Technique, Pearls, and Outcomes

Introduction: The modified small-incision face-lift is a safe, effective, minimally invasive way to treat facial rhytidosis in carefully selected patients. The purpose of this study is to describe a modified small-incision face-lift technique. Materials and Methods: Institutional review board– approved retrospective case series. Results: Twenty-six patients underwent a modified small-incision face-lift. The average age of the patients was 62.1 years. Two patients developed hypertrophic scarring requiring surgical revision. There were no other complications, including infection, wound dehiscence, or flap necrosis. Patient satisfaction with the procedure was high. Conclusions: The modified short-scar face-lift is a safe and effective procedure that can be done in the office with or without sedation and requires less recovery time than traditional face-lift techniques.

Small-Incision Lower Lid Entropion Repair: Description of a Novel Procedure

Introduction: To describe a novel technique for lower lid entropion repair using a small incision with minimal dissection. To present surgical indications, initial outcomes, and complications associated with this technique. Materials and Methods: The small-incision lower lid entropion repair technique is described. A retrospective chart review of the first 5 consecutive patients undergoing this procedure in 2011 was conducted at the Dean Clinic of Madison, Wis. The medical records of these adult patients undergoing the small-incision repair were reviewed for surgical outcome, complications, and reoperation period, if applicable. Results: Of the first 5 consecutive patients undergoing this technique for small-incision entropion repair in 2011, all patients experienced surgical success. One patient experienced recurrence 6 months after the operation, following cataract surgery. Conclusions: This small-incision procedure is a safe and fast technique suitable for selected cases of involutional lower lid entropion.

Blepharoptosis Treatment Options during Upper Eyelid Cosmetic Blepharoplasty

Introduction: To describe surgical techniques of blepharoptosis treatment during upper eyelid cosmetic blepharoplasty. Materials and Methods: All patients underwent a preoperative evaluation, including eyelid position measurements, visual field testing, and, where appropriate, phenylephrine testing. Standard upper eyelid blepharoplasty skin/orbicularis excision was performed, exposing the orbital septum. External levator repair was then performed through an 8-mm incision in the orbital septum. In other patients, internal ptosis repair was performed transconjunctivally following upper eyelid blepharoplasty. Results: Ptosis repair methodologies of internal versus external approaches are compared and contrasted. Discussion: Combining ptosis repair with cosmetic blepharoplasty is a safe, effective treatment for patients who demonstrate both dermatochalasis and ptosis.