Blepharoplasty

What is a Browlift?

A forehead lift, also known as a browlift or browplasty, is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or to remove the deep worry lines that run across the forehead and may portray to others anger, sternness, hostility, fatigue or other unintended emotions.



Why does the brow droop?

Eyebrow ptosis is a result of gravitational and involutional changes that result in eyebrows that rest lower than their normal position.
Other causes of brow ptosis include facial palsy, tumors, and asymmetry.
Patients may present complaining of difficulty with vision because of Aging: The effects of aging lead the brow and forehead to fall due to the skin's loss of elasticity.Environmental: Sun, wind, and the pull of gravity all affect the face; Frown lines and wrinkles may develop across the forehead
  -  secondary dermatochalasis   -  irritation of the eyes from lash ptosis (again caused by secondary dermatochalasis), or   -  cosmetic concerns.



What happens as the brow drops?

  - Your expression may not reflect how you actually feel, you may appear tired or angry.
  - As a result, many people have opted for a procedure known as the forehead lift.
  - Based on variations in how men and women age and on new advances in medical technology, different methods are used to perform this procedure.



Indications for Brow lift

  - Sagging forehead; brows which hang low and close to the eyes   - Deep vertical furrows between the brows



Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes.Should you consider a brow lift?

  - To predict the outcome, use your hands above your brows and on the edges of your eyes and lift the skin upwards while looking in a mirror.
  - The distance from the central brow-to-upper eyelid is very small (brow-upper-lid, BUL)
  - The opening of the eye (palpebral fissure) is very small (excess skin)



it usually done between age forty and sixty-five, although it may be necessary at an earlier age.When is the best age to consider this surgery?

Good health and realistic expectations are prerequisites





Implant & Surgery

Coronal Browlift

What is Coronal Brow Lift?

If you have sagging eyebrows that create a tired or sad appearance, deep horizontal creases across your forehead, or frown lines or furrows between your eyebrows, you may be a good endoscopic brow lift candidate.To get a glimpse of the potential results, you can try a simple test on your own. Place your fingertips at the outer edges of your eyebrows and gently raise the skin upwards.
This will give you a good indication of what the procedure might do for your appearance. Of course, the best way to determine if an endoscopic brow lift is right for you is by a thorough consultation with your plastic surgeon.

Indications for Endoscopic Brow lift:   - Brow ptosis (drooping)
  - Pseudoptsis of the eyelids
  - Vertical and transverse rhytids (wrinkling) of the forehead



Direct Browlift

  - This procedure elevates eyebrows by removing excess skin above the eyebrows.
  - The surgeon makes incisions directly above the eyebrow and removes excess skin.
  - The incisions are closed with fine sutures.



In-Direct Browlift

Direct Fixation For Direct Results
The ENDOTINE TransBleph allows the surgeon to perform a browlift through a single, upper lid incision used for a conventional blepharoplasty. Using the multipoint soft tissue fixation technology—via a small, three tined bioabsorbable implant—your sugeoon has new opportunities to help your patients regain a youthful, beautiful appearance around the eyes, without undergoing a complete forehead lift.


How It Works   - The ENDOTINE is placed underneath the brow and anchored directly to the underlying bone for secure brow elevation, with minimal subperiosteal dissection required.
  - The surgeon can now achieve the combined goals of removing upper eyelid skin and repositioning of the brow in a single surgical session. No endoscope required.
  - By utilizing the upper blepharoplasty incision for access, the ENDOTINE TransBleph helps simplify the browlift procedure. No expensive endoscopic equipment is required meaning fewer instruments to set up, process and maintain.

The ENDOTINE TransBleph is the best of both worlds for rejuvenation surgeries: the pioneering fixation of Coapt multipoint, bioabsorbable implants, and the ability to perform two effective procedures through a single incision—without the need of general anesthesia or expensive equipment.



Endoscopic Browlift

What is an Endoscopic Brow Lift?

  - An endoscopic brow lift, also called a forehead lift, surgically corrects drooping eyebrows and softens worried or angry expressions that result from frown lines.
  - During the procedure, commonly performed on men and women between the ages of 35 and 70, the surgeon elevates the skin and underlying tissues of the upper face, and may remove part of the muscle that causes frown lines between the brows.
  - The result is a more youthful, relaxed, and refreshed appearance.


Am I a Brow Lift Candidate?

