A 35-year-old female presented with a chief complaint of exudates from the outer corner of the left eye for more than half a year after cosmetic lateral canthoplasty. A fistula was seen in the skin of the left eye 5 mm from the lateral canthus, with clear fluid inside it. Left eyelid fistula was diagnosed and surgically removed. The histopathological examination confirmed that the tissue connected with the fistula was lacrimal gland tissue. No recurrence was found during the 2-month follow-up.
1例35岁双眼内外眦成形术后左眼外眼角渗液半年余女性患者，在左眼距外眦角5 mm处皮肤可见瘘口，其内有透明清亮液体，临床诊断为左眼眼睑瘘。行左眼眼睑瘘口切除术，组织病理学检查结果证实术中切除的与瘘管相连的组织为泪腺组织。术后随访2个月未见复发。.

OBJECTIVE: Investigate the most appropriate mathematical formula to objectively express upper eyelid contour symmetry.
METHODS: 62 eyes of 31 patients were included in the study. The upper eyelid contour symmetry of the patients was classified subjectively (independent of MRD1) as poor, acceptable, and good by three oculoplastic specialists (senior, expert, and junior surgeon). Bézier curves of the upper lid contour were drawn with ImageJ software (NIH, Bethesda, MA, USA). Using the algorithms created by Author SKC in Spyder (Python 3.7.9.), the symmetry of the Bézier curves of the left eyelids were obtained according to the y-axis, and the mid-pupils of both eyes were superimposed. The lower curve moved vertically to the equal height of the other curve to equalize MRD1\'s. R2 (Coefficient of determination), RMSE (Root-mean-square error), MSE (Mean squared error), POC (Percentage of co-efficiency), and MAE (Mean absolute error) were calculated. We evaluated the correlation between these objective formulas and the subjective grading of three surgeons using Spearman\'s rho (ρ).
RESULTS: The correlation coefficient of RMSE and MSE were the same for all surgeons grading. There was a strong correlation between the senior surgeon\'s subjective scoring (N; poor = 8, acceptable = 16, good = 8) and R2, RMSE, POC, MAE (ρ = 0.643, p < 0.001, ρ = -0.607, p < 0.001, ρ = 0.562, p < 0.001, ρ = -0.517, p < 0.001, respectively). We found a strong relationship between the expert surgeon\'s subjective scoring (N; poor = 9, acceptable = 13, good:10) and R2 (ρ = 0.611, p < 0.001), RMSE (ρ = -0.549, p < 0.001), POC (ρ = 0.511, p < 0.001), and MAE (ρ = -0.450, p < 0.05). We found a strong correlation between junior surgeon\'s subjective scoring (N; poor = 6, acceptable = 18, good = 8) and R2, RMSE, and POC (ρ: -0.517, p < 0.001; ρ: -0.470, p < 0.001; ρ: 0.521, p < 0.001; respectively) and moderate correlation between MAE (ρ:-0.394, p < 0.05). The highest correlation is observed with R2.
CONCLUSIONS: RMSE, MSE, POC, MAE, and especially R2, may quantitatively express upper eyelid contour symmetry, comparable with the oculoplastic surgeon. The highest correlation was observed between the senior surgeon and R2, and decreases with the experience of the surgeon.

BACKGROUND: In oculoplastic surgery, reconstruction of a large defect after the removal of a massive malignant lower lid tumor still represents a unique challenge. We will report on this case, including a presentation of the case using step ladder V-Y advancement flap.
METHODS: During November 2018 to March 2023, five patients of lower eyelid malignant tumor had wide resection with safety margin and reconstructed using step ladder V-Y advancement flap. The flap was used step ladder V-Y advancement flap.
RESULTS: No complications, including ectropion deformity, occurred. This flap does not sacrifice healthy skin as seen with the cheek rotation flap, and the area of dissection is very small and can be performed in a short time.
CONCLUSIONS: Step ladder V-Y advancement flap is highly useful in cases that require a reconstruction of a large defect after the removal of a massive malignant lower lid tumor from viewpoints of operating time, ease of procedure, aesthetics, and complications.

After reading this article, one should better understand the anatomy of the forehead, brow, and eyelid complexes in the male patient. A thorough history and physical examination allows the facial plastic surgeon to properly select male patients in whom blepharoplasty and brow lift may be indicated. Specific surgical approaches to upper and lower blepharoplasty are discussed in detail. Surgical techniques and indications for each approach to brow lift in men, including direct, midforehead, coronal, pretrichial, endoscopic, temporal, and transblepharoplasty are explicitly outlined.

