The American Journal of Cosmetic Surgery

To describe surgical techniques of blepharoptosis treatment during upper eyelid cosmetic blepharoplasty.

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.

Ptosis repair methodologies of internal versus external approaches are compared and contrasted.

Combining ptosis repair with cosmetic blepharoplasty is a safe, effective treatment for patients who demonstrate both dermatochalasis and ptosis.

Preoperative evaluation with detailed surgical planning is imperative to avoid potential complications in cosmetic eyelid surgery.

Before undergoing cosmetic upper eyelid blepharoplasty, patients should be thoroughly evaluated. Patients should be examined for ptosis, dry eye syndrome, prolapsed lacrimal gland, and brow ptosis. In addition to the evaluation for dry eye syndrome, patients interested in cosmetic lower eyelid blepharoplasty should be assessed for ectropion, entropion, lid retraction, scleral show, lid laxity, and lagophthalmos. Preoperatively, risk factors for orbital hemorrhage, including hypertension, anti-platelet or anticoagulant medication, history of abnormal bruising of bleeding, or underlying diseases that may contribute to bleeding, should be assessed. Intraoperative management of cosmetic upper eyelid surgery complications should focus on decreasing the risk of postoperative ptosis, lagophthalmos, lid retraction, and lid asymmetry, with special attention to limiting the risk of visual loss secondary to orbital hemorrhage.

Management of cosmetic lower eyelid blepharoplasty complications should focus on methods to assess lower lid laxity, limit the risk of diplopia, and manage orbital hemorrhage.

Techniques to revise cosmetic eyelid surgery complications during the postoperative period will be described.

Selective nonablative wrinkle reduction by laser is an exciting and appealing concept. The Nlite laser is a 585-nm pulsed dye laser that works on the concept that mild laser light injury of microvessels in the skin induces production of new collagen and may cause reduction in depth and visibility of wrinkles. This study reports on the author's experience with this new technology and the 6-month evaluation of 50 consecutive patients in his practice.

Fifty consecutive patients were treated with the Nlite laser according to the parameters suggested by the manufacturer. All patients had preoperative photographs taken and their wrinkles graded according to the Fitzpatrick and Glogau score. Three observers performed postoperative evaluation of 37 patients at 6- to 9-month intervals using photographs. Patient survey of 42 patients was completed with statistical analysis of the results.

Three observers were asked to evaluate pretreatment and posttreatment photographs and to determine if any detectable improvement had occurred after treatment. A total of 54%, 27%, and 37% of patients were found to have detectable improvement, respectively, for the periorbital, forehead, and perioral areas (marionette and lip lines). Patients surveyed on their results indicated detectable improvement in 70%, 62%, and 70% of patients, respectively, for the periorbital, forehead, and perioral areas. Most patients and observers graded the improvement as 0–25%.

The Nlite laser is a noninvasive treatment that improves skin wrinkles in some patients as noted by observer evaluation of pretreatment and posttreatment photographs and by patients as perceived by patient survey. The degree of improvement does not appear to be as great as that claimed by the laser manufacturer.

Liposuction has undergone many revisions since 1980, the most notable being the introduction of the tumescent technique of local anesthesia by Jeffery Klein, MD. Since then, in an effort to improve the aesthetics of the technique and the ease and safety of the procedure, other techniques have been introduced. These include superficial liposuction, UAL, external ultrasonic liposuction, mechanically assisted liposuction, and, most recently, laser-assisted liposuction.

Four centers in the United States, operating under an 1RB protocol, performed liposuction with the tumescent technique of local anesthesia on specified cosmetic units of the body. One side was exposed to 635-nm laser therapy after tumescence was achieved, whereas the contralateral side was not. Observations were recorded during surgery and at 2 weeks postoperatively.

Observations of intraoperative technique did not show an advantage to laser-assisted liposuction. Observations of the postoperative course were equivocal, though there was evidence of reduction of edema in certain patients.

The addition of laser therapy to liposuction technique is based on years of experience demonstrating improved wound healing using a technique of low-level laser therapy. Although the recorded observations did not support an advantage to the addition of laser therapy, there was a paradoxical difference of opinion among patients and surgeons who participated in the study. These individuals believed that, compared with patients not treated with low-level laser therapy, there was at least a reduction in degree and duration of postoperative pain and induration. As low-level laser therapy may have systemic effects on wound healing, comparing treated and untreated contralateral sides may not be valid because both sides experienced improvements in postoperative course. Laser-assisted liposuction has a potential advantage, not supported by this study, in the intraoperative and postoperative course of liposuction surgery. New studies using double-blind techniques will need to be conducted.