Abstract
Introduction
The term beautiful eyes can be defined as youthful, brilliant, vivid, and attractive eyes. The anthropometric findings about beautiful eyes may differ according to gender or race. In order to form such a beautiful eye, a variety of surgical, nonsurgical, or combination methods for periorbital region rejuvenation have been proposed. The surgical methods include coronal/peritrichial, endoscopic, upper and lower eyelid, or transconjunctival incisional procedures. Neuromodulators, fillers, and laser treatments are some of the nonsurgical approaches. Regardless of the method, while treating this particular area, the aesthetic unit concept should always be taken into consideration.
Methods
We attempted to combine an endoscopic dynamic canthopexy procedure with endoscopic temporal and brow lift, which we call “bella eyes” to achieve a more attractive look, especially in young people who desire a slanted eyelid. We aim to share our clinical experience from 35 patients and the technical details of the bella eyes procedure.
Results
Patient satisfaction was high, and the endoscopic technique eliminated all of the minor deformities and provided excellent harmony through each subunit of the periocular area with minimal discomfort and well-hidden scars.
Conclusion
We believe that this procedure is a good way to achieve a beautiful eye in young women.
Level of Evidence IV
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References
Rhee SC, Woo KS, Kwon K (2012) Biometric study of eyelid shape and dimensions of different races with references to beauty. Aesthetic Plast Surg 36(5):1236–1245
Romm S (1989) The changing face of beauty. Aesthetic Plast Surg 13(2):91–98
Iglesias-Linares A, Yáñez-Vico RM, Moreno-Manteca B, Moreno-Fernández AM, Mendoza-Mendoza A, Solano-Reina E (2011) Common standards in facial esthetics: craniofacial analysis of most attractive black and white subjects according to People magazine during previous 10 years. J Oral Maxillofac Surg 69(6):e216–e224
Perrett DI, May KA, Yoshikawa S (1994) Facial shape and judgements of female attractiveness. Nature 368(6468):239–242
McCurdy JA Jr (2006) Beautiful eyes: characteristics and application to aesthetic surgery. Facial Plast Surg 22(3):204–214
Liu D, Hsu WM (1986) Oriental eyelids anatomic difference and surgical consideration. Ophthalmic Plast Reconstr Surg 2(2):59–64
Heir JS, Sandhu BS, Barber HD (2000) Considerations for esthetic facial surgery in the African-American patient Atlas. Oral Maxillofac Surg Clin North Am 8(2):113–125
Rhee SC, Lee SH (2010) Attractive composite faces of different races. Aesthetic Plast Surg 34(6):800–801
Arnaoutakis D, Bassichis B (2018) Surgical and nonsurgical techniques in forehead rejuvenation. Facial Plast Surg 34(5):466–473
Beer KR, Julius H, Dunn M, Wilson F (2014) Remodeling of periorbital, temporal, glabellar, and crow’s feet areas with hyaluronic acid and botulinum toxin. J Cosmet Dermatol 13(2):143–150
Snider CC, Amalfi AN, Hutchinson LE, Sommer NZ (2017) New insights into the anatomy of the midface musculature and its implications on the nasolabial fold. Aesthetic Plast Surg 41(5):1083–1090
Park KS, Park DD (2017) Objective outcome measurement after upper blepharoplasty: an analysis of different operative techniques. Aesthetic Plast Surg 41(1):64–72
Bernardini FP, Gennai A, Izzo L, Zambelli A, Repaci E, Baldelli I, Fraternali-Orcioni G, Hartstein ME, Santi PL, Quarto R (2015) Superficial enhanced fluid fat injection (Seffi) to correct volume defects and skin aging of the face and periocular region. Aesthet Surg 35(5):504–515
Fathi R, Pfeiffer ML, Tsoukas M (2015) Minimally invasive eyelid care in dermatology: medical, laser, and cosmetic therapies. Clin Dermatol 33(2):207–216
Morgan JM, Gentile RD, Farrior E (2005) Rejuvenation of the forehead and eyelid complex. Facial Plast Surg 21(4):271–278
