The Experts below are selected from a list of 108 Experts worldwide ranked by ideXlab platform
David M Knize - One of the best experts on this subject based on the ideXlab platform.
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an anatomically based study of the mechanism of Eyebrow Ptosis
American Journal of Ophthalmology, 1996Co-Authors: David M KnizeAbstract:The development of Eyebrow Ptosis with aging is commonly attributed to progressive laxity of scalp and forehead soft tissues. If the change in Eyebrow position with aging resulted entirely from this basic mechanism of tissue stretching, uniform lowering of the medial and lateral Eyebrow segments should occur. Clinical observations show, however, that the lateral Eyebrow segment usually becomes ptotic earlier than the medial segment, indicating that a more complex mechanism exists. To clarify this process, anatomic studies were done on 20 (40 half-head) fresh cadaver specimens. Histologic studies also were performed to complement the gross anatomic findings. These studies confirm that the mechanism producing Eyebrow Ptosis has a relatively greater effect on the lateral Eyebrow segment. The lateral Eyebrow has less support from deeper structures than the medial Eyebrow, and the balance of forces acting on the Eyebrow selectively depresses the lateral segment. Structures that may promote mobility and gravitational descent of the Eyebrow, especially the lateral Eyebrow segment, are (1) the galea fat pad, (2) the preseptal fat pad, and (3) the subgalea fat pad glide plane space. Three forces that act on the lateral Eyebrow are (1) frontalis muscle resting tone, which suspends that Eyebrow segment medial to the temporal fusion line of the skull, (2) gravity, which causes the soft-tissue mass lateral to the temporal line to slide over the temporalis fascia plane and push the lateral Eyebrow segment downward, and (3) corrugator supercilii muscle hyperactivity in conjunction with action of the lateral orbicularis oculi muscle, which can antagonize frontalis muscle activity and directly facilitate descent of the lateral Eyebrow. The axis point for these forces is the temporal fusion line of the skull near the superior orbital rim. The interaction of those structures and forces contributing to the mechanism producing Eyebrow Ptosis is discussed. Derived concepts are applied to the execution of the forehead lift procedure.
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limited incision forehead lift for Eyebrow elevation to enhance upper blepharoplasty
American Journal of Ophthalmology, 1996Co-Authors: David M KnizeAbstract:Treatment of Eyebrow Ptosis to enhance the cosmetic effect from blepharoplasty is commonly done with a forehead lift using a coronal incision approach. The coronal scalp incision is associated with the annoying sequelae of frontoparietal scalp numbness, itching, and paresthesias, all of which can be permanent. A forehead lift technique with temporal scalp incisions only 4.5 to 5.0 cm in length can produce a result comparable with that of the coronal incision approach when combined with transpalpebral resection of the corrugator supercilii muscles and transection of the procerus muscle. This Eyebrow elevation technique, like the endoscopic approach, minimizes the risk of permanently injuring the supraorbital nerve branches that innervate the frontoparietal scalp. Unlike the approach using only endoscopy, however, this technique can effectively treat cases of advanced Eyebrow Ptosis. The appropriate area of eyelid skin for excision may be difficult to assess when a forehead lift and upper blepharoplasty are done concomitantly. The described forehead lift incorporates a method to determine this area. This forehead lift technique, combined with a technique for protecting against overresecting upper eyelid skin, is described as used effectively on 140 blepharoplasty cases followed for 3 months to 4 years.
James L Baker - One of the best experts on this subject based on the ideXlab platform.
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response to comments on lateral subcutaneous brow lift updated technique
Aesthetic Surgery Journal, 2016Co-Authors: Umar Mahmood, James L BakerAbstract:No screw fixation is used in our technique,1 nor is it in the original article by Miller.2 Only a single layer closure of 4-0 nylon is utilized. Dr Tjong Joe Wai states that there is a possibility of rupture in this static solution, resulting in recurrence of Eyebrow Ptosis.3 In well over 100 consecutive patients utilizing our technique,1 and in the …
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lateral subcutaneous brow lift updated technique
Aesthetic Surgery Journal, 2015Co-Authors: Umar Mahmood, James L BakerAbstract:Age-related changes affecting the periorbital area and resulting in Eyebrow Ptosis have a greater impact on the lateral Eyebrow; correction of this deformity is a common request from patients seeking periorbital rejuvenation.1 Various techniques have been utilized to address Eyebrow Ptosis, including the coronal brow lift, endoscopic technique, anterior hairline approach, transpalpebral lift, midforehead lift, and direct brow lift. Furthermore, arguments for dissection in each of the different tissue planes—subcutaneous, subgaleal, or subperiosteal—have all been discussed. Each of these approaches has specific indications, risks, and benefits, and should be selected after comprehensive evaluation of the patient.2-4 In our experience, a full coronal incision often results in an obvious midline scar in the central forehead, increases the risk of elongating the vertical height of the forehead, and can result in paresthesias posterior to the hairline, a symptom that is very bothersome to patients. Endoscopic brow lifts require additional equipment with increased operative time, and the deeper dissection involved in this technique results in suboptimal brow elevation compared to the subcutaneous approach. Furthermore, not all patients are appropriate candidates for endoscopic brow lifts, including those with significant convex frontal bones, high or receding hairlines, deep transverse rhytides, or significant brow Ptosis. In patients presenting with lateral brow descent, the temporal or lateral subcutaneous brow lift has produced consistent and effective results. This technique has been well described in the literature, and has several advantages, including shorter operative time, feasibility under local anesthesia, decreased …
Mehmet Mutaf - One of the best experts on this subject based on the ideXlab platform.
