Introduction

Basic science/disease processEssential and dynamic anatomyOsteology and periorbital

The orbits are pyramids formed by the frontal, sphenoid, maxillary, zygomatic, lacrimal, palatine, and ethmoid bones

Lateral retinaculumThese structures, known as the lateral retinaculum, coalesce at the lateral orbit and support the globe and eyelids like a hammock.Recent cadaveric dissections suggest that the lateral canthal tendon has dual insertions. A deep component connects directly to the Whitnall tubercle is classically known as the lateral canthal tendon.In contrast to the canthal tendon, the thick tarsal strap is relatively resistant to laxity changes seen with aging

(14 고대 뱅킹) 상안검 성형술과 관련한 역동 해부학 (dynamic anatomy) 의 내용으로 옳지 않은것은? 41) 안와는 피라미드 모양으로, 전두골, 접형골, 상악골, 관골, 누골, 구개골, 사골로 이루어져 있다.2) Lateral retinaculum 은 안와 외측에서 합쳐져 안구와 안검을 해먹과 같이 지지하는 구조이다.3) 가쪽 눈구석 인대 (Lateral canthal tendon) 는 이중으로 부착 되며 (dual insertion) 이 중 깊은

부착 부분 (deep component) 은 Whitnall tubercle 과 직접 연결되어있다4) Tarsal strap 은 눈구석 인대와 마찬가지로 노화가 진행되며 늘어짐을 보인다.5) 서양인의 경우, 안와 격막은 올림근 널힘줄과 유착되어있다

Medial orbital vaultForehead and temporal regionEyelidsUpper eyelidSeptal extensionThe orbital septum has an adhesion to the levator aponeurosis above the tarsusLower eyelidRetaining ligamentsBlood supply

The arcade of the superior and inferior palpebral arteries gives a rich blood supply to the eyelids. The superior palpebral artery consists of a peripheral arcade located at the superior tarsal border – the area where surgical dissection occurs to correct lid ptosis and to define lid folds. Damage to a vessel within this network commonly results in a hematoma of Müller’s muscle, causing lid ptosis for 2–8 weeks postoperatively.

Likewise, on the lower lid, the inferior palpebral artery lies at the inferior border of the inferior tarsus. The supratrochlear, dorsal nasal, and medial palpebral arteries all traverse the orbit medially. Severing these arteries during fat removal, without adequately providing hemostasis, may lead to a retrobulbar hematoma, a vision-threatening complication of blepharoplasty

(14 고대 뱅킹) 상안검 수술을 시행한 20 세 여자환자가 수술 다음날부터 lid ptosis 와 bruise 가 생겼고, 상안검을 촉지하였을 때 mild 한 혈종이 만져졌다. 보존적 치료로 환자를 치료하였으며 6 주 후 lid ptosis 가 해소되었다. 상기 환자의 상안검 수술 시 손상 받았을 것으로 생각되는 혈관은? 21) Supratrochlear artery2) Superior palpebral artery3) Lacrimal artery4) Medial palpebral artery5) Ophthalmic artery

Innervation: trigeminal nerve and facial nerveYouthful, beautiful eyesEtiology of agingDiagnosis/patient presentationEvaluation basicsMedical and ophthalmic historyOcular examinationVisual acuityExternal examinationOrbits and malar eminenceThe tear trough is at the inferior orbital rim most medially,triangulated by the orbicularis, levator labii superioris alaeque nasi and levator labii superioris muscles (Fig. 8.21). The indentation is at the junction of the thin eyelid skin above and the thicker and different nasal and cheek skin below, with attenuated subcutaneous tissue overlying the maxillary bone. It is the deepening of this groove that leads to true indentation and significantly impacts facial appearance. The relative lack of subcutaneous tissue in this area is subject to worsening concavity with aging. The cause of the deformity is due to a combination of orbital fat herniation, skin laxity and malar volume loss and ptosis of skin and subcutaneous tissue. The ability to place the side of the finger into the bony furrow under the nasojugal grooves suggests a potential benefit from a tear trough implant or the addition of soft tissue augmentation (Fig. 8.22).

(고대 14 뱅킹) 그림과 (A) 같이 인지를 사용하여 진단할 수 있는 medial infraorbital area 의 bony depression 영역을 이루는 근육의 조합은? 4 1) Orbicularis oculi, Risorius, Nasalis2) Orbicularis oculi, Zygomaticus major, Zygomaticus minor3) Orbicularis oculi, Zygomaticus major, Levator labii superioris

4) Orbicularis oculi, Levator labii superioris, Levator labii superioris alaeque nasi5) Zygomaticus major, Levator labii superioris, Levator labii superioris alaeque nasiPupilsExtraocular musclesGlobeTear film

Photographic documentationUnintentional deception in eye appearancePatient selectionOperative planningAnatomic-directed therapyUpper eyelid positionLower eyelid tonicityEyelid ptosis or retractionGlobe position and malar prominenceTear trough deformitiesOptimal brow positioning

Treatment/techniqueContinuum of aesthetic enhancementUpper eyelid surgerySimple skin blepharoplastyAnchor (or invagination blepharoplasty)Orbital fat excisionBlepharoptosisSurgical techniqueLower lid blepharoplastyTransconjunctival blepharoplastyTranscutaneous blepharoplastyOrbital fatOrbital fat transpositionPlication techniquesOrbital septum plicationCapsulopalpebral fascia plicationOrbicularis suspension

CanthopexyMidfacelifting

Postoperative careComplicationsThe most common complication after blepharoplasty is chemosis. Disruption of ocular and eyelid lymphatic drainage leads to development of milky, conjunctival and corneal edema. Chemosis can be limited by atraumatic dissection, cold compresses, elevation

and massage. It is usually self-limited and resolves spontaneously, though prolonged chemosis can be treated with topical steroids.

(14 고대 뱅킹) 안검성형술 후 가장 흔히 발생하는 합병증으로 옳은 것은? 11. chemosis2. retrobulbar hemorrhage3. dry eye 4. infection5. asymmetry

Special considerationsMale blepharoplastyBlepharoplasty in people of color