Critical Evaluation of the Periorbital Aesthetic Patient

Chapter

Abstract

The periorbital aesthetic evaluation requires a structured approach. The assessment may be subdivided to the following units: (1) orbitoskeleton and globe, (2) the forehead and upper eyelid complex, and (3) the lower eyelid and midface complex. It is imperative to recognize the interrelationships and continuity of these structures. Underlying anatomy should be correlated to physical findings. Eyelid and facial dynamic function are important in the assessment. The exam should also include palpation and digital repositioning. Patient involvement and dialogue is vital and a mirror is a helpful tool. With an organized evaluation, a customized approach can be offered and optimal functional and aesthetic surgical results can be achieved.

Keywords

Entropion Fatigue Depression Glaucoma Fluorescein 

References

  1. 1.
    McCurdy Jr JA. Beautiful eyes: characteristics and application to aesthetic surgery. Facial Plast Surg. 2006;22(3):204–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Springer IN, Wannicke B, Warnke PH, Zernial O, Wiltfang J, Russo PA, et al. Facial attractiveness: visual impact of symmetry increases significantly towards the midline. Ann Plast Surg. 2007;59(2):156–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Rhodes G, Proffitt F, Grady JM, Sumich A. Facial symmetry and the perception of beauty. Psychon Bull Ver. 1998;5(4):659–69.CrossRefGoogle Scholar
  4. 4.
    Ho T, Brissett AE. Preoperative assessment of the aging patient. Facial Plast Surg. 2006;22(2):85–90.PubMedCrossRefGoogle Scholar
  5. 5.
    McCord CD, Codner MA. Aging changes in the eyelid and periorbital area. In: Eyelid and periorbital surgery. St. Louis, MO: Quality Medical; 2008. p. 133–50.Google Scholar
  6. 6.
    Hester Jr TR, Douglas T, Szczerba S. Decreasing complications in lower lid and midface rejuvenation: the importance of orbital morphology, horizontal lower lid laxity, history of previous surgery, and minimizing trauma to the orbital septum: a critical review of 269 consecutive cases. Plast Reconstr Surg. 2009;123(3):1037–49.PubMedCrossRefGoogle Scholar
  7. 7.
    Hirmand H, Codner MA, McCord CD, Hester Jr TR, Nahai F. Prominent eye: operative management in lower lid and midfacial rejuvenation and the morphologic classification system. Plast Reconstr Surg. 2002;110(2):620–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Ahmadi H, Shams PN, Davies NP, Joshi N, Kelly MH. Age-related changes in the normal sagittal relationship between globe and orbit. J Plast Reconstr Aesthet Surg. 2007;60(3):246–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Gunter JP, Antrobus SD. Aesthetic analysis of the eyebrows. Plast Reconstr Surg. 1997;99(7):1808–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Alex JC. Aesthetic considerations in the elevation of the eyebrow. Facial Plast Surg. 2004;20(3):193–8.PubMedCrossRefGoogle Scholar
  11. 11.
    McCord CD, Doxanas MT. Browplasty and browpexy: an adjunct to blepharoplasty. Plast Reconstr Surg. 1990;86(2):248–54.PubMedCrossRefGoogle Scholar
  12. 12.
    Pitanguy I, Radwanski HN. Rejuvenation of the brow. Dermatol Clin. 1997;15(4):623–34.PubMedGoogle Scholar
  13. 13.
    Morton AD. Assessment and management of the eyebrow. In: Albert DM, Jakobiec FA, editors. Principles and practice of ophthalmology. Basic sciences. Philadelphia: Elsevier; 2008. p. 3529–42.Google Scholar
  14. 14.
    Starck WJ, Griffin Jr JE, Epker BN. Objective evaluation of the eyelids and eyebrows after blepharoplasty. J Oral Maxillofac Surg. 1996;54(3):297–302.PubMedCrossRefGoogle Scholar
  15. 15.
    Ross AT, Neal JG. Rejuvenation of the aging eyelid. Facial Plast Surg. 2006;22(2):97–104.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldstein SA, Goldstein SM. Anatomic and aesthetic considerations in midfacial rejuvenation. Facial Plast Surg. 2006;22(2):105–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Perkins SW, Batniji RK. Rejuvenation of the lower eyelid complex. Facial Plast Surg. 2005;21(4):279–85.PubMedCrossRefGoogle Scholar
  18. 18.
    Logau RG. Systematic evaluation of the aging face. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd ed. Philadelphia: Elsevier; 2008. p. 2295–9.Google Scholar
  19. 19.
    Goldberg RA, McCann JD, Fiaschetti D, Ben Simon GJ. What causes eyelid bags? Analysis of 114 consecutive patients. Plast Reconstr Surg. 2005;115(5):1395–402.PubMedCrossRefGoogle Scholar
  20. 20.
    Byrd HS, Burt JD. Achieving aesthetic balance in the brow, eyelids, and midface. Plast Reconstr Surg. 2002;110(3):926–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Hester Jr TR, 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(1):393–406.PubMedCrossRefGoogle Scholar
  22. 22.
    Goldberg RA. The three periorbital hollows: a paradigm for periorbital rejuvenation. Plast Reconstr Surg. 2005;116(6):1796–804.PubMedCrossRefGoogle Scholar
  23. 23.
    Holck DEE, Foster JA, Kalwerisky K. Lower eyelid blepharoplasty and midface elevation surgery. In: Albert DM, Jakobiec FA, editors. Principles and practice of ophthalmology. Basic sciences. Philadelphia: Elsevier; 2008. p. 3471–82.Google Scholar
  24. 24.
    Patipa M. Combined hard palate spacer graft, midface suspension, and lateral canthoplasty for lower eyelid retraction: a tripartite approach. Plast Reconstr Surg. 2005;115(7):2115–7.Google Scholar
  25. 25.
    Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg. 2004;113(7):2124–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Muzaffar AR, Mendelson BC, Adams Jr WP. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast Reconstr Surg. 2002;110(3):873–84.PubMedCrossRefGoogle Scholar
  27. 27.
    Kikkawa DO, Bradley NL, Dortzback K. Relations of the superficial musculoaponeurotic system to the orbit and characterization of the orbitomalar ligament. Ophthal Plast Reconstr Surg. 1996;12(2):77–88.PubMedCrossRefGoogle Scholar
  28. 28.
    Atiyeh BS, Hayek SN. Combined arcus marginalis release, preseptal orbicularis muscle sling, and SOOF plication for midfacial rejuvenation. Aesthet Plast Surg. 2004;28(4):197–202.CrossRefGoogle Scholar
  29. 29.
    De Cordier BC, de la Torre JI, Al-Hakeem MS, Rosenberg LZ, Costa-Ferreira A, Gardner PM, et al. Rejuvenation of the midface by elevating the malar fat pad: review of technique, cases, and complications. Plast Reconstr Surg. 2002;110(6):1526–36.PubMedCrossRefGoogle Scholar
  30. 30.
    Kawamoto HK, Bradley JP. The tear “TROUF” procedure: transconjunctival repositioning of orbital unipedicled fat. Plast Reconstr Surg. 2003;112(7):1903–7; discussion 1908–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Oculoplastic Surgery, Department of OphthalmologyUniversity of CaliforniaIrvineUSA

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