Modern blepharoplasty:From bench to bedside

The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years.Blepharoplasty is one of the most frequently performed procedures worldwide to date.Surgery is currently the first choice in order to achieve permanent and effective results;however,it is burdened by potential surgical complications feared by patients.There is an increasing trend in individuals to request less invasive,non-surgical,effective,and safe procedures for eyelid treatment.The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years.Numerous modern techniques that provide a rejuvenation of the entire area have been described.Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings.Dermal fillers are a commonly chosen option for providing enhanced aesthetic results,especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging.Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits.The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis.Furthermore,techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.

Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition

Objective:To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing.Methods:In this retrospective pre-post study,an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020.Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses.As part of routine practice,glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition;taped examinations were excluded from analysis.Clinical and demographic characteristics,mean deviation,and pattern standard deviation were evaluated within a two year period before and after eyelid surgery.Results:The final analysis included 60 eyes of 38 patients.Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses.Among patients with ptosis,the margin reflex distance-1 was not associated with change in mean deviation after surgery(Pearson R^(2)=0.0061;P=0.700).Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery.Conclusions:Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields.Unreliable visual fields could be a sign of eyelid interference in this population.