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Background In this study, we seek to answer the question: Does blepharoplasty for dermatochalasis alter visual performance? Objectives We seek to determine the impact of blepharoplasty on visual performance (refraction, contrast sensitivity, and visual field) in patients with dermatochalasis. Methods A total of 146 eyelids of 74 patients, 48 (64.9%) females and 26 (35.1%) males ranging from 40 to 68 years old, with dermatochalasis were analyzed prospectively. Refraction, contrast sensitivity, visual acuity, higher-order aberrations (HOAs), and mean deviation index (MDI) in the Humphrey visual field were evaluated and recorded before and at 2, 4, and 6 months after upper eyelid blepharoplasty. Results At the latest follow-up, uncorrected and corrected distance visual acuity showed no significant differences (P > .05). Patients’ contrast sensitivity increased significantly at all spatial frequencies under both conditions (P < .05) except at 12 cycles per degree in the photopic condition (P = .947). Mean astigmatism significantly decreased from −1.17 ± 0.83 to −0.89 ± 0.66 postoperatively (P ≤ .001). Total HOAs decreased significantly from 0.59 ± 0.13 μm to 0.51 ± 0.09 μm (P < .01) after surgery. The root mean square of the spherical aberration (P < .01), vertical trefoil (P = .018), horizontal trefoil (P < .01), horizontal coma (P < .001), and vertical coma (P < .01) decreased significantly. The MDI of the Humphrey visual field increased significantly postoperatively at all times compared with preoperatively (P < .05). The Blepharoplasty Outcomes Evaluation questionnaire showed significant favorable satisfaction with visual quality indexes (P < .001). Conclusions Upper lid blepharoplasty, in addition to its aesthetic effect, is an effective intervention to promote visual function and quality of life. Level of Evidence: 3

Background During their work on the cerebrospinal fluid (CSF) circulatory system of human nerves and brain, the authors applied imaging and tissue techniques that complemented basic anatomical dissection. Objectives The authors sought to show how integrating fluorescent imaging and basic immunohistochemistry (IHC) with facial anatomy can address current problems in aesthetic surgery. Methods The authors developed an algorithm and a set of principles from their work on the CSF circulatory system and applied these to 3 problems in aesthetic surgery: the functional anatomy of the vermilion-cutaneous junction; chemosis; and the functional anatomy of periosteal fixation. Results Integrating fluorescent imaging and IHC with anatomical dissection characterizes structural and functional anatomy. Fluorescent imaging helps to identify and locate easily missed structures. IHC defines cell type and function. The vermilion-cutaneous junction is defined by a major lymphatic vessel. Lymphatic flow from the medial limbus to the lateral canthus suggests the etiology of chemosis. Periosteal sites of fixation prevent shear where dural CSF vessels drain directly to subcutaneous lymphatics. Conclusions Integrating anatomical dissection with fluorescent imaging and basic IHC characterizes structural and functional anatomy and helps to better understand many problems encountered in aesthetic surgery.

Transconjunctival lower lid blepharoplasty is a safe and effective procedure with a low complication rate. Success with this procedure depends on proper patient analysis and selection. The lower lid periorbital fat can be resected, or preserved, and draped over the orbital rim or used as free fat grafts, depending on the clinical presentation. The lower lid skin can be resurfaced with a peel, with a laser, or by skin pinch depending on surgeon preference.

BACKGROUND Aesthetic surgery is a core component of plastic and reconstructive surgery. In 2014, the Accreditation Council for Graduate Medical Education established aesthetic surgery minimums for plastic surgery residents in training. Although many plastic surgery graduates successfully enter practice as an attending plastic surgeon after completion of plastic surgery training, others choose subspecialization. Aesthetic surgery fellowships offer further instruction in surgical and nonsurgical aesthetic procedures in addition to a unique opportunity for mentorship. The American Society for Aesthetic Plastic Surgery currently endorses 25 aesthetic fellowships. However, the literature regarding fellowship specifics is lacking. OBJECTIVES This study aimed to better define the current aesthetic surgery fellowships programs regarding operative experience, fellowship autonomy, program strengths, didactic learning, research experience/opportunities, compensation, and geographic region. METHODS This study was performed by Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Georgia. In February 2019, an anonymous survey was sent via e-mail to all American Society for Aesthetic Plastic Surgery-endorsed aesthetic fellowship program directors. Three weeks later, a reminder e-mail was sent. No incentives were provided for survey completion. RESULTS A 40% survey response rate was achieved (10/25). Aesthetic surgery fellowships are diverse in exposure, number of procedures, and training environment. In all programs, the fellow functioned as the first assistant in most cases. The percentages of face, breast, and total body procedures varied greatly among fellowships, as well as fellow involvement in critical portions of a case. Nearly all fellowships (9/10) offered a fellow's clinic. Didactic learning and research are components of all programs. CONCLUSION This study provides an overview of the current state of plastic surgery aesthetic fellowships in the United States, serving as the first of its kind.

[This corrects the article DOI: 10.1093/asjof/ojz008.][This corrects the article DOI: 10.1093/asjof/ojz008.].