forHEALTHYlife

Another Health Blog..

Suborbital maxillary volume/ malar suborbital deflciences

Jan 13

Posted by for healthy life in Cosmetic | No Comments

A medial sulcus just lateral to the nasal pyramid, which extends distally for 2.5 cm obliquely towards the angle of the mandible, has been termed a ‘nasojugal’ sulcus or ‘tear trough.’7‘8 However, either by heredity or mainly with aging changes, this suborbital depres­sion continues beneath the entire lower eyelid. This volume deficiency is not at the level of the inferior orbital rim as originally thought by plastic surgeons. Instead, it occurs consistently at a measured distance of 8 to 10 mm below the orbital rim. This observation was made by me early in the 1980s, when postoperative blepharoplasty patients began complaining about their more tired, ‘hollow’ look.

The etiology of why such a depression in this area appears as early as the third decade of life and certainly by the late 40s and early 50s has been unclear. Recently, however, largely through the photographic and com­puter studies of Lambros,4 it is now agreed upon that a true atrophy or involution of fat occurs in the upper two-thirds of the face and largely in the periorbital region. This disappearance of fat correlates with the increased appearance of a suborbital hollowness, which creates a tired, haggard appearance.

When indeed, as in many instances, weakening of the orbicularis oculi muscle and orbital septum occurs, per­mitting the intraorbital fat to protrude forward into what has been commonly called ‘fat bags,’ the suborbital hollow sulcus is accentuated even further. Ambient light creates a highlight on the top of the fat bag ‘mountains’ while a shadow is created in the suborbital ‘valley.’ The juxtaposi­tion of the positive and negative contours enhances the tired ‘ring’ appearance at the lid-cheek junction.

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The upper eyelid crease and fold

Jan 5

Posted by for healthy life in Cosmetic | No Comments

What has been less understood, are the actual changes that occur to the upper eyelid crease and fold. Often the position of the eyelid crease is obscured by the appearance of redundant upper eyelid skin and fold displacement. A careful analysis of the crease in most individuals shows varied change from youth. The changes may also be asymmetric in any one individual (Fig. 8-8). This includes an elevated crease that may manifest in one or both upper eyelids. The solution has been, in most cases, to raise the eyelid crease of the affected upper eyelid with the excision of ‘excess’ soft tissue with or without brow lift. This maneuver, however, is routinely and repeatedly performed without respect for the presenescent appearance or understanding of the actual age-related changes of the upper periorbita (Figs 8-2, 8-3, 8-6).

The routine applications of traditional concepts in incision placement and soft tissue excision have also plagued some other technical aspects in upper blepha­roplasty. The usual design of the upper eyelid crease commonly involves the use of 10 mm or greater (height) eyelid crease incision with excision of skin, orbicularis oculi muscle, and preaponeurotic fat.7‘8 This is customary whether or not upper blepharoplasty is per­formed with or without a brow lift. In part, the basis of this approach has been an attempt to elevate the upper eyelid crease, in essence, to expose a greater amount of the pretarsal surface and to ‘debulk’ the upper eyelid fullness by en-bloc or separate resection of skin and muscle.8 This approach, however, facili­tated additional steps in upper blepharoplasty that are also aesthetically detrimental, including better access to the prcaponeurotic fat (resulting in further soft tissue reduction and volume depletion) and the levator aponeurosis for supratarsal fixation. Concerns with a lower placed incision included possible visibility of the upper eyelid incision scar, inability to achieve adequate final pretarsal exposure, and risk to the levator apo­neurosis insertion to the pretarsal surface, especially when utilizing a full thickness skin muscle excision whether removed in separate ‘layers’ or ‘en-bloc’ The long-term consequences of the traditional approach, however, can be suboptimal. Deep or ‘hollow’ upper eyelid sulci are common effects, presumably from over-resection of soft tissue (Fig. 8-3), especially fat. In some, the upper eyelid crease scar becomes hypopig-mented (Fig. 8-9) and usually more visible with time, usually at a much higher level (15—20 mm). This is especially true in the patient with a prominent globe, negative upper periorbital vector, or in those who habitually elevate their eyebrows for a variety of reasons. The color transition can also at times become quite obvious, as the upper edge of the incision is placed in the darker and thicker sub-brow skin. The pretarsal skin also becomes progressively less taut (more ‘crepey’ in appearance) due to the sliding effect as most original points of fixation have been compro­mised by over-dissection.

