Eighty-three cases with severe blepharoptosis were treated by the superiorly based muscle flaps around eye including orbicularis oculi muscle, frontalis muscle, levator muscle. The selection of the muscle flaps were done in accordance with the levator function of patients. The orbicularis oculi muscle flap technique in 32 patients who have 2-5 mm levator function, 21 cases of the interdigitated orbicularis oculi-frontalis muscle flap for 1-3 mm levator function, frontalis muscle flap technique for less than 2 mm levator function, 22 cases of levator muscle resection for 2-8 mm levator function, 7 cases of levator plication for 5-9 mm levator function. The majority of patients recorded as satisfactory results. There has been no complete failure but there were 14 cases of undercorrection, 4 cases of overcorrection, 2 cases of exposure keratitis, 3 cases of corneal erosion, 2 cases of sensory loss, hematoma loss of wrinkle and a few cases of eyelid deformity such as notching, entropion, fading or unnatural fold. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over conventional frontalis muscle flap technique such as being a simple with a good operative field, single incision or supratarsal fold, no depression on the forehead, no risk of neurovascular injury and relatively easy technique with less complication. The levator resection or levator plication could offer good results by careful selection of patients. In conclusion, we would like to say that the interdigitated frontalis orbicularis oculi muscle flap technique is best in cases with less than 2 mm levator function, orbicularis oculi muscle flap technique in 2-4 mm levator function, levator resection in 4-8 mm levator function, levator plication in more that 8 mm levator function.
Blepharoptosis* ; Congenital Abnormalities ; Depression ; Entropion ; Eyelids ; Forehead ; Hematoma ; Humans ; Keratitis

PURPOSE: To assess the effectiveness and results of a simplified levator resection technique for ptosis repair. METHODS: The author simplified the levator resection technique for ptosis repair using a single 6-0 prolene radial suture to control the lid height and curvature. 68 ptosis patients who received the operation were retrospectively reviewed including surgical techniques and their results. RESULTS: 46 patients (mean age 7.8 years) had congenital ptosis, and 22 patients (mean age 64.3 years) had acquired ptosis. 11 eyes of congenital ptosis and 6 eyes of acquired ptosis showed unsatisfactory surgical results. Eyelid contour deformity was present in 2 eyes of patients with acquired ptosis. CONCLUSIONS: The single stitch levator resection is simple and effective surgical procedure for ptosis repair except severe congenital ptosis which need medial and lateral crus cutting.
Congenital Abnormalities ; Eyelids ; Humans ; Polypropylenes ; Retrospective Studies ; Sutures

PURPOSE: Congenital upper eyelid defect is rare anomaly whether it is compared with syndromic anomaly or not. It has many clinical manifestation in the extent, location. Many operation procedures such as simple closure, semicircular rotation flap, Cutler Beard procedure, lower lid rotation flap, etc can be used to reconstruct eyelid defects. We intend to introduce a simple, congenital eyelid defect which was not compared with syndromical anomaly, ophthalmic complication. METHODS: Our experience is a case of 19 years old female who had a upper eyelid coloboma without any other anomalies. we could not find any skeletal deformity in orbital CT scan. she had no ophthalmic problem. we reconstructed the defect with bilateral marginal flap after deepithelization of supramarginal area and tarsal reposition. RESULTS: There were no visible deformity of lid lining. postoperative scar was favorable. satisfactory results were obtained in cosmetic and functional aspects. CONCLUSION: Upper lid coloboma without other anomalies is rare. we obtained satisfactory outcome as treated this rare case with marginal flap advancement.
Cicatrix ; Coloboma ; Congenital Abnormalities ; Cosmetics ; Eyelids ; Female ; Humans ; Orbit

The term ectropion denotes an outward turning or eversion of the eyelid margin. Depending on the mechanism of its causation may be classified into five types-spastic, senile, paralytic, mechanical and cicatricial. Cicatricial ectropion results most frequently from burns and is the result of the destruction of skin of the eyelid and of the surrounding facial area. Cicatricial ectropion must be treated by some form of blepharoplasty. The milder degrees of deformity may be corrected by local procedures, such as converting a V-shaped incision into a Y; but more extensive contractures necessitate the excision of scar tissue and its replacement by grafting, using either the pedicle or free methods. The authors treated a case of cicatricial ectropion of the upper and lower eyelids due to burn with full thickness skin graft.
Blepharoplasty ; Burns ; Cicatrix ; Congenital Abnormalities ; Contracture ; Ectropion* ; Eyelids ; Skin ; Transplants

Blepharoptosis due to functional deficit of superior levator palphebralis muscle or its aponeurosis is the most common deformity of the upper eyelids complicated problems not only function but aesthetics of upper eyelids. Many operative techniques for blepharoptosis such as Fasanella-Servat method, levator palphebralis muscle shortening and resection, frontalis muscle or frontalis myofascial flap transfer and frontalis muscle suspension operation have been developed and applied as the degree of blepharoptosis. Author has treated 17 cases of blepharoptosis in the 12 patients during 3 years from September 1999 to August 2002 using the fronto-orbicularis oculi muscle advancement technique which is a modification of the frontalis muscle transfer technique. This technique includes the elevation of frontalis and orbicularis oculi muscle flap as a single unit but doesn't make medial and lateral vertical incision of orbicularis oculi muscle flap. The advanced flap is fixed to the tarsal plate with horizontal mattress suture of 6-0 nylon. After fixation, remaining muscle flap is excised. Author's method is more simple than other technique. The incidence of supraorbital N. damage and lagophthalmos is also very low. Fronto-orbicularis oculi advancement technique could be applied in all case of blepharoptosis from mild to severe cases.
Blepharoptosis* ; Congenital Abnormalities ; Esthetics ; Eyelids ; Humans ; Incidence ; Nylons ; Sutures

