Abstract. Lateral candial fixation is widely used. This article sought to determine if a periosteal flap used routinely in conjunction with a tarsaJ strip provides lasting lateral canthal fixation. This consecutive clinical series from two ambulatory surgery centers followed 79 patients who underwent 141 lateral canthal fixation procedures. Outcome was measured by the position of the lateral canthus. Correct positioning of the lateral canthus was achieved in 78 of 79 patients representing 139 of 141 procedures (98%). The failed case was a patient with floppy eyelid syndrome in whom the sutures tore through the tarsal strips. The tarsal strip-periosteal flap technique is a successful, technically direct method of lateral canthal fixation. It is promoted as an enhancement of the tarsal strip technique, and is especially helpful in patients with prominent eyes. [Ophthalmic Surg Lasers 1999;30:232-236.]
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.
• Colloid solutions of technetium Tc 99m and india ink injected into the retrobulbar space of the cynomolgus monkey outside the extraocular muscle cone were removed from the orbit by the lymphatic vessels of the conjunctiva and eyelids and were then concentrated within the lymph nodes that drained the conjunctival and eyelid areas. Colloid solutions injected into the retrobulbar space inside the extraocular muscle cone did not reach the conjunctiva and did not collect in any lymph nodes over a 24-hour period. Within the orbit, the injected colloids spread along the planes of the connective-tissue septa. No lymphatic vessels were identified within the orbits posterior to the conjunctiva. Small amounts of india ink left the posterior orbit and ultimately entered the contralateral orbit. This posterior pathway did not lead to lymphatic vessels or lymph nodes and therefore does not appear to represent a prelymphatic pathway.
Summary The orbital and eyelid relationships of the superficial musculoaponeurotic system (SMAS) were studied in human cadavers. Using gross and microscopic techniques, the SMAS was found to be intimately related to the eyelids and orbicularis oculi muscle, and to have distinct orbital bony attachments. Sub-SMAS fat in the malar region was found to be continuous with the submuscular fat in the eyebrow region. The malar sub-SMAS fat continued superiorly into the lower eyelid above the inferior orbital rim, as a postorbicularis layer. A bony attachment emanating from the inferior orbital rim, the orbitomalar ligament, traveled through the orbicularis oculi muscle in a lamellar fashion prior to inserting into the dermis. The cutaneous insertion of this attachment corresponds to the malar and nasojugal skin folds. With aging, relaxation of the orbitomalar ligament allows inferior migration of orbital fat, in addition to the anterior migration that occurs through an attenuated orbital septum. These findings have implications not only in cosmetic surgery but also in the understanding of facial soft tissue changes that occur with aging.
Monopolar electrocautery in the cutting mode is a superb surgical technique in many types of oculoplastic surgery because it efficiently dissects tissue with excellent hemostasis. The purpose of this article is to define how monopolar electrocautery functions and point out specific steps of certain oculoplastic procedures in which electrocautery dissection is useful. We have found it to be a helpful adjunct in over 1,200 clinical cases. We review the problems with electrocautery reported in the literature and discuss ways to avoid them.
To perform a quantitative analysis of adipocyte viability after fat processing during autologous fat transfer, comparing the processing methods of washing, centrifuging, and sedimentation.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.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.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.
The purpose of this book is to describe procedures in ophthalmic plastic surgery that the author, based on his experience and that of many colleagues, has found most useful over the course of time. The text is not intended to be encyclopedic, and few of the operations are new. It is directed in particular toward the less experienced surgeon in ophthalmic plastic surgery procedures, namely, residents and those who perform these operations less frequently. The atlas is organized into three parts based on surgery in the three major areas of ophthalmic plastic surgery—eyelid, lacrimal drainage system, and orbit. Each of these three major divisions is introduced by a section on the relevant surgical anatomy and an overview of related general principles. The three sections are further subdivided into related procedures, each preceded by a description of the underlying pathologic characteristics, preoperative evaluation, and proper selection of procedure. Each operation is