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Eyebrow position and volume

Jan 4

Posted by for healthy life in Cosmetic | No Comments

The term brow ptosis suggests a descent of the eyebrow position from its ‘normal’ state. Obviously some younger individuals with ‘low’ brows may request a ‘change’ or improvement of their brow position much as one would desire otoplasty or rhinoplasty (Fig. 8-5). Additionally, many patients will present wishing for surgical correction to accomplish more pretarsal ’show’ for reasons that include creating more area to apply cosmetics, a mistaken memory of what their upper eyelid looked like in youth, or simply their desired outcome. A review of old photographs is most often revealing, yet the ultimate determination must rest on the choice of each individual patient. Careful analysis including the use of morphing techniques as shown by Lambros11 and others,1- repeatedly and consistently has shown that the deflationary effects from facial volume loss with age can yield the apparent and illu-sionary effects of facial soft tissue ptosis. These misper-ceptions include an illusion of brow ptosis in some individuals that is due to soft tissue volume depletion, particularly in the temporal and lateral infrabrow regions, which may have prompted a brow lift when replacement of soft tissue volume has been shown to enhance aesthetics (Fig. 8-7)u (see Chapter 23). There are also some individuals who would have compro­mised aesthetic results by not undergoing the necessary brow lift. Which individuals then, benefit from which procedures?

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What Are the Symptoms of Kidney Moving

Jan 3

Posted by health in Disease & Illness | No Comments

Kidney Stones in the kidneys of calcium and other small mineral fragments collected in the bladder through the ureter is created by large ones too. The main symptoms of kidney stone formation, and severe local pain and intense sweating are also related disease.

The most common symptom of kidney stone formation in the abdominal region of human sudden and Read the rest of this entry »

Upper Blepharoplasty: Volume Enhancement via Skin Approach: Lowering the Upper

Jan 2

Posted by for healthy life in Cosmetic | No Comments

Lid Crease
Steven Faeien
Over the years, success of a particular surgical procedure, even aesthetic, has been measured mostly by perceived outcome and to some degree by the frequency of complications. Since the overwhelming majority of aesthetic periorbital ‘complications’ have occurred with lower blepharoplasty, most of the attention on newer and improved techniques has focused on the lower periorbita’”6 (see Chapters 14-19, Lower blepharoplasty).
As functional misadventures are a much less encountered occurrence after upper blepharoplasty, complacency with existing methods and perpetuation of ill-perceived solutions to rejuvenation of the upper periorbita prevail.7,8
With rare exception, the approach to upper blepharoplasty has not been particularly physiologic or individualized and the universal application of traditional remedies for upper periorbital rejuvenation has translated to mediocrity.7″”9 The prevailing perception has been that the appearance of the aged upper eyelid is primarily due to excessive skin, muscle, and fat often in conjunction with brow descent. Additionally, there is the confounding erroneous memory in many individuals of what their upper periorbita looked like in youth. Finally, there is the influence of the ‘famous and beautiful’ people on what patients may request for their eventual appearance despite their configuration in earlier years (Fig. 8-1) that may explain some of the historical aesthetic desires as well as changes in ideas and what is currently expected after surgery.
Steven Fagien
The consultation
As with all surgical approaches to rejuvenation, we must take into account what are the actual changes that occur in the upper periorbita and whether the existing methods consider these occurrences for a wide variety of indi¬vidual presentations (Fig. 8-2). Do these techniques result in a rejuvenative appearance or simply achieve a ’cause and effect’ outcome whereby an altered appearance replaces youth? (Fig. 8-3). And, ultimately, what surgical procedures are some patients willing to undergo and what do they expect from surgery?

