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J Cosmet Med 2017; 1(1): 30-38

Published online June 30, 2017

https://doi.org/10.25056/JCM.2017.1.1.30

Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Kyoung-Jin Kang, MD, PhD1, Hung-Hsu Yang, MD, MS2, Choong-Yee Chai, MS3

1Seoul Cosmetic Surgery Clinic, Busan, Korea, 2101 Skin Clinic, Taipei, Taiwan, 3Korean College of Cosmetic Surgery, Busan, Korea

Correspondence to :
Kyoung-Jin Kang, Seoul Cosmetic Surgery Clinic, 4, Gudeok-ro 34 Beon-gil, Jung-gu, Busan 48594, Korea
Tel: 82-51-247-7776, Fax: 82-51-248-7765, E-mail: kccs7777@gmail.com

Received: March 7, 2017; Revised: April 25, 2017; Accepted: May 8, 2017

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.
Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods: The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-to-skeletal relationship.
Results: The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n.
Conclusion: Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.

Keywords: lid-cheek junction, transconjuctival lower blepharoplasty, transcutaneous lower blepharoplasty, globe-to-skeletal relationship, negative and positive vector

  1. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007;120:1367-76; discussion 1377.
    Pubmed CrossRef
  2. Hester TR Jr, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging:maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 2000;105:393-406; discussion 407-8.
    Pubmed CrossRef
  3. Tomlinson FB, Hovey LM. Transconjunctival lower lid blepharoplasty for removal of fat. Plast Reconstr Surg 1975;56:314-8.
    CrossRef
  4. Zarem HA, Resnick JI. Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg 1991;88:215-20; discussion 221.
    Pubmed CrossRef
  5. Undavia S, Briceño CA, Massry GG. Quantified incision placement for postseptal approach transconjunctival blepharoplasty. Ophthal Plast Reconstr Surg 2016;32:191-4.
    Pubmed CrossRef
  6. Codner MA, Wolfli JN, Anzarut A. Primary transcutaneous lower blepharoplasty with routine lateral canthal support:a comprehensive 10-year review. Plast Reconstr Surg 2008;121:241-50.
    Pubmed CrossRef
  7. Yaremchuk MJ. Restoring palpebral fissure shape after previous lower blepharoplasty. Plast Reconstr Surg. 2003;111:44150.
    CrossRef
  8. Haddock NT, Saadeh PB, Boutros S, Thorne CH. The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg 2009;123:1332-40;discussion 1341-2.
    Pubmed CrossRef
  9. Segal KL, Patel P, Levine B, Lisman RD, Lelli GJ Jr. The effect of transconjunctival blepharoplasty on margin reflex distance
  10. Aesthetic Plast Surg 2016;40:13-8.
    Pubmed CrossRef
  11. Palmer FR 3rd, Rice DH, Churukian MM. Transconjunctival blepharoplasty. Complications and their avoidance: a retrospective analysis and review of the literature. Arch Otolaryngol Head Neck Surg 1993;119:993-9.
    CrossRef
  12. Goldberg RA. Transconjunctival orbital fat repositioning:transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 2000;105:743-8; discussion 749-51.
    Pubmed CrossRef
  13. Turk JB, Goldman A. SOOF lift and lateral retinacular canthoplasty. Facial Plast Surg 2001;17:37-48.
    Pubmed CrossRef
  14. Kikkawa DO, Lemke BN, Dortzbach RK. Relations of the superficial musculoaponeurotic system to the orbit and characterization of the orbitomalar ligament. Ophthal Plast Reconstr Surg 1996;12:77-88.
    Pubmed CrossRef
  15. El-Garem YF. Estimation of bony orbit depth for optimal selection of the injection technique to correct the tear trough and palpebromalar groove. Dermatol Surg 2015;41:94-101.
    Pubmed CrossRef

Article

Original Article

J Cosmet Med 2017; 1(1): 30-38

Published online June 30, 2017 https://doi.org/10.25056/JCM.2017.1.1.30

Copyright © Korean Society of Korean Cosmetic Surgery.

Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Kyoung-Jin Kang, MD, PhD1, Hung-Hsu Yang, MD, MS2, Choong-Yee Chai, MS3

1Seoul Cosmetic Surgery Clinic, Busan, Korea, 2101 Skin Clinic, Taipei, Taiwan, 3Korean College of Cosmetic Surgery, Busan, Korea

Correspondence to:Kyoung-Jin Kang, Seoul Cosmetic Surgery Clinic, 4, Gudeok-ro 34 Beon-gil, Jung-gu, Busan 48594, Korea
Tel: 82-51-247-7776, Fax: 82-51-248-7765, E-mail: kccs7777@gmail.com

Received: March 7, 2017; Revised: April 25, 2017; Accepted: May 8, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.
Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods: The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-to-skeletal relationship.
Results: The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n.
Conclusion: Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.

Keywords: lid-cheek junction, transconjuctival lower blepharoplasty, transcutaneous lower blepharoplasty, globe-to-skeletal relationship, negative and positive vector

References

  1. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007;120:1367-76; discussion 1377.
    Pubmed CrossRef
  2. Hester TR Jr, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging:maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 2000;105:393-406; discussion 407-8.
    Pubmed CrossRef
  3. Tomlinson FB, Hovey LM. Transconjunctival lower lid blepharoplasty for removal of fat. Plast Reconstr Surg 1975;56:314-8.
    CrossRef
  4. Zarem HA, Resnick JI. Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg 1991;88:215-20; discussion 221.
    Pubmed CrossRef
  5. Undavia S, Briceño CA, Massry GG. Quantified incision placement for postseptal approach transconjunctival blepharoplasty. Ophthal Plast Reconstr Surg 2016;32:191-4.
    Pubmed CrossRef
  6. Codner MA, Wolfli JN, Anzarut A. Primary transcutaneous lower blepharoplasty with routine lateral canthal support:a comprehensive 10-year review. Plast Reconstr Surg 2008;121:241-50.
    Pubmed CrossRef
  7. Yaremchuk MJ. Restoring palpebral fissure shape after previous lower blepharoplasty. Plast Reconstr Surg. 2003;111:44150.
    CrossRef
  8. Haddock NT, Saadeh PB, Boutros S, Thorne CH. The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg 2009;123:1332-40;discussion 1341-2.
    Pubmed CrossRef
  9. Segal KL, Patel P, Levine B, Lisman RD, Lelli GJ Jr. The effect of transconjunctival blepharoplasty on margin reflex distance
  10. Aesthetic Plast Surg 2016;40:13-8.
    Pubmed CrossRef
  11. Palmer FR 3rd, Rice DH, Churukian MM. Transconjunctival blepharoplasty. Complications and their avoidance: a retrospective analysis and review of the literature. Arch Otolaryngol Head Neck Surg 1993;119:993-9.
    CrossRef
  12. Goldberg RA. Transconjunctival orbital fat repositioning:transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 2000;105:743-8; discussion 749-51.
    Pubmed CrossRef
  13. Turk JB, Goldman A. SOOF lift and lateral retinacular canthoplasty. Facial Plast Surg 2001;17:37-48.
    Pubmed CrossRef
  14. Kikkawa DO, Lemke BN, Dortzbach RK. Relations of the superficial musculoaponeurotic system to the orbit and characterization of the orbitomalar ligament. Ophthal Plast Reconstr Surg 1996;12:77-88.
    Pubmed CrossRef
  15. El-Garem YF. Estimation of bony orbit depth for optimal selection of the injection technique to correct the tear trough and palpebromalar groove. Dermatol Surg 2015;41:94-101.
    Pubmed CrossRef

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