The authors present the contemporary landscape for males seeking Asian blepharoplasty and Asian rhinoplasty, with special emphasis on the unique anatomical and aesthetic considerations for this patient population. The authors highlight the latest techniques used to achieve superlative results.

OBJECTIVE: YouTube, a popular source for diverse information, hosts a wealth of content on aesthetic canthoplasty. Yet, concerns linger about the accuracy and reliability of these videos, with potential for inaccuracies, biases, or misleading information. This study aims to evaluate the quality and reliability of YouTube content on this sought-after facial enhancement procedure.
METHODS: The study employs four distinct scoring tools: the Global Quality Score (GQS), the Medical Quality Video Evaluation Tool (MQ-VET), the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V), and the Video Power Index (VPI).
RESULTS: Analysis of a total of 173 YouTube videos relevant to aesthetic canthoplasty revealed scores that were primarily indicative of poor quality and reliability.(Mean score ± SD, PEMAT A/V: 30.75 ± 28.8, MQ-VET: 28.57 ± 12.6, GQS: 1.7 ± 1) Notably, these videos were predominantly uploaded by healthcare professionals (82.1%), and they focused more on advertisements (46.2%) than on scientific or educational information. Their elevated viewership and engagement metrics (likes, comments, and shares) attest to their significant popularity and influence. (Mean VPI score: 176.6 ± 635.8).
CONCLUSIONS: YouTube\'s influence on aesthetic eyelid surgery is undeniable, shaping patient choices and expectations. However, unrealistic beauty ideals, heightened body dissatisfaction, and social comparisons lurk within its content, potentially harming psychological well-being and surgical decisions. Prioritizing qualified medical guidance and critical evaluation of online information are crucial for patients. Authors and platforms must act responsibly: authors by producing high-quality content, platforms by tackling misinformation.

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BACKGROUND: As one of the most common aesthetic surgical procedures carried out today, blepharoplasty should be in the repertoire of every plastic surgeon. The term blepharoplasty encompasses a wide range of techniques and options that must be tailored to the specific defect and patient one has to treat. A sound knowledge of the upper and lower eyelids\' anatomy is essential for proper surgical execution. Trends have shifted towards more conservative methods (especially of the fat compartment) and sometimes in combination with augmentation techniques, helping to reach a rejuvenated appearance.
OBJECTIVE: To present an overview of the surgical techniques considered for upper lid blepharoplasty and fat pad management, in addition to information on how a surgeon may approach the best treatment for his patient based on current publications in literature.
METHODS: We searched the literature published between 2013, to 2023 using Medline and Reference Citation Analysis. The database was searched using the keywords \"upper blepharoplasty\" AND \"fat\". Papers without full text/abstracts and reviews were excluded. The search strategy followed the PRISMA. The American Society of Plastic Surgeons guidelines for Therapeutic Studies checklist was used to assess all articles. Two authors individually reviewed each article and rated them for importance and relevance to the topic. A consensus was sought and the most relevant studies.
RESULTS: After the application of the selection criteria used in our review, 13 publications were found to address upper lid blepharoplasty specifically. Three of these studies were reviews and three were retrospective studies. Five publications were comparative studies and a further two were clinical trials.
CONCLUSIONS: The tendency of modern surgery is to be conservative, by removing adipose tissue only if strictly necessary and restoring the volume of the upper eyelid in a concept of beauty that espouses a \"full\" sight. There is no gold standard technique to achieve younger and enhanced eyelids. Long-term prospective comparative studies are fundamental in understanding which path is the best to follow.

In a recent Letter to the Editor authored by Daungsupawong et al. in Aesthetic Plastic Surgery, titled \"ChatGPT and Clinical Questions on the Practical Guideline of Blepharoptosis: Correspondence,\" the authors emphasized important points regarding the input language differences between input and output references. However, advanced versions, such as GPT-4, have shown marginal differences between English and Chinese inputs, possibly because of the use of larger training data. To address this issue, non-English-language-oriented large language models (LLMs) have been developed. The ability of LLMs to refer to existing references varies, with newer models, such as GPT-4, showing higher reference rates than GPT-3.5. Future research should focus on addressing the current limitations and enhancing the effectiveness of emerging LLMs in providing accurate and informative answers to medical questions across multiple languages.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .