David E E Holck

Wilford Hall Ambulatory Surgery Center, Lackland Air Force Base, Texas, United States

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Publications (49)91.62 Total impact

  • David E. E. Holck · Christopher M. DeBacker · Cole, H.C., III
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    ABSTRACT: Techniques in midface lifting allow rejuvenation of an anatomic subunit that is not addressed in traditional lower face lifting procedures. Endoscopic and open forehead rejuvenation techniques address the brows and upper eyelid region, whereas standard face-lifting techniques address the lower third of the face and neck. Most facelift procedures do not adequately address the region from the lateral canthus to the lateral oral commissure [1]. Attempts at elevating the midface using bidirectional techniques and multiplanar dissection offered only modest improvement, with increased operative risks to the motor innervation of the lower eyelid and midface region [2, 3]. Extensive dissection of the superficial musculoaponeurotic system with release of the zygomatico-osseocutaneous retaining ligaments allowed greater manipulation of the malar fat pad and was advocated to realize upward movement of the medial cheek and improvement in the melolabial fold [15, 16]. Midface rejuvenation using the transeyelid composite approach advocated by Hamra, and the subperiosteal approach described by Baker have become more popular in recent years [2, 4]. Aggressive stretching, dissecting, and fixation of the orbicularis oculi and orbital septum may produce untoward and occasionally unpredictable results. In the demanding aesthetic population, the risks of lower eyelid retraction, frank ectropion, or neuropraxia must be minimized [5, 6]. © Springer Science+Business Media, LLC 2012. All rights reserved.
    No preview · Article · Aug 2013
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    ABSTRACT: This pilot study examines the rates of exposure and fibrovascular ingrowth of silicone-capped, porous, polyethylene orbital implants in the New Zealand white rabbit animal model. Unwrapped, silicone-capped, porous, polyethylene orbital spheres were implanted in 16 enucleated rabbit orbits. Four implants were removed at 3, 6, 9, and 12-month intervals and submitted for histopathologic analysis. A board-certified pathologist reviewed and graded vascular ingrowth, inflammation type, and severity for all specimens. Fibrovascular ingrowth in the center of all implants occurred as early as 3 months. No fibrovascular ingrowth occurred at the interface between the silicone cap and the porous polyethylene implant. The overlying Tenon's and conjunctival tissues remained intact without significant host inflammatory response. No implant exposure occurred at any time point. Silicone-capped porous polyethylene orbital implants appear to offer an inexpensive, easy-to-manufacture implant that resists exposure without the need for a wrapping material and achieves successful biointegration soon after implantation.
    No preview · Article · Jun 2013 · Ophthalmic plastic and reconstructive surgery
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    ABSTRACT: With an increased understanding of facial aging changes and midface anatomy, midface surgical techniques have achieved greater popularity in the management of lower eyelid and facial reconstruction and rejuvenation. In lower eyelid reconstruction and retraction management, midface skin recruitment through vertical lifting techniques may decrease the necessity for full-thickness skin grafting. Since the landmark descriptions by Shorr, the transeyelid subperiosteal midface lift combined with a lower eyelid spacer graft is an effective means to manage surgically lower eyelid retraction [1-5]. A serendipitous side effect of this vertical recruitment was midfacial rejuvenation via the elevation of the malar fat pad. © Springer Science+Business Media, LLC 2012. All rights reserved.