BACKGROUND: The transposition flap is one of the most useful methods of facial reconstruction after Mohs micrographic surgery of the basal cell carcinoma, but occasionally some variations are needed. OBJECTIVE: We present our experience with several variations of the transposition flap to overcome the disadvantages of classic rhomboid flaps. METHODS: We performed the Webster 30-degree angle flap on the lower eyelid, the double 30-degree angle flap on the temple area and the nasolabial flap on the ala nasi. RESULTS: These variations of the transposition flap gave no complications such as ectropion, tissue distortion, protrusion, or trapdoor deformity. CONCLUSION: The variations of the transposition flap in our cases might be of help in selecting the ideal method in facial reconstruction.
Carcinoma, Basal Cell* ; Congenital Abnormalities ; Ectropion ; Eyelids ; Methods ; Mohs Surgery*

Lots of Koreans have relatively thick skin, small palpebral fissures and unfolded eyelids with a prominent epicanthal fold. Various methods have been developed to correct epicanthal fold. However, excessive or hypertrophic scar can be occurred, especially in the medial canthal and nasal area. And the recurrence may restrict the application of these methods. We developed a new epicanthoplasty using Y-M plasty to correct the epicanthal folds without obvious scar. From February 1999 to August 2010, all patients underwent Y-M plasty for the correction of epicanthal folds. Y-shaped incision line was designed not extending to the nasal area and the orbicularis oculi muscles were resected with skin. The dog ear deformities were corrected and sutured using nylon 7-0. The epicanthal folds were completely corrected. Prominent scar and recurrence were not observed. Most of the patients are satisfied with the results. Mean preoperative ICD(intercanthal distance) was 38.84 mm and average 2.24 mm ICD was reduced after the operation. Epicanthoplasty using Y-M plasty is relatively safe, easy and rapid method to design and apply even in the beginners with low risk of scars and recurrences. So, the authors propose this new versatile technique in the case of minimal to moderate epicanthal folds.
Animals ; Blepharoplasty ; Cicatrix ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Dogs ; Ear ; Eyelids ; Humans ; Muscles ; Nylons ; Recurrence ; Skin ; Skin Abnormalities

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.
Classification ; Cleft Lip ; Cleft Palate ; Congenital Abnormalities ; Craniofacial Abnormalities ; Eyelids ; Maxillary Sinus ; Orbit ; Rare Diseases ; Reconstructive Surgical Procedures

PURPOSE: Lateral canthoplasty is utilized in aesthetic surgery to lengthen the lateral palpebral fissure of the lateral canthal area. However, complication such as recurrence, contour deformity or hypertrophic scar make its results doubtful. Therefore, we developed lateral canthoplasty with lateral canthotomy and Y-V advancement to effectively lengthen the palpebral fissure without recurrence. METHODS: A total number of 117 patients were reviewed from March 1991 to April 2005. The operative procedure was lateral canthoplasty with lateral canthotomy and Y-V advancement. To prevent recurrence, we dissected lateral conjunctiva of lower eyelid and cutted retaining ligament. The author believes that by this procedure, V flap would be able to advance laterally without tension. RESULTS: We performed lateral canthoplasty in 117 patients. There were no recurrence and patients were satisfied with the results. There were 12 patients who presented with complication. Complication included hypertrophic scar in 4 patients, web formation in 3 patients and over-correction in 5 patients. CONCLUSION: Lateral canthoplasty with lateral canthotomy and simple Y-V advancement may be used as an effective method to lengthen palpebral fissure without recurrence.
Cicatrix, Hypertrophic ; Congenital Abnormalities ; Conjunctiva ; Eyelids ; Humans ; Ligaments ; Recurrence ; Surgical Procedures, Operative

The choice of operative procedures was determined by many factors, but the levator function is considered as the most important factor. Fox recommended that when the levator function was 2 to 9 mm, the patient should be treated by the levator resection and when the levator function was below 2 mm, the patient should be crated by frontalis suspension. But Collin recommended that when the levator function was below 4 mm, the brow suspension procedure got the better result. Beside that, many other authors recommended various opinions. Therefore, when levator function of the patients was between 2 and 4 mm, the choice of operative procedure was much confusing us. The aim of this study is to clarify which is better Procedures between levator resection and the frontalis transfer or orbicularis oculi muscle transfer among the patients with 2 to 4 mm of levator action. From Jan. of 1991 to Dec. of 1994, among 26 patients with 2 to 4 mm levator function, 13 cases of 10 patients were operated by levator resection, 21 cases of 16 patients were teated by frontalis transfer or orbicularis oculi muscle flap. The results were evaluated with the average 27 months of follow-up and we compared the result of the levator resection procedure with that of frontalis muscle transfer or orbicularis oculi muscle transfer. The preoperative average amount of ptosis is about 2.7 mm in cases with levator resection, about 4.0 mm in cases with frontalis muscle transfer or orbicularis oculi muscle flap transfer. The postoperative average amount of ptosis is about 1.7 mm in cases with levator resection about 2.14 mm in cases with frontail muscle transfer or orbicularis oculi muscle flap transfer and so the postoperative improvement of amount of ptosis is about 1.0 mm in cases with levator resection, about 1.86 mm in cases with frontails muscle transfer or orbicularis oculi muscle flap transfer. The major complication of levator resection method is undercorrection. However, the eyelid deformity due to excessive upward traction was more frequent in frontalis muscle flap technique.
Blepharoptosis* ; Congenital Abnormalities ; Eyelids ; Follow-Up Studies ; Humans ; Surgical Procedures, Operative ; Traction