  - If you have sagging eyebrows that create a tired or sad appearance, deep horizontal creases across your forehead, or frown lines or furrows between your eyebrows, you may be a good endoscopic brow lift candidate.To get a glimpse of the potential results, you can try a simple test on your own. Place your fingertips at the outer edges of your eyebrows and gently raise the skin upwards.
  - This will give you a good indication of what the procedure might do for your appearance. Of course, the best way to determine if an endoscopic brow lift is right for you is by a thorough consultation with your plastic surgeon.
  - Indications for Endoscopic Brow lift Several small incisions are made behind the hairline.
    -Brow ptosis (drooping)
    -Pseudoptsis of the eyelids
    -Vertical and transverse rhytids (wrinkling) of the forehead


How is an Endoscopic Brow Lift Performed?

  - The endoscopic brow lift technique uses a small, pencil-like camera device connected to a television monitor. The endoscope is inserted into several small, one-half-inch to one-inch incisions placed just behind the hairline, providing the surgeon with a clear view of the muscles and tissues beneath the skin. The surgeon then inserts another instrument through one of the small incisions to lift the skin and remove or alter muscle, if necessary. During an endoscopic procedure, the eyebrows and forehead can be lifted and secured at the optimal height through the use of a new, sutureless mechanism called the ENDOTINE™ Forehead fixation device.
  - A brow lift procedure can also be performed using a traditional “open” method, where an incision is made slightly behind or at the natural hairline, beginning above the ears and continuing toward the top of the head. The surgeon works through the incision to secure tissue and modify or remove excess skin and parts of the muscle that cause wrinkling and frown lines. The incision is closed with stitches.
  - Because of the smaller incisions, endoscopic brow lift patients usually experience less of the itching sensation and temporary scalp numbness felt by patients who have had the open technique. In addition, endoscopic brow lift patients may feel ready to return to normal activities sooner.
  - In some cases, a combination of endoscopic and open techniques may be used. In either case, the procedure typically takes between one-to-two hours, and is usually performed in the surgeon’s office-based facility or an outpatient surgery center under intravenous sedation or general anesthesia.


Goals of surgery

  - Reduction of forehead wrinkles
  - Elevation of eyebrows
  - Reduction of excess skin which can cause hooding of the upper eyelids


Complications

  - Excessive bone bleeding in some patients
  - Bone tunnel collapse
  - Internal screws/plate can be felt by the patient
  - External screw
  - Left protruding above the skin for several weeks
  - Potential for infection and alopecia
  - Requires second procedure to remove screws





Risks & Complications

What Results Can I Expect After Surgery?

  - Immediately after surgery, you will experience some temporary swelling and bruising in your eyebrow and forehead areas, which may last for up to 10 days. The first night, it’s important to rest with your head elevated. You can use a cold compress to help control swelling. You may also experience mild discomfort at the surgical site, which is typically controlled with doctor prescribed oral medications. Head dressings and drain tubes (if used) are removed within a few days after surgery. You can usually take a shower and wash your hair a few days later. When healing begins, you may experience numbing and itching at the incision sites. Most patients recover from traditional brow lift surgery in about 2 weeks. Recovery time can be even faster with endoscopic brow lift surgery. At this point, you may feel the Endotine Forehead device under the skin and experience some increased sensitivity in the area until the bioabsorbable material goes away.
  - If you’re like most brow lift patients, you’ll be very pleased with your refreshed and rejuvenated appearance. Although it may take several months to see the final results, you’ll probably agree that your new look was worth the wait.
  - The length of time your brow lift lasts will vary. A number of factors, including heredity and lifestyle, all play a role in your long-term results. Although you will appear younger, remember that you are still continuing to age. In the future, you may also want to make additional surgical improvements.
  - Complications of brow lifts depend on the technique used.
  - Complications may be related to either the incision or due to the extent of dissection site.



Potential complications include

  - Visible scar
  - Alopecia is believed to due to ischemia along the opposing wound edges.
  - Hypesthesia and hematoma
  - Overcorrection
  - Undercorrection



What are the Surgical Risks?

  - Each year, thousands of men and women undergo endoscopic brow lift procedures and experience no complications.
  - Although problems are rare and usually minor, it’s best to discuss possible complications with your surgeon. And, remember that you can help minimize risks by following the advice and instructions you receive from your health care professional, both before and after surgery.



Possible Risks Associated with the ENDOTINE Forehead Fixation Device and Other Medical Implants?