    No preview · Chapter · Aug 2012
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    ABSTRACT: Determine if raising the pH of 2% lidocaine with epinephrine 1:100 000 to a physiologic level decreases pain perception during periocular, subcutaneous anesthesia. Double-blind, prospective, randomized study. Simultaneous unilateral injections of buffered and unbuffered lidocaine solutions were given before surgery to patients having bilateral, periocular surgery. Fifty-four consecutive patients (27 male and 27 female; mean age, 68 years; standard deviation, 11 years). Patients were given simultaneous injections of buffered and unbuffered 2% lidocaine with epinephrine 1:100 000. The needles were inserted simultaneously and the anesthesia was injected for a 20-second count for a total volume of 1.0 ml per injected side. After the simultaneous injections, the patients were asked to rate the pain on each side on a Likert-type visual analog scale of 0 to 10. Sixty-five percent of patients preferred the buffered lidocaine with a scaled pain reduction of 0.9 (P = 0.0005). Additionally, for the patients who believed that the buffered solution was less painful, the mean decrease in scaled pain rating was 2, for a 51% reduction in pain level (P = 0.001). No gender differences were noted. Buffering 2% lidocaine with epinephrine 1:100 000 with sodium bicarbonate 8.4% offers a clinically and statistically significant reduction in pain experienced by two-thirds of patients receiving periocular subcutaneous anesthesia. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    Full-text · Article · Jul 2012 · Ophthalmology
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    ABSTRACT: To evaluate the functional indications and outcomes for blepharoplasty and blepharoptosis repair by assessing functional preoperative impairment and surgical results. Literature searches of the PubMed and Cochrane Library databases were conducted on July 24, 2008, with no age or date restrictions, and they were limited to articles published in English. These searches retrieved 1147 citations; 87 studies were reviewed in full text, and 13 studies met inclusion criteria and were included in the evidence analysis. The 13 studies reported the functional effects or treatment results of simulated ptosis; several types of blepharoptosis repair, including conjunctiva-Müller's muscle resection, frontalis suspension, and external levator resection; and upper eyelid blepharoplasty. Repair of blepharoptosis and upper eyelid dermatochalasis provides significant improvement in vision, peripheral vision, and quality of life activities. Preoperative indicators of improvement include margin reflex distance 1 (MRD(1)) of 2 mm or less, superior visual field loss of at least 12 degrees or 24%, down-gaze ptosis impairing reading and other close-work activities, a chin-up backward head tilt due to visual axis obscuration, symptoms of discomfort or eye strain due to droopy lids, central visual interference due to upper eyelid position, and patient self-reported functional impairment. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    No preview · Article · Dec 2011 · Ophthalmology
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    ABSTRACT: A novel medical device that has been approved by the Food and Drug Administration is available for treatment of postsurgical edema. The device emits a low-level, pulsed electromagnetic energy field, which modulates resting cell membrane potential, allowing a return to physiologic resting membrane potential. To investigate the benefits of electromagnetic energy in eyelid wound healing. Fifty-seven individuals participated in this randomized, double-blinded study. All patients underwent upper blepharoplasty. At the postoperative visit, patients rated pain, edema, and ecchymosis, and the physician rated edema, ecchymosis, and erythema. There was no difference (p = .76) in patient pain rating when comparing placebo (1.6) with the patch (1.3). Patients reported 6% less edema (p = .11) and 10% less ecchymosis (p = .17) with the active patch eye than in control eye. The physician-graded edema, ecchymosis, and erythema had a mean Likert-type scale difference between placebo and active eyes of -0.3 (p = .12), -0.3 (p = .17), and -0.2 (p = .004) respectively. The use of pulsed electromagnetic energy did not have an effect on postoperative pain, edema, or ecchymosis as rated by patients and physicians. There was a statistically significant reduction in physician-graded erythema for active patch eyes versus placebo.