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mesh lift a new procedure for long lasting results in brow lift surgery
Plastic and Reconstructive Surgery, 2005Co-Authors: Mehmet MutafAbstract:Background: Prevention of recurrent Eyebrow Ptosis is the greatest challenge in brow lift surgery today. In this article, the author describes a new surgical procedure to provide long-lasting results in brow lift surgery. Methods: Over 7 years, this new technique was used in 37 patients. Except for four, all patients were women aged 22 to 57 years. In this procedure, a polypropylene mesh strap is used as a suspender to maintain the elevated position of the Eyebrow. The mesh suspender is placed in a subgaleal tunnel that is created between a limited temporal scalp incision and a classic upper blepharoplasty incision. The distal end of the mesh is sutured to the undersurface of the upper orbital part of the orbicularis oculi muscle, and the proximal end is fixed to the periosteum at the temporal region after a desired Eyebrow position is obtained by traction of the mesh suspender superolaterally. Results: The polypropylene mesh was tolerated well in all patients. No complication related to foreign body reaction was encountered. During 6 months to 4 years of follow-up, none of the patients experienced recurrent Eyebrow Ptosis. The long-term results revealed a long-lasting, almost permanent Eyebrow elevation in all patients. Conclusions: This new technique seems to be useful in prevention of recurrent Eyebrow Ptosis following brow lift surgery. The author suggests that, after its integration with reoperative tissue, the mesh suspender becomes an artificial suspensory aponeurosis that provides stable fixation to maintain the elevated position of the Eyebrow. This is considered to be the main reason for the excellent long-lasting results obtained in the current clinical study.
Umar Mahmood - One of the best experts on this subject based on the ideXlab platform.
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response to comments on lateral subcutaneous brow lift updated technique
Aesthetic Surgery Journal, 2016Co-Authors: Umar Mahmood, James L BakerAbstract:No screw fixation is used in our technique,1 nor is it in the original article by Miller.2 Only a single layer closure of 4-0 nylon is utilized. Dr Tjong Joe Wai states that there is a possibility of rupture in this static solution, resulting in recurrence of Eyebrow Ptosis.3 In well over 100 consecutive patients utilizing our technique,1 and in the …
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lateral subcutaneous brow lift updated technique
Aesthetic Surgery Journal, 2015Co-Authors: Umar Mahmood, James L BakerAbstract:Age-related changes affecting the periorbital area and resulting in Eyebrow Ptosis have a greater impact on the lateral Eyebrow; correction of this deformity is a common request from patients seeking periorbital rejuvenation.1 Various techniques have been utilized to address Eyebrow Ptosis, including the coronal brow lift, endoscopic technique, anterior hairline approach, transpalpebral lift, midforehead lift, and direct brow lift. Furthermore, arguments for dissection in each of the different tissue planes—subcutaneous, subgaleal, or subperiosteal—have all been discussed. Each of these approaches has specific indications, risks, and benefits, and should be selected after comprehensive evaluation of the patient.2-4 In our experience, a full coronal incision often results in an obvious midline scar in the central forehead, increases the risk of elongating the vertical height of the forehead, and can result in paresthesias posterior to the hairline, a symptom that is very bothersome to patients. Endoscopic brow lifts require additional equipment with increased operative time, and the deeper dissection involved in this technique results in suboptimal brow elevation compared to the subcutaneous approach. Furthermore, not all patients are appropriate candidates for endoscopic brow lifts, including those with significant convex frontal bones, high or receding hairlines, deep transverse rhytides, or significant brow Ptosis. In patients presenting with lateral brow descent, the temporal or lateral subcutaneous brow lift has produced consistent and effective results. This technique has been well described in the literature, and has several advantages, including shorter operative time, feasibility under local anesthesia, decreased …
Cruz, Antonio Augusto Velasco E - One of the best experts on this subject based on the ideXlab platform.
