Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods:The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-toskeletal relationship. Results:The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n. Conclusion:Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.

Background: Traditional subciliary incision lower blepharoplasty (TSILB) is commonly used for improving aged lower eyelid. Fat grafting has been popularly performed to correct shortcomings of TSILB such as infraorbital hollowness and incomplete blending of lid-cheek junction (LCJ). LCJ has been known as an objective index to measure the aging of lower eyelid. However, there was no study on the changes of LCJ length and shape with complementary fat grafting.Objective: This study aimed to evaluate the effect of complementary fat grafting by observing the changes in length and shape of the LCJ. Methods:Between 2010 and 2016, the authors observed the change of LCJ in 33 patients who were followed-up for more than 3 months among patients who underwent TSILB alone (Group 1, G1) or TSILB combined with fat grafting (Group 2, G2). The fat graft was performed by sequential autologous fat injection method, having the concept of volumetric face lifting. The groups were further divided into subgroups G1p, G1n, G2p, and G2n according to positive (p) or negative (n) globe-to-skeletal rim relations. Suborbicularis oculi fat lifting and lateral retinacular canthopexy were mainly performed in patients who had negative vector. Results:The length of LCJ in G2 decreased significantly compared to that of G1. There was no significant difference between G1p and G1n, and G2p and G2n. The shape of LCJ changed diversely from V-shape to flat shape and was more dramatic in G2 than in G1. In G1, superolateral shifting in lateral points of LCJ was a typical change, but in G2, superolateral shifting and vertical shifting of LCJ were more prominently occurred at medial and middle points of LCJ, which were mainly induced by fat grafting. Conclusion:Complementary fat grafting showed better rejuvenation effect through further changes of LCJ in length (shortening) and shape (flattening) than that of TSILB alone. Level of Evidence: IV

Background: Botulinum toxin is most commonly used as a safe cosmetic injectable to improve dynamic wrinkles. However, side effects still occur. Among them, brow ptosis is known to occur relatively infrequently. The condition is self-limiting; however, for about 3 months post-injection, the patient must endure related uncomfortable symptoms. Several methods have been recommended to prevent this complication; however, no treatment has been developed to improve such symptoms instantly. Currently, various processed threads, such as polydioxanone (PDO), are widely used for facial rejuvenation; PDO thread is bio-absorbable.Objective: The authors performed brow lifting using a cogged PDO thread to improve uncomfortable symptoms associated with brow ptosis. Methods:In total, 14 PDO threads with multi-bidirectional cogs (two 1.0 threads, with lengths of 9.0 cm each, and twelve 1.0 threads, with lengths of 6.0 cm each) were placed in 7 rows, which were inserted into the superficial fat layer and deep fat layer (dual plan insertion) separately, at approximately 1.0-cm intervals.Results: Following the use of the thread, the positions of the left and right eyebrows were observed to have slightly increased by an average of 1.43±0.65 mm and 1.7±0.9 mm after two weeks, respectively; the patients indicated a high degree of satisfaction with immediate improvement of the uncomfortable symptoms. Conclusion:It is suggested that PDO thread brow lifting would be a reliable procedure to immediately treat botulonum-toxin induced brow ptisos noninvasively.

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