    No preview · Article · Nov 2011 · Dermatologic Surgery
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    ABSTRACT: The purpose of this study was to compare postoperative eyelid position using fibrin sealant versus suture for wound closure in Müller's muscle-conjunctiva resection ptosis repair. One hundred ninety-six patients (367 eyelids) who underwent Müller's muscle-conjunctiva resection ptosis repair were divided into two groups: wounds closed with suture and those closed with fibrin sealant. Preoperative and postoperative eyelid measurements were compared statistically using appropriate t tests. Complications, eyelid symmetry, and revision rates were analyzed using a two-tailed Fisher's exact test. Suture was used for wound closure on 53 eyelids of 39 patients and fibrin sealant was used on 314 eyelids of 157 patients. There was no statistically significant difference (p = 0.49) when comparing the change from preoperative to postoperative margin-to-reflex distance 1 between the two groups. Postoperative symmetry within 0.5 mm was achieved in 87 percent of patients in the suture group and in 96 percent of patients in the fibrin sealant group (p = 0.06). The percentage of patients requiring additional ptosis adjustment was 2 percent in both groups (p = 1.0). Major complications were more common in the suture group (p = 0.0001). Müller's muscle-conjunctiva resection ptosis repair using fibrin sealant for wound closure offers equivalent lid position and symmetry as compared with suture wound closure. There is also a reduction in major postoperative complications when using fibrin sealant.
    No preview · Article · Aug 2011 · Plastic and Reconstructive Surgery
  • Lisa D Mihora · David E E Holck
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    ABSTRACT: Hematic cyst formation after placement of nonporous alloplastic orbital floor implants is well described. A benefit of porous polyethylene is fibrovascular ingrowth without capsular formation. This ingrowth inhibits hematic cyst formation. In the case presented here, a hematic cyst developed on a screw-fixated porous polyethylene/titanium mesh implant (Medpor Titan B-T-M, Porex Surgical, Newnan, GA, U.S.A.). The risk factor for this patient was the nonporous barrier surface of the implant and inadequate fracture reduction. Proper surgical technique, including implant sizing, placement, and fixation, are factors reported to prevent hematic cyst formation. This patient's symptoms resolved after removal of the implant and cyst and replacement of the orbital implant.
    No preview · Article · Feb 2011 · Ophthalmic plastic and reconstructive surgery
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    ABSTRACT: To compare fibrin sealant (Tisseel) versus suture for wound closure in Müller muscle-conjunctiva resection ptosis repair. The charts of 114 patients (211 eyelids) who had undergone Müller muscle-conjunctiva resection were retrospectively reviewed. Suture versus Tisseel were used for wound closure. Preoperative and postoperative eyelid measurements, postoperative symmetry within 0.5 mm, and complications were compared. Müller muscle-conjunctiva resection ptosis repair was performed on 211 eyelids of 114 patients. Seventeen cases were unilateral and 97 cases were bilateral. Method of wound closure included suture (45 eyelids of 31 patients) versus Tisseel (166 eyelids of 83 patients). For the suture group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.9. For the Tisseel group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.8. The 2 groups did not differ statistically in preoperative (p = 0.97) or postoperative MRD1 values (p = 0.53), the difference (p = 0.63), or postoperative symmetry within 0.5 mm (p = 0.39). In the suture group, complications included moderate to severe pain (10%), suture granuloma (6%), corneal abrasion (3%), loose suture (3%), and persistent keratopathy (3%). We found no evidence of keratopathy attributable to the Tisseel (p = 0.0001). This difference in the prevalence of complications was statistically significant (p = 0.0001). Four patients in the suture group (13%) underwent subsequent procedures including suture granuloma removal (2) and suture removal (1); 1 patient (3%) required levator resection. Three patients in the Tisseel group (4%) subsequently underwent levator resection. Müller muscle-conjunctiva resection ptosis repair using fibrin sealant for wound closure offers comparable eyelid position results compared with suture. Use of Tisseel showed fewer postoperative complications and was associated with fewer subsequent surgical procedures.
    No preview · Article · Mar 2009 · Ophthalmic plastic and reconstructive surgery
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    ABSTRACT: Ectopic brain in the orbit is a rare entity with only 14 other case reports in the literature. This case is unique in that symptomatic presentation occurred 20 years prior to diagnosis. Symptoms are generally due to mass effect. We report an unusual case of diplopia secondary to ectopic orbital brain and a review of the literature.
