Aesthetic eyelid ptosis correction: a review of technique and cases

Upper eyelid ptosis can present both functional and aesthetic problems. Because proper correction of ptosis can be difficult to achieve, numerous surgical procedures have been developed. Plication of levator aponeurosis can be combined with aesthetic blepharoplasty and facial rejuvenation procedures to successfully address ptosis. The authors assessed the effectiveness of levator aponeurosis plication for correction of acquired upper eyelid ptosis in patients presenting for concomitant cosmetic facial procedures. The medical records of 74 consecutive patients (68 women and six men) who had upper eyelid ptosis correction in conjunction with cosmetic facial procedures from January of 1994 to January of 2000 were reviewed. During this period, 400 endoscopic forehead lifts and 479 face lifts were performed. The correction was performed through an external upper blepharoplasty approach removing an ellipse of skin and orbicularis muscle. Once the orbital septum was opened, a plication of the levator aponeurosis was accomplished by one or more horizontal mattress sutures of 6-0 clear nylon (with the first bite placed at or just medial to the vertical level of the pupil). The average follow-up period was 14 months. Long-term correction of the ptosis was excellent. The complications were minor, with the most common occurrence being asymmetry. Revisions were performed on only four patients. Correction of ptosis can be performed safely and effectively in conjunction with periorbital and facial rejuvenation. The technique described is simple, reliable, and reproducible.     

Correction of lower eyelid ptosis in the anophthalmic orbit: a long-term follow-up

We describe a 10-year review of 53 patients having had correction of lower eyelid ptosis using fascia lata sling suspension by the operation first described in 1973. The overall conclusion is that this continues to be a reliable procedure with a low complication rate. Four major changes relating to operative technique that create a better result are as follows: (1) the surgical correction must begin with a prosthesis that is ideal for the socket; (2) the fascial strip is narrower at 2 mm; (3) the lateral orbital rim burr hole is placed higher; and (4) the passage of the fascial strip is facilitated by the use of Wright's needle. The optimal sequence of operative procedures in the anophthalmic orbit syndrome is (1) correction of enophthalmos and superior sulcus depression, (2) correction of lower eyelid ptosis, and (3) correction of upper eyelid ptosis.     

A simple approach to identification of the levator aponeurosis in the correction of eyelid ptosis

A new method of approach for the correction of upper eyelid ptosis is described. This involves both conjunctival and skin incisions. It allows for greater ease of identification of the levator aponeurosis and appears to facilitate in the identification of Müller's muscle. Although advised for all patients requiring ptosis correction, it is particularly recommended in those patients in whom the eyelids are involved with extensive posttraumatic scarring.     

Frontalis muscle advancement: a dynamic structure for the treatment of severe congenital eyelid ptosis

Forty-two consecutive patients have had severe eyelid ptosis corrected by intraorbital frontalis flap advancement as a motor unit to substitute for the function of the levator muscle. This technique has avoided the need for the linking structure necessary in the standard frontalis sling approach and has improved the direction of pull to more closely mimic that of a normal levator. This simple technique includes elevation of the innervated frontalis muscle flap and the creation of a pulley near the insertion of the orbital septum at the superior orbital rim, which redirects the lid movement along the surface of the globe rather than lifting it from the globe's surface toward the brow. This type of displacement is produced because the muscle is directed posteriorly by the pulley, so that it conforms to the plane of the levator aponeurosis all the way down to the tarsal plate. In addition, to improve the remaining function of the levator muscle (if any) and to facilitate voluntary positioning of the eyelid, the levator aponeurosis is shortened by plication. Symmetry is created by intervention on the contralateral eyelid to provide symmetrical supratarsal creases.     

Correction of lower eyelid ptosis in the anophthalmic orbit with an autogenous ear cartilage graft

We describe the correction of lower eyelid ptosis in patients with an anophthalmic orbit, using ear cartilage grafts. This procedure has been particularly useful in the scarred or previously reconstructed lower eyelid.     

Nutrient intake and cataract extraction in women: a prospective study.