  - Although the ENDOTINE Forehead fixation device is designed for endoscopic appearance. brow lift surgery, it’s important to understand there are potentialrisks inherent in this and other medical implants. For example, you mayexperience discomfort, infection, and wound healing problems over the implant. In addition, you may be able to feel the device under the skin which may be sensitive to touch. Much less likely, but possible, is that your skin or hair may become thinner over the device, and you may experience some scarring if there is a wound healing complication around the device. At some point, you may want to remove the implant requiring a minor procedure if your sensitivity to the device is great enough that you don’t want to wait until the implant dissolves.
  - Since the ENDOTINE Forehead fixation device and other fixation devices used in endoscopic brow lift surgery are anchored in the bone of the skull,other risks are possible, though extremely rare. There may be complications from making the bone hole that could lead to serious injury. There is a possibility of bone infection, or the device may disengage from the bone leading to a compromised surgical result or feeling of a moving implant under your skin. And, although the ENDOTINE Forehead fixation device is absorbable, you may experience prolonged absorption time and want to remove the device, especially if you are experiencing discomfort or other problems.





Procedures
Anophthalmos
- Anophthalmia is a medical term used to describe the absence of the globe and ocular tissue from the orbit. - This was first reported more than 400 years ago, yet it is only recently that significant reconstructive options became available. - There are many reasons why one might lose an eye. - Surgeries which result in anophthalmos
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Blepharoplasty
What is Blepharoplasty?
- Your eyes including your eyelids, are perhaps one of the first things people notice in you. This makes your eyes and eyelids one of the most important components for an appealing facial expression and aesthetic appearance. Any visible change in the shape or size of the orbital or periorbital region can spoil the look of your face.
- As you age and grow older, your eyelids may become ‘droopy’ or ‘baggy’ due to the stretching of your eyelid skin and gradually decreasing tone of your eyelid muscles. Your droopy eyelids and brow together cut a sorry figure for your face making you look tired, sleepy and haggard, further leading to eyelid or brow straining or both. In extreme cases, your saggy, baggy eyelids can even obstruct your vision, particularly peripheral vision causing difficulty in reading or driving.
- Blepharoplasty ensures cosmetic or functional corrections to the area around your eyes to enhance your look or to correct any abnormalities in function.
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Blepharospasm
- Blepharospasm is defined as an abnormal, involuntary, sustained and forceful closure or twitching of the eyelids. It is derived from the Greek word ‘blepharon’ which means eyelid, and ‘spasm’ which is an uncontrolled muscle contraction. Blepharospasm is usually associated with headache, eyebrow strain and occasionally loss of vision.
- Isolated blepharospasm is rare and represents a minority of patients presenting with blepharospasm. Blepharospasm is commonly associated with lower facial spasms as part of a syndrome or disease complex. Some examples are:
   - Meige Syndrome: Characterized by spasm of the eyelids and midface.
    - Brueghel’s Syndrome: Presents with blepharospasm and marked spasms in the lower face and neck.
    - Segmental Cranial Dystonia: In addition to the usual spasms of the eyelids and facial muscles it is associated with spasms along distribution of various cranial nerves, most frequently involving the Facial Nerve.
    - Generalized Dystonia: Presents with spasms across various body parts in addition to blepharospasm and facial spasms.
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Brow Lift
A forehead lift, also known as a browlift or browplasty, is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or to remove the deep worry lines that run across the forehead and may portray to others anger, sternness, hostility, fatigue or other unintended emotions
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Congenital
Congenital anomolies include :
- Eyelid Disorders
- Orbital Disorders
- Congenital Ptosis
- Congenital Nasolacrimal Duct Obstruction

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Dry Eye
What is Dry Eye?
- Dry eye is a reduction in your eye’s ability to produce sufficient natural tears.
- Insufficient tear production can lead to irritation and pain, and even scarring of the cornea (the transparent part of the eye that covers the pupil and iris).
- Many people will experience dry eye symptoms at some point in their lives.
- Often due to environmental factors such as indoor heating or air conditioning, it can also be caused by occupational factors such as prolonged computer use.
- Dry eye symptoms can affect anyone.
- Some of the symptoms of dry eye include a burning sensation or gritty feeling in the eyes. You may also experience decreased tolerance to contact lens wear or sensitivity to light.
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Eyelid Laxity
- Eyelids protect your eyes from any foreign bodies while keeping them lubricated throughout. Any alteration in the shape, position or function of your eyelids can predispose your eyes to a plethora of ailments or interfere with our vision.
Our eyelid is a complex structure consisting of three theoretical layers:
   - Anterior Layer contains the skin and orbicularis muscle
   - Middle Layer contains the orbital septum and eyelid retractors
   - Posterior Layer contains tarsus and conjunctiva.