    No preview · Article · Jan 2009 · Orbit (Amsterdam, Netherlands)
  • David E.E. Holck · Manuel A Lopez
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    ABSTRACT: Autologous fat transfer is a useful adjunct to augment facial soft tissue deflation in the periocular region. With meticulous technique, small aliquot placement, and reinjection at appropriate intervals, fat makes an excellent adjunct to the management of the aging face, and compliments other facial rejuvenation techniques. Appropriate counseling, realistic expectations, and meticulous technique make fat transfer an effective method of soft tissue augmentation.
    No preview · Article · Dec 2008 · Facial plastic surgery clinics of North America
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    ABSTRACT: To investigate whether orbital radiation offers effective and safe treatment for Graves ophthalmopathy. Medical literature databases were searched to identify all published reports relating to orbital radiation treatment for Graves ophthalmopathy. To be included in the technology assessment, reports had to provide original data, to report on a case series or uncontrolled trial of at least 100 subjects or a randomized clinical trial of any size, to focus on orbital radiation for the treatment of Graves ophthalmopathy, and to follow-up patients for at least 3 months. Abstracted data included study characteristics, patient characteristics, treatment response, and safety information. Fourteen studies were included in the technology assessment: 5 observational studies and 9 randomized controlled trials. Three of the observational studies report on treatment response, with overall favorable outcomes for 40% to 97% of patients. Three of the observational studies provided intermediate-term safety data. The risk of definite radiation retinopathy is 1% to 2% within 10 years after treatment. Patients treated with orbital radiation did not have an increased risk of secondary malignancy or premature death. The 9 randomized trials were qualitatively heterogeneous. Patients with optic neuropathy generally were excluded from participating in the randomized trials. Three of the randomized trials were sham controlled. None of these studies showed that orbital radiation was more efficacious than sham irradiation for improving proptosis, lid fissure, or soft tissue changes such as eyelid swelling. Two of the 3 sham-controlled randomized trials demonstrated improved vertical range of motion in radiation-treated subjects compared with controls. Systematic review of the effect of orbital radiation on Graves ophthalmopathy is limited by the lack of standardization and variable quality of published reports. Extraocular motility impairment may improve with radiotherapy, although the evidence of a treatment effect is mixed in clinical trials. Future studies are needed to determine if a potentially beneficial motility effect results in improved patient function and quality of life. Level I evidence indicates that proptosis, eyelid retraction, and soft tissue changes do not improve with radiation treatment. The efficacy of orbital radiation for compressive optic neuropathy resulting from Graves ophthalmopathy has not been investigated in clinical trials and merits further study. Radiation retinopathy, although rare, is a risk of orbital radiation, even in patients without diabetes who receive appropriate radiation dose and delivery.
    Full-text · Article · Mar 2008 · Ophthalmology
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    ABSTRACT: Facial rhytidectomy surgery is a reconstructive/cosmetic procedure to restore anatomic changes to the lower third of the aging face and neck. It is a surgery of planes. Understanding safe dissection planes allows the surgeon to maximize his or her results in a reliable fashion.1,2 Facial rhytidectomy may also be considered a surgery of opportunity and compromise in which soft tissue dissection and redraping take advantage of the facial blood supply while predictable and desirable wound healing provide the rejuvenated appearance. Mastery of facial anatomy and the relationships of the superficial and deep facial layers, muscles, nerves, and vasculature are of paramount importance in performing rhytidectomy surgery safely, effectively, and with confidence.3,4 We have noted 10 areas in which attention to detail offers a predictable and reliable rhytidectomy procedure and avoids some of the stigmata of rhytidectomy surgery.5
    No preview · Chapter · Dec 2007
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    ABSTRACT: The transtemporal subperiosteal approach to the midface may be continued as an extension of an endoscopic or open browlift procedure as well as combined with lower third facial rhytidectomy surgery to optimize entire facial rejuvenation. This technique also allows for fat graft injection, orbital fat pedicle repositioning, malar augmentation, and/ or lateral retinacular suspension of the lower eyelid if desired, in a safe fashion. Using a resorbable midface elevation device on a leash allows predictable reliable midface elevation with improved surgical efficiency.
