Subperiosteal Midface Lift with or without a Hard Palate Mucosal Graft for Correction of Lower Eyelid Retraction

Department of Ophthalmology, University of California, Los Angeles, Los Ángeles, California, United States
Ophthalmology (Impact Factor: 6.14). 10/2006; 113(10):1869-73. DOI: 10.1016/j.ophtha.2006.05.014
Source: PubMed


To compare functional and surgical outcomes of a subperiosteal midface lift with and without the placement of a hard palate mucosal graft (HPMG) in patients with lower eyelid retraction.
Retrospective, comparative, interventional case series.
Thirty-four patients with lower eyelid retractions who underwent surgery at the Jules Stein Eye Institute in a 5-year period.
Medical record review of all patients who underwent surgery for lower eyelid retraction by a subperiosteal midface lift with or without an HPMG. Preoperative and postoperative digital photographs were taken in all patients.
Change in margin reflex distance 2 (MRD2), measured from the pupillary margin to the upper margin of the lower eyelid; patient discomfort; and surgical complications.
Thirty-four patients (20 female; mean age, 64 years) participated in the study; 11 underwent bilateral surgery, with overall 43 surgeries performed. Eighteen patients (42%) had lower eyelid retraction secondary to previous transcutaneous lower eyelid blepharoplasty. Postoperatively, patients attained a better lower eyelid position, with improvement of lower eyelid height of 1.4 mm (P<0.001, 1-sample t test). Patients operated using an HPMG (12 surgeries) achieved a greater reduction in MRD2 postoperatively as compared with patients operated by subperiosteal midface lift alone (31 surgeries; 2.2 mm vs. 1.1 mm, respectively; P = 0.02, Wilcoxon Mann-Whitney). One patient needed reoperation secondary to symptomatic lower eyelid retraction postoperatively.
The subperiosteal midface lift is effective in correction of lower eyelid retraction of various causes. The use of an HPMG spacer may enhance surgical outcomes and results in a better lower eyelid position.

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    • "Hard palate or nasal turbinate mucosal tissue is often used as an autologous spacer since the surfaces of these tissues possess an appropriate degree of rigidity.10-12 Although keratinization can occur, it only irritates the ocular surface.9,12,13 As an alternative spacer material, auricular cartilage can be utilized. "
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    ABSTRACT: Objective: Among the surgical procedures used to correct the positions of the eyelids or improve their cosmetic appearance, procedures for treating eyelid retraction are some of the most challenging. Lower eyelid retraction can occur iatrogenically after various surgical procedures. We performed a successful corrective procedure for lower eyelid retraction, which had occurred at some point in the 2 decades after primary surgery for epiblepharon. Method: A 23-year-old woman underwent primary surgery for bilateral epiblepharon at the age of 5 years. However, at the age of 17, she noticed that an abnormally large proportion of her right sclera was visible when her eyes were in their natural position. In the primary position of gaze, the distance from the lower limbus of the right cornea to the upper margin of the lower eyelid was approximately 2 mm. An incision was made in the lower eyelid along the scar caused by the previous operation. Subsequently, the connections between the tarsus and the lower eyelid retractors were broken, and harvested auricular cartilage was placed between the lower edge of the tarsus and the lower eyelid retractors. Results: One year after the operation, there was no gross difference in the distance between the lower margin of the corneal limbus and the lower eyelid on either side, and the patient was extremely happy with the results. Conclusion: Using a novel surgical technique, we successfully lengthened the posterior layer of the lower eyelid retractors with a small amount auricular cartilage, resulting in good functional and cosmetic outcomes.
    Eplasty 10/2013; 13:e55.
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    • "The hard palate mucosa and nasal turbinate mucosa are often used as autologous spacers (Bartley and Kay 1989; Kersten et al 1990; Cohen and Shorr 1992; Wearne et al 2001; Patel et al 2005; Ben Simon et al 2006), since they have a mucosal surface of appropriate rigidity (Cohen and Shorr 1992; Wearne et al 2001). Although keratinization can occur, it only irritates the ocular surface (Kersten et al 1990; Ben Simon et al 2006; Cohen and Shorr 1992). As an alternative material, ear cartilage is sometimes used via a transconjunctival approach (Baylis et al 1985; Moon et al 2005), and some of this remains exposed and requires removal (Kersten et al 1990). "
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    ABSTRACT: The lower eyelid retractors consist of double layers, the posterior layer of which is the main tractional component. Therefore, shortening of the posterior layer of the lower eyelid retractors causes lower eyelid retraction or cicatricial entropion. Based on this concept, we report a modified lower eyelid lengthening surgery involving complete recession of the posterior layer of the lower eyelid retractors by way of a transcutaneous approach that leaves the palpebral conjunctiva intact and inserts ear cartilage as a rigid spacer between the lower edge of the tarsal plate and the recessed anterior layer of the lower eyelid retractors. This procedure completely extirpated the preoperative maladjusted states of lower eyelid retraction and cicatricial entropion. Our procedure also prevented postoperative discomfort of the ocular surface due to the intact palpebral conjunctiva. As well, lower eyelid mobility and contour were good and within their respective permissible ranges. The lower eyelid lengthening surgery focusing on the posterior layer of the lower eyelid retractors using auricular cartilage via a transcutaneous approach is a useful procedure for lower eyelid retraction or cicatricial entropion.
    Clinical ophthalmology (Auckland, N.Z.) 07/2007; 1(2):141-7.
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    ABSTRACT: Complications are an inevitable part of surgery and, despite the best preparative efforts, events may not unfold as planned and unanticipated complications inescapably occur. A thorough knowledge of potential complications in order of likelihood and importance is paramount in achieving the best possible outcome, not simply to minimize the occurrence of these events but also to provide the capacity to optimally evaluate and manage such events should they arise. This review summarizes the evaluation and management of complications associated with commonly performed surgical procedures in the field of ophthalmic plastic and reconstructive surgery.
    Expert Review of Ophthalmology 11/2007; 2(6):1001-1018. DOI:10.1586/17469899.2.6.1001
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