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Surgical approach to the medial retrobulbar space.
To expose the medial retrobulbar space, an incision is made across the entire brow from the level of the lateral canthal ligament into the medial canthal area. The periosteum is incised and separated from the roof and medial wall to the level of the posterior ethmoidal foramen. The orbital tissues may then be brought forward and downward, making the area more accessible. Damage to the trochlea and levator palpebrae superioris muscle may be avoided by separation of the periorbita and careful handling of the tissues. This approach permitted the removal of a cavernous hemangioma in a 69-year-old woman. The only postoperative complication was supraorbital nerve anesthesia.
Congenital trichomegaly, pigmentary retinal degeneration, and short stature.
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Critical analysis of methods of reconstruction of exenterated orbits.
Reconstructive procedures were used on 14 patients who had undergone orbital exenteration and radiotherapy for malignant tumours. All patients were tumour free after a follow-up of between 5 and 18 years. Reconstruction was carried out in 3 stages. In the first operation the orbit was filled, in the second the orbital rims and eyelids were shaped, and in the third a cavity for a static eye prosthesis was created. Critical assessment of results showed that the first stage alone produced a marked improvement in appearance and occluded existing fistulae. The subsequent procedures improved aesthetic results further. Difficulties were encountered from retraction of the tissues and insufficient tissue mobility.
The influences of orbital contours and lid ptosis on the size of the peripheral visual field.
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Transmission of HIV-1 infection via sports injury.
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Lymphomatoid granulomatosis of eyelid and brow with progression to lymphoma.
Lymphomatoid granulomatosis is an uncommon lymphoreticular disease that primarily involves the lungs, skin, and central nervous system and has a high mortality rate. This is the first report in the American literature of lymphomatoid granulomatosis with involvement of the skin of the eyelid and brow. After a protracted clinical course, the patient died of pulmonary complications.
Esthetic evaluation and treatment of the upper one third of the face.
Esthetic assessment and treatment planning for the upper one third of the face is reviewed. The importance of esthetic anatomy in evaluation of the face as a whole is stressed. Three basic approaches to the forehead and brow lift are discussed, with particular regard to patient selection, indications, and contraindications. Clinical cases are presented as examples.
A systematic multiple stage surgical approach for attainment of satisfactory and favourable surgical results in an extremely severe von Recklinghausen's disease, elephantiasis neurofibromatosa.
This disease was first described by von Recklinghausen and Festscher and has been known as the von Recklinghausen's disease or neurofibromatosis (NF). Numerous articles have been published on this subject where majority of the authors have stressed their difficulty in achieving favourable surgical results. This disease is pathologically accepted to be of neuroectodermal origin with a positive family history in approximately 50% of the cases, autosomal dominant trait and is known to involve the periorbital regions, orbit (preoperative CT scan: upper left and right photographs), temporal region to a variable extent, mid-facial region to the mandibular region. The indicated treatment for this disease is surgery including cranio-maxillofacial surgery even though re-evaluation of the conventional methods of surgery should be considered. This particular case is an extremely difficult and challenging case for any reconstructive plastic surgeon and required extensive preoperative planning. The systematic multiple stage surgical approach for an extremely severe von Recklinghausen's disease, elephantiasis neurofibromatosa is presented and discussed in detail.
Small incision subperiosteal and trans-blepharoplasty forehead and browlift.
The purpose of the study is to evaluate the safety and efficacy of non-endoscopic, small-incision subperiosteal forehead and browlift in patients undergoing associated upper eyelid blepharoplasty. This is a retrospective, non-comparative case series of 14 consecutive patients in 12 months. Eleven patients underwent bilateral and three unilateral surgery. Unilateral surgery was performed in patients with facial palsy and was augmented with cable suspension. The technique involves five small scalp incisions to create a single subperiosteal and deep temporal cavity. Superior arcus marginalis release and direct visualisation of the supraorbital nerve was achieved via a trans-blepharoplasty approach. All patients achieved a desirable browlift and contour. Follow up ranged from 2 to 40 weeks. Minor complications included transient diplopia (1), reduced upper eyelid sensation (1), and brief postoperative bleeding from one of the small incision sites (1). Small incision and trans-blepharoplasty forehead and browlift is a safe and effective method to achieve a cosmetically desirable browlift in patients that require associated upper eyelid blepharoplasty, using standard oculoplastic equipment without the need for an endoscope.
Management of forehead and brow deformities.
The subcutaneous trichophytic forehead browlift allows rejuvenation of the forehead with precise, stable brow positioning, excellent visualization, and direct treatment of the brow and forehead musculature. This method avoids lengthening the forehead and, with meticulous closure, can produce an imperceptible scar and natural-appearing hairline.
Periorbital reconstruction: brows and eyelids.
The eyes and periorbital structures are principle components of the upper region of the face. A thorough understanding of orbital and periorbital anatomy and function is important for anyone wishing to perform reconstructive surgery in this region. This article discusses the unique challenges presented to the surgeon when performing reconstruction of the eyelids and periorbital structures.
The beautiful eye.
Improved esthetic results in the periorbital region can be accomplished with a thorough knowledge of the features of the "beautiful eye." The information provided in this article, culled from the literature and years of clinical experience, should allow the reader to develop an improved esthetic sensibility as applied to the periorbital region. Deviations from the "ideal" can be identified properly and addressed appropriately, leading to improved esthetic outcomes.
The use of botulinum toxin type A in the upper face.
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Endoscopic brow-lift with deep temporal fixation only (DTFO).
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Rejuvenation of the aging forehead.
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Combining techniques to optimize upper facial rejuvenation.
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Analysis of the upper face and selection of rejuvenation techniques.
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