    No preview · Chapter · Dec 2007
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    ABSTRACT: Over the past decade, improved appreciation of facial aging changes have modified management considerations for facial rejuvenation. In the brow region, traditional changes of soft tissue descent due to loss of skin elasticity and gravitational effect have been updated to include soft tissue and bony volume loss (deflation).1,2 Thus, optimal management of age-related brow ptosis should address these changes.
    No preview · Chapter · Dec 2007
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    ABSTRACT: To present three cases of chronic infraorbital nerve hyperesthesia relieved by surgical decompression of the infraorbital nerve. Retrospective chart review. We identified three cases of chronic hyperesthesia of the infraorbital nerve. Two cases were related to previous blunt orbital trauma, whereas the third was associated with a long-standing anophthalmic socket with numerous previous surgeries. In each case, patients had dramatic relief of infraorbital nerve hyperesthesia and pain after surgical decompression of the infraorbital nerve. Surgical decompression of the infraorbital nerve can provide significant symptomatic improvement in patients with chronic infraorbital nerve hyperesthesia secondary to nerve compression.
    No preview · Article · Jan 2007 · Ophthalmic Plastic and Reconstructive Surgery
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    ABSTRACT: To determine the safety and efficacy of fibrin sealant for use in Müller muscle-conjunctiva resection ptosis repair. This was a retrospective review of a consecutive case series. All patients underwent Müller muscle-conjunctiva resection ptosis repair with fibrin sealant used for wound closure. Surgery was performed in a manner similar to a previously described technique, using fibrin tissue sealant rather that suture for wound closure. Postoperative symmetry was defined as MRD1 of each eyelid within 0.5 mm. Müller muscle-conjunctiva resection ptosis repair with fibrin sealant used for wound closure was performed on 53 eyelids of 33 patients. There were 27 female patients and 6 male patients. Twenty patients underwent bilateral ptosis repair and 13 patients underwent unilateral ptosis repair. Average follow-up was 17 weeks (range, 3 to 45 weeks). Mean preoperative MRD1 was 1.22 mm (range, -1.5 to 2.5 mm) in the right upper eyelid and 1.50 mm (range, 0 to 2 mm) in the left upper eyelid. Mean postoperative MRD1 was 3.11 mm (range, 2 to 4.5 mm) in the right upper eyelid and 3.12 mm (range, 1 to 4.5 mm) in the left upper eyelid. Postoperative symmetry was found in 32 of 33 patients (97%). We found no evidence of keratopathy or other complications attributable to the fibrin sealant. Müller muscle-conjunctiva resection ptosis repair with fibrin sealant used for wound closure may allow for predictable results with few complications and appears to be an acceptable alternative to traditional suture techniques.
    No preview · Article · May 2006 · Ophthalmic Plastic and Reconstructive Surgery
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    ABSTRACT: To evaluate the safety and efficacy of botulinum toxin type A for treatment of eyelid retraction resulting from thyroid eye disease (TED) during the inflammatory phase of the condition. In this prospective, nonrandomized case series, 18 patients with inflammatory eyelid retraction caused by active TED received botulinum toxin type A injection (10, 5, or 2.5 U) for treatment of upper eyelid retraction. Botulinum toxin type A (Allergan, Irvine, CA, U.S.A.) was injected transconjunctivally just above the superior tarsal border in the elevator complex of the upper eyelid. Seventeen of 18 patients (94%) demonstrated a reduced marginal reflex distance (MRD1) after botulinum toxin injection. The average change in MRD1 of the treated eyelid after injection was -2.35 mm (range, 0 to -8.0 mm). Of the 27 eyelids injected, 33% had a 0- to 1-mm drop in eyelid height, 30% had a 1.5- to 2-mm decrease, 22% had a 2.5- to 3-mm decrease, and 15% had a greater than 3-mm decrease in eyelid height. None of the treated eyelids were noted to increase in height. One patient showed no alteration inafter treatment. One patient had clinically MRD1 significant ptosis and one patient reported worsening of preexisting diplopia after injection. Three patients undergoing unilateral injection had relative contralateral eyelid elevation. All untoward effects resolved spontaneously without sequelae. : Botulinum toxin type A may be used in the inflammatory stage of thyroid eye disease to improve upper eyelid retraction. Individual response to treatment is variable, but this modality should be considered as a temporizing measure until stability for surgery is reached.