- Eyelid malpositions include any unnatural or incorrect positioning and orientation of eyelids due to various factors that influence any of the three layers of the eyelids. They may be caused due to ageing, trauma, scarring, birth defects or medical disease involving any or all of the three layers.
- The most common forms of eyelid malposition are eyelid retraction, ptosis, entropion and ectropion.
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Face
The world of cosmetic surgery has advanced tremendously over the last two decades. New procedures have emerged that can make an individual look and feel younger in a matter of a few minutes. Amongst the vast number of cosmetic procedures currently available, the face lift is a commonly performed one that is sought after by both men and women. Here we shall take a look at this procedure in a little more detail.

- What is a face lift?    - A face lift is called a rhytidectomy in the world of medicine. It involves tightening the muscles of the face and smoothening of the skin so that the face appears younger.    - However, it must be remembered that a face-lift is not an anti ageing solution.
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Lacrimal System
- The lacrimal gland produces tears which enter into the "duct" that drain the tears from the eye into the nose. The most common symptoms are If one has a plugged up "tear duct," not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected.    (1) excess tearing (tears may run down the face) and    (2) mucous discharge - This may lead to recurrent red eyes and infections. - The excessive tearing can also produce secondary skin changes on the lower eyelids.
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Lagophthalmos
Patients with lagophthalmos have an inability to close eyelids. This may occur, for instance, in patients with Thyroid eye disease.
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Latisse
LATISSE® makes lash growth possible because of its active ingredient: bimatoprost. Although the precise mechanism of action is not known, research suggests that the growth of eyelashes occurs by increasing the percent of hairs in, and the duration of, the anagen (or growth) phase. Lashes can grow longer, thicker and darker because bimatoprost can also prolong this growth phase.
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Orbital Tumors
- Orbital Tumor is any tumor that occurs within the orbit of the eye. The orbit is a bony housing in the skull about 2 inches deep that provides protection to the entire eyeball except the front surface. It is lined by the orbital bones and contains the eyeball, its muscles, blood supply, nerve supply, and fat.
- Tumors may develop in any of the tissues surrounding the eyeball and may also invade the orbit from the sinuses, brain, or nasal cavity, or it may metastasize (spread) from other areas of the body. Orbital tumors can affect adults and children. Fortunately, most are benign.
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Ptosis
- Ptosis is an abnormally low position (drooping) of the upper eyelid
- Ptosis occurs when the muscles that raise the eyelid (levator and Müller's muscles) are not strong enough to do so properly.
- It can affect one eye or both eyes and is more common in the elderly, as muscles in the eyelids may begin to deteriorate.
- Compare with dermatochalsis (extra skin and fat)
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Skin Rejuvination
A radiant, smooth, youthful skin is the essence of beauty and trendy looks. Skin care routine highly contributes in the slowing down of rate of aging of the skin. Choosing the right skin care products for your skin type enhances your beauty keeping the skin cleansed, moisturized and well toned. Use of superficial skin resurfacing treatments to counter fine lines and wrinkles, acne scars and blemishes before they deepen ensures skin rejuvenation.
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Skin Tumors
Cancer of the eyelid, like any other cancer, can be a worrying thing. Treatments are variable and depend on the type of cancer. In this article, we shall take a brief look at the different kinds of eyelid tumors.
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Symblepharon
A symblepharon is a fibrous tract that connects bulbar conjunctiva to conjunctiva on the eyelid.
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Thyroid
Graves' disease is an autoimmune disease.
It most commonly affects the thyroid, causing it to grow to twice its size or more (goiter), be overactive, with related hyperthyroid symptoms such as increased heartbeat, muscle weakness, disturbed sleep, and irritability. It can also affect the eyes, causing bulging eyes (exophthalmos).
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Trauma
Eye injuries are extremely common with over 2 million cases reported every year that require medical treatment. Blindness in one eye is most commonly due to cataract and this is followed closely by eye injuries. In addition, in children, injury to the eye is a recognized as the most common cause of blindness in one eye that is not due to a birth defect.
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