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Postoperative care

Dec 12

Posted by for healthy life in Cosmetic | No Comments

No dressings are used after surgery. The patient is instructed to apply ice cold compresses on the eyelids. Pads 4 by 4 inches, soaked in a buckle of saline and ice are applied with slight general pressure to the lids. When the pads become warm, they arc dipped again into the saline and ice and reapplied. This process is repeated for 24 hours. The application should be fairly constant for the few postoperative hours. After that the compresses are applied for about 15 minutes with a 15-minute rest period in between until bedtime. The applications are resumed on awakening.

To reduce edema postoperatively the patient lies in bed with the head approximately 45° higher than the rest of the body. Nurses should check for bleeding associated with proptosis, pain, or loss of vision every 15 minutes for the first two to three hours postopera­tively or until the patient leaves the surgical facility. Every hour thereafter until bedtime, the family or patient should monitor the patient’s ability to count

fingers and should check for residual proptosis and pain. If the patient cannot count fingers or has marked proptosis or pain, the family should take him or her to the emergency room. If loss of vision occurs secondary to retrobulbar hemorrhage, it could easily be detected by opening the incision involved.’ Garamycin ointment is applied to the eyes twice a day for the first two weeks.

No dressings are used after surgery. The patient is instructed to apply ice cold compresses on the eyelids. Pads 4 by 4 inches, soaked in a buckle of saline and ice are applied with slight general pressure to the lids. When the pads become warm, they arc dipped again into the saline and ice and reapplied. This process is repeated for 24 hours. The application should be fairly constant for the few postoperative hours. After that the compresses are applied for about 15 minutes with a 15-minute rest period in between until bedtime. The applications are resumed on awakening.

To reduce edema postoperatively the patient lies in bed with the head approximately 45° higher than the rest of the body. Nurses should check for bleeding associated with proptosis, pain, or loss of vision every 15 minutes for the first two to three hours postopera­tively or until the patient leaves the surgical facility. Every hour thereafter until bedtime, the family or patient should monitor the patient’s ability to count

fingers and should check for residual proptosis and pain. If the patient cannot count fingers or has marked proptosis or pain, the family should take him or her to the emergency room. If loss of vision occurs secondary to retrobulbar hemorrhage, it could easily be detected by opening the incision involved.’ Garamycin ointment is applied to the eyes twice a day for the first two weeks.

No dressings are used after surgery. The patient is instructed to apply ice cold compresses on the eyelids. Pads 4 by 4 inches, soaked in a buckle of saline and ice are applied with slight general pressure to the lids. When the pads become warm, they arc dipped again into the saline and ice and reapplied. This process is repeated for 24 hours. The application should be fairly constant for the few postoperative hours. After that the compresses are applied for about 15 minutes with a 15-minute rest period in between until bedtime. The applications are resumed on awakening.

To reduce edema postoperatively the patient lies in bed with the head approximately 45° higher than the rest of the body. Nurses should check for bleeding associated with proptosis, pain, or loss of vision every 15 minutes for the first two to three hours postopera­tively or until the patient leaves the surgical facility. Every hour thereafter until bedtime, the family or patient should monitor the patient’s ability to count

fingers and should check for residual proptosis and pain. If the patient cannot count fingers or has marked proptosis or pain, the family should take him or her to the emergency room. If loss of vision occurs secondary to retrobulbar hemorrhage, it could easily be detected by opening the incision involved.’ Garamycin ointment is applied to the eyes twice a day for the first two weeks.

Complications

Several patients in whom I performed the transcon­junctival approach had postoperative residual derma-tochalasis, which needed to be removed through an external approach or a laser skin resurfacing. Better patient selection or combined initial procedure with skin flap excision or orbicularis muscle plication could have prevented this problem.

Although this procedure has not caused any motility problems, in several patients in whom this procedure was combined with a tarsal strip procedure, ocular

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