    No preview · Article · Jun 2004 · Ophthalmic Plastic and Reconstructive Surgery
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    ABSTRACT: To determine the safety and efficacy of processed human pericardium as a barrier material for gold weight implantation. In this retrospective, noncomparative case series, all patients undergoing gold weight implantation with human pericardium barrier between November 2000 and May 2002 were studied. Charts were reviewed for surgical indications, gold weight size, follow-up interval, and complications. Twenty-three eyelids of 23 patients underwent gold weight implantation with processed human pericardium barrier material. There were 15 female and 8 male patients. Mean patient age was 53 years (range, 22 to 78 years). Indications for surgery included extruded implant (4 eyelids), thin tissues overlying existing implant (3 eyelids), thin anterior lamellar eyelid tissues (6 eyelids), radiotherapy (1 eyelid), and requirement for long-term gold weight therapy (9 eyelids). Mean follow-up was 11 months (range, 3 to 36 months). Acceptable tissue coverage was found in 23 of 23 eyelids. There were no complications of infection, extrusion, or thinning of overlying tissues. One patient had prolonged eyelid edema and erythema that resolved spontaneously 3 months after surgery. Human pericardium appears to be well tolerated on at least a short-term basis within the eyelid when used as a barrier material for gold weight implantation.
    No preview · Article · Apr 2004 · Ophthalmic Plastic and Reconstructive Surgery
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    ABSTRACT: This report aims to increase awareness of an unusual mechanism of orbital injury sustained by bicycle riders. In this retrospective small case series, we describe two cases of orbital injury caused by upper eyelid penetration. A 5-year-old boy (patient 1) and a 6-year-old boy (patient 2) presented to our service within a 2-week period. Both had been injured by similarly styled, handlebar-mounted bicycle hand brake levers. Patient 1 had an orbital roof fracture and penetrating brain injury and underwent repair of a left upper eyelid laceration, craniotomy for pseudoencephalocele, and ptosis repair. Patient 2 had orbital hemorrhage and underwent repair of left upper eyelid laceration. In both cases, a handlebar-mounted bicycle hand brake lever perforated the left eyelid when the rider fell onto it. Neither patient was wearing protective headwear or eyewear. Two months after surgery, patient 1 had 20/25 visual acuity OU and excellent cosmetic appearance. Patient 2 had baseline amblyopic vision 2 days after surgery but moved from town and was lost to follow-up. Orbit injuries from bicycle brake levers are rare, and helmets or protective eyewear probably would not have prevented these injuries. However, a change in the design and/or mounting location of handlebar-mounted brake levers might help prevent further injuries of this type.
    No preview · Article · Feb 2004 · Ophthalmic Plastic and Reconstructive Surgery

Publication Stats

605 Citations
91.62 Total Impact Points


  • 1997-2013
    • Wilford Hall Ambulatory Surgery Center
      Lackland Air Force Base, Texas, United States
  • 2007
    • Saint Louis University
      Saint Louis, Michigan, United States
  • 2003
    • Brooke Army Medical Center
      Houston, Texas, United States
  • 1996
    • Duke University Medical Center
      • Department of Ophthalmology
      Durham, North Carolina, United States