OBJECTIVE--To examine prospectively the association between dietary intake of vitamins C and E, carotene, and riboflavin and cataract extraction in women. DESIGN--Prospective cohort study beginning in 1980 with eight years of follow up. SETTING--11 states of the United States. PARTICIPANTS--Female registered nurses who were 45 to 67 years of age. 50,828 women were included in 1980 and others were added as they became 45 years of age. MAIN OUTCOME MEASURE--Incidence of extraction of senile cataracts. RESULTS--493 cataracts were extracted during 470,302 person years of follow up. Intake of carotene and vitamin A was inversely associated with cataract: in multivariate analyses, women in the highest fifth of total vitamin A intake (excluding supplements) had a 39% lower risk of cataract relative to women in the lowest fifth (relative risk 0.61; 95% confidence interval 0.45 to 0.81). Neither riboflavin nor dietary vitamins E or C were associated with cataract in a multivariate analysis. Among specific food items spinach (rather than carrots, the greatest source of beta carotene) was most consistently associated with a lower relative risk. The risk of cataract was 45% lower among women who used vitamin C supplements for 10 or more years(relative risk 0.55 (0.32 to 0.96)), but no association was noted for multivitamin intake. CONCLUSION--Dietary carotenoids, although not necessarily beta carotene, and long term vitamin C supplementation may decrease the risk of cataracts severe enough to require extraction.     

Temporary management of upper lid ptosis, lid malposition, and eyelid fissure asymmetry with botulinum toxin type A

During the past 10 years the primary focus for the aesthetic use of botulinum toxin has been directed to the treatment of dynamic facial lines. This agent has been shown to be very effective for the improvement of facial shape. The use of botulinum toxin type A for the correction of a variety of presentations of facial asymmetry has also been well established. The general principles regarding the counter-effects of facial muscle protagonists and antagonists and their potential effects on the position of facial soft-tissue regions apply here as well. Twenty-two patients received botulinum toxin type A for the temporary treatment of mild to moderate unilateral upper eyelid ptosis and aesthetic improvement of lower eyelid position, with favorable results. Although commonly related to a rare yet feared adverse consequence from the inappropriate application of botulinum toxin, its application for the treatment of upper eyelid ptosis, eyelid position, and other lid fissure asymmetries for aesthetic improvement is presented.     

Divided nevus of the eyelid.

The two-stage surgical treatment of an adult female patient who presented with a congenital divided nevus of the left upper and lower lid is described.     

The importance of the intrathecal infusion test in the diagnostics of normal pressure hydrocephalus.

OBJECTIVE: The intrathecal infusion test is a reliable method in diagnosing normal pressure hydrocephalus. METHODS: Between May 1982 and January 1997 we investigated 200 patients suspected for a normal pressure hydrocephalus (NPH) by carrying out an intrathecal infusion test in a constant flow technique. The resistance to cerebrospinal fluid outflow (Rout) in the intrathecal infusion test was the main criterion for grouping patients into these with normal pressure hydrocephalus or those with cerebral atrophy. A further differentiation into early stage and late stage was made by measuring the compliance (Cp)--this being the secondary criterion. RESULTS: In 107 patients (54%) the diagnosis of a NPH could be confirmed. Of these, 102 patients (95%) underwent a shunt operation. Graduation of NPH and cerebral atrophy following the results of the infusion test in an early stage and an advanced stage allows the conclusion of prognostic evaluations about the course of disease to be made. Patients with a NPH in an early stage are reporting in the follow up about an improvement of their symptoms after a shunt operation in 65 percent of cases and those with an advanced stage NPH in 50 percent. CONCLUSION: The computer aided infusion test allows a reliable differentiation between patients with NPH and those with cerebral atrophy.     

Upper lip measurements at the time of surgery and follow-up after modified rotation-advancement flap repair in unilateral cleft lip patients

The purpose of this prospective study was to determine whether unilateral cleft lip repaired by the rotation-advancement flap will grow short on the repaired side. This study involved 56 patients with nonsyndromic unilateral cleft lip (31 with complete and 25 with incomplete cleft lip) who underwent a rotation-advancement flap repair by a single surgeon between 1989 and 1997. Eleven patients were lost to follow-up. Forty-five patients have been followed for a varying period of between 8 and 84 months (mean = 37 months). The upper lip was measured immediately after the lip repair and follow-up using calipers. The growth ratios of vertical, horizontal, and nostril sill dimensions were compared between the cleft side and the noncleft side of the same face. Statistical analysis was performed to compare the growths between the cleft and noncleft sides. There was not a significant difference in the growth ratios of vertical (Wilcoxon signed rank test, p = 0.85) and horizontal dimensions (Student's t test, p = 0.18) between the cleft and noncleft sides. There was, however, a statistically significant difference in the growth ratios of nostril sill width between the cleft and noncleft sides (Student's t test, p = 0.02). Our findings indicated that a repaired unilateral cleft retained the vertical and horizontal dimensions determined at the time of the initial repair.