Langsdon P, Karter N (2018) Manipulation of the periorbital musculature. Facial Plast Surg 34(2):194–200
Wojtanowski MH (1994) Bicoronal forehead lift. Aesthetic Plast Surg 18(1):333–339
Ramirez OM (1995) Endoscopically assisted biplanar forehead lift. Plast Reconstr Surg 96(2):323–333
Plowes Hernandez O, Montes-Bracchini JJ, Ulloa FL, LaFerriere K (2016) Endoscopic brow elevation and reshaping. Facial Plast Surg 32(6):607–614
Guyuron B, Son JH (2017) Transpalpebral corrugator resection: 25-year experience, refinements and additional indications. Aesthetic Plast Surg 41(2):339–345
Alghoul M (2019) Blepharoplasty: anatomy, planning, techniques, and safety. Aesthet Surg J 39(1):10–28
Guida S, Nisticò SP, Farnetani F, Del Duca E, De Carvalho N, Persechino F, Verdina T, Giannetti L, D’Alessandro M, Urtis GG, Pellacani G, D’Alessandro G (2018) Resurfacing with ablation of periorbital skin technique: indications, efficacy, safety, and 3D assessment from a pilot study. Photomed Laser Surg 36(10):541–547
Balzani A, Chilgar RM, Nicoli M, Sapountzis S, Lazzeri D, Cervelli V, Nicoli F (2013) Novel approach with fractional ultrapulse CO2 laser for the treatment of upper eyelid dermatochalasis and periorbital rejuvenation. Lasers Med Sci 28(6):1483–1487
Lighthall JG (2018) Rejuvenation of the upper face and brow: neuromodulators and fillers. Facial Plast Surg 34(2):119–127
Beer KR, Bayers S, Beer J (2014) Aesthetic treatment considerations for the eyebrows and periorbital complex. J Drugs Dermatol 13(1 Suppl):s17–s20
de Saint Cornette, Cyr B, Maillard GF, Scheflan M, Ramirez O (1993) The subperiosteal lift. Aesthetic Plast Surg 17(2):151–155
Gülbitti HA, Bouman TK, Marten TJ, van der Lei B (2018) The orbital oval balance principle: a morphometric clinical analysis. Plast Reconstr Surg. 142(4):451e–461e
Lessa S, Nanci M (2009) Simple canthopexy used in transconjunctival blepharoplasty. Ophthalmic Plast Reconstr Surg 25(4):284–288
Yaremchuk MJ, Chen YC (2009) Bridge of bone canthopexy. Aesthet Surg J 29(4):323–329
Tepper OM, Steinbrech D, Howell MH, Jelks EB, Jelks GW (2015) A retrospective review of patients undergoing lateral canthoplasty techniques to manage existing or potential lower eyelid malposition: identification of seven key preoperative findings. Plast Reconstr Surg 136(1):40–49
Botti G, Botti C, Rossati L, Gualdi A, Nocini P, Nocini R, Bertossi D (2019) “Dynamic Canthopexy” Drill Hole Canthal Repositioning. Aesthet Surg J. https://doi.org/10.1093/asj/sjz077
Flowers RS, Ceydeli A (2008) The open coronal approach to forehead rejuvenation. Clin Plast Surg 35(3):331–351
Trussler AP, Schaub TA, Byrd HS (2012) Endoscopic management of the difficult lower eyelid: a review of 300 cases. Plast Reconstr Surg 130(3):690–699
Bernardini FP, Skippen B, Gennai A, Zambelli A (2019) Minimal incisions vertical endoscopic lifting (MIVEL) for the management of lateral canthal and lower eyelid malposition. Aesthet Surg J 39(5):472–480
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The endoscopic dissection starting from the temporal zone down to the lateral canthal retinaculum. The suture is passed from the middle 1/3 of the retinaculum. You can see the effect of dynamic canthopexy with adequate vectoral pull on our patient (MP4 129478 kb)
Video 2
A short video of preoperative (left) and postoperatively 6 months after the Bella eyes procedure (right) of a 33-year-old female is presented (MP4 11711 kb)
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Askeroglu, U., Pilanci, O. A New Perspective to the Periorbital Aesthetics: Bella Eyes. Aesth Plast Surg 43, 1564–1569 (2019). https://doi.org/10.1007/s00266-019-01497-0
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DOI: https://doi.org/10.1007/s00266-019-01497-0