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Eyelid alterations after the age of 50 years
Conselho Brasileiro de Oftalmologia, 2005Co-Authors: Siqueira Michael, Joaquim Andrei, Schellini, Silvana Artioli, Padovani, Carlos Roberto, Cruz, Antonio Augusto Velasco EAbstract:OBJETIVO: Avaliar quantitativamente as mudanças da posição palpebral e as medidas da fenda palpebral de indivíduos acima dos 50 anos. MÉTODOS: Estudo observacional, tendo sido avaliados 325 indivíduos, com idade acima de 50 anos, segundo distância intercantal, largura e altura da fenda palpebral, ângulo palpebral externo e interno, distância entre o reflexo pupilar e a margem da pálpebra superior (distância reflexo-margem) e a área total da fenda palpebral. Utilizou-se filmadora Sony Lithium para obtenção das imagens digitais, com o indivíduo fixando um objeto a 1 metro de distância, sendo as imagens transferidas posteriormente para computador McIntosh G4 e processadas pelo programa NIH 1.58. Os dados foram submetidos à análise estatística. RESULTADOS: Os participantes apresentavam dermatocálase (96,5%), ptose do supercílio (60,8%), prolapso de gordura orbital (50,0%) ou ptose palpebral (39,1%). As alterações foram bilaterais em 68,8% dos indivíduos. A distância intercantal aumentou com a idade; a largura da fenda palpebral, a distância reflexo-margem e a medida do ângulo externo diminuíram nos mais idosos. As diferenças foram mais significativas quando os olhos foram estudados separadamente. CONCLUSÃO: A distância intercantal aumenta, ao passo que a largura da fenda palpebral, a distância reflexo-margem e a área total da fenda palpebral diminuem com o aumento da idade.PURPOSE: To quantify the palpebral alterations occurring in subjects after the age of 50 years. METHODS: An observational study was done with 325 subjects older than 50 years. The data comprised measurements of intercantal distance, palpebral fissure length and height, external and internal eyelid angles, margin reflex distance (MRD) and total palpebral fissure area. Digital images were obtained with a Sony Lithium movie camera at the frontal view in ocular primary position, with the object of observation being located at the height of the pupil. The images were saved on tape, transferred to a McIntosh G4 computer and processed with the NIH 1.58 program. The data were submitted to statistical analysis. RESULTS: The subjects presented dermochalasis (96.5%), Eyebrow Ptosis (60.8%), orbital fat prolapse (50.0%) or eyelid Ptosis (39.1%). The alterations were bilateral in 68.8% of the subjects. The intercantal distance was higher with age; the eyelid fissure length, the margin reflex distance and the external angle decreased in the elderly. The differences were more important on evaluating each eye separately. CONCLUSION: Intercantal distance increase and palpebral fissure length, margin reflex distance and total eyelid area decrease with age
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Alterações palpebrais após a idade de 50 anos
Conselho Brasileiro de Oftalmologia, 2005Co-Authors: Siqueira Michael, Joaquim Andrei, Schellini, Silvana Artioli, Padovani, Carlos Roberto, Cruz, Antonio Augusto Velasco EAbstract:OBJETIVO: Avaliar quantitativamente as mudanças da posição palpebral e as medidas da fenda palpebral de indivíduos acima dos 50 anos. MÉTODOS: Estudo observacional, tendo sido avaliados 325 indivíduos, com idade acima de 50 anos, segundo distância intercantal, largura e altura da fenda palpebral, ângulo palpebral externo e interno, distância entre o reflexo pupilar e a margem da pálpebra superior (distância reflexo-margem) e a área total da fenda palpebral. Utilizou-se filmadora Sony Lithium para obtenção das imagens digitais, com o indivíduo fixando um objeto a 1 metro de distância, sendo as imagens transferidas posteriormente para computador McIntosh G4 e processadas pelo programa NIH 1.58. Os dados foram submetidos à análise estatística. RESULTADOS: Os participantes apresentavam dermatocálase (96,5%), ptose do supercílio (60,8%), prolapso de gordura orbital (50,0%) ou ptose palpebral (39,1%). As alterações foram bilaterais em 68,8% dos indivíduos. A distância intercantal aumentou com a idade; a largura da fenda palpebral, a distância reflexo-margem e a medida do ângulo externo diminuíram nos mais idosos. As diferenças foram mais significativas quando os olhos foram estudados separadamente. CONCLUSÃO: A distância intercantal aumenta, ao passo que a largura da fenda palpebral, a distância reflexo-margem e a área total da fenda palpebral diminuem com o aumento da idade.PURPOSE: To quantify the palpebral alterations occurring in subjects after the age of 50 years. METHODS: An observational study was done with 325 subjects older than 50 years. The data comprised measurements of intercantal distance, palpebral fissure length and height, external and internal eyelid angles, margin reflex distance (MRD) and total palpebral fissure area. Digital images were obtained with a Sony Lithium movie camera at the frontal view in ocular primary position, with the object of observation being located at the height of the pupil. The images were saved on tape, transferred to a McIntosh G4 computer and processed with the NIH 1.58 program. The data were submitted to statistical analysis. RESULTS: The subjects presented dermochalasis (96.5%), Eyebrow Ptosis (60.8%), orbital fat prolapse (50.0%) or eyelid Ptosis (39.1%). The alterations were bilateral in 68.8% of the subjects. The intercantal distance was higher with age; the eyelid fissure length, the margin reflex distance and the external angle decreased in the elderly. The differences were more important on evaluating each eye separately. CONCLUSION: Intercantal distance increase and palpebral fissure length, margin reflex distance and total eyelid area decrease with age
