Korean Lepr Bull.  2019 Dec;52(1):23-27. 10.33161/klb.2019.52.1.23.

Easy method for Upper lid blepharoplasty in elderly Hansen affected persons

• Ahn SY
• Park HJ
• Kim JP

• KMID: 2466489
• DOI: http://doi.org/10.33161/klb.2019.52.1.23

Abstract

BACKGROUND
The average age of Korean Hansen affected persons who have become less than 10,000 is 76 years old. The upper eyelid lesions of these patients coexist with senile lesions and paralytic lesions due to facial paralysis. This senile change includes skin laxity, eyebrow drooping, eyelid drooping, medial and lateral canthal relaxation and paralytic changes include wrinkle disappearance in the forehead, eyebrows asymmetry, eyelash drooping in the upper eyelid, and simultaneously symptoms of lower eyelid such as ectropion and lapophthalmos.
OBJECTIVE
Authors want to present a prescribed method of treatment that makes it easier to fix changes in senile and paralytic eyelids in elderly Hanson affected persons.
METHODS
For senile blepharochalasis, if the distance between eye blow and eyelash (brow-lash distance) is to the 2.5 cm or more the sub-brow resection should be done. However, if brow-lash distance is less than 2.5 cm, the supra-brow resection should be done. For paralytic cases if there is a difference in height on the eyebrow. the skin is removed to create the same level as the eyebrow height on the healthy side. if both eyes are paralyzed the supra blow skin excision are done with prudence not to make the lagophthalmos. RESULT: In recent 2 years of 2018-2019 we treated 32 cases of blepharochalasis, Blephnaroptosis, paralylic eyebrow droping and lash-laden eyelid margin excision for trichiasis correction. Satisfactory results were obtained in all patients who underwent surgery.
CONCLUSION
The authors report our experience of treating various upper eyelid lesions in the past 2 years in 32 cases of Hansen affected persons a history of Hansen's disease, together with literature review.

Keyword

subbrow resection; supra-brow resection; fold-line skin resection; trichiasis

MeSH Terms

Aged*
Blepharoplasty*
Ectropion
Eyebrows
Eyelids
Facial Paralysis
Forehead
Humans
Leprosy
Methods*
Relaxation
Skin
Trichiasis

Figure

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  Fig. 1 The design of skin resection Subbrow resection is first and the next is narrow skin excision in fold line not to make the lag ophthalmos

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  Fig. 2 Subbrow resection is performed in above than 2.5cm of the Brow-lash distance Median 1cm of the eyebrow is spared, not to make the scar prominently The lateral brow is fixed to the periosteum by one bite of 5-0 black nylon at 1.5cm above orbital rim(Lt) Tattooing on 3 point after local anesthetics infiltration to prevent a unnecessary third line formation in th medial side of eyelid(Rt)

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  Fig. 3 Supra-brow reduction is done in less than 2.5mm of the Brow-lash distance. Supra-brow scar is easily visible if not to suture the meticulous dermo-stitch

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  Fig. 4 Levator advance technique Levator aponeurosis is advanced and fix to the 2mm below the upper border of the tarsus

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  Fig. 5 The eye-lash bearing skin near lid margin is directly excised and sutured with 7-0 black nylon which will remove 7 days later

Reference

1. Ahn SY. Upper eyelid blepharoplasty in Aged person. J Korean Soc Aesthetic Plast Surg. 2010; 16:64–71.

2. Ahn SY, Park HJ, KIim JP. Aesthetic surgical Treatment of the Periorbital area in Hansen's Patient. Korean Lepr Bull. 2017; 50:3–17.

3. Ahn SY. Upper eyelid blephaloplasy in Aged person. Berlin: Lambert Acad Pub;2017.

4. Kanter WR, Wolfort FG. Ptosis and other special cases in cosmetic Blepharoplasty. In : Wolfort FG, Kanter WR, editors. Aesthetic Blepharoplasty. Copenhagen: Library of Congreas;1995. p. 143–165.

5. Ahn SY, Kim JP, Park HJ. Lid splitting with lash Resection for trichiasis in long-standing leprosy. Korean Lepr Bull. 2015; 48:31–36.