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To outline a reproducible algorithm for periocular reconstruction that restores margin stability, ocular protection, and aesthetic outcome in partial upper and lower eyelid defects.

Retrospective review of reconstructions stratified by defect size: upper eyelid (≤1/3, 1/3–2/3 width) and lower eyelid (subtotal). Techniques included direct closure/lateral cantholysis, Tenzel semicircular advancement, Fricke cheek flap, and Mustardé rotation, combined with posterior lamellar grafts (tarsoconjunctival, hard-palate, auricular cartilage). Outcomes assessed: margin apposition, corneal exposure, ectropion/entropion, and patient-reported cosmesis at 6 months.

Direct closure achieved stable lids in ≤1/3 upper defects without corneal events. For 1/3–2/3 defects, advancement flaps with spacer grafts preserved lid rigidity and prevented keratinopathy in 94 % of cases. Lower eyelid reconstructions with cheek rotation plus spacer grafts reduced ectropion rates to <10 %. Minor revisions were needed in 15 % for contour refinement.

Stratifying eyelid reconstruction by horizontal involvement and lamellar need allows reliable functional and aesthetic results; meticulous posterior support and canthal anchorage are decisive for success.

Dermatochalasis is characterized by excess upper eyelid skin and may be associated with orbital fat or lacrimal gland prolapse and involutional blepharoptosis. Upper eyelid blepharoplasty is the gold-standard treatment and one of the most commonly performed aesthetic procedures worldwide. Because this surgery is frequently performed in older patients, among whom diabetes mellitus (DM) is prevalent, concerns remain regarding increased postoperative complications and impaired wound healing. The safety of upper eyelid blepharoplasty in diabetic patients remains insufficiently defined. This study evaluated the safety and outcomes of upper eyelid blepharoplasty in patients with DM.

A retrospective analysis included 390 consecutive upper eyelid blepharoplasty for dermatochalasis performed over three years at Turku University Hospital. Patients were stratified according to DM status and antidiabetic therapy. Individuals with prior eyelid or orbital surgery were excluded. Postoperative complications and patient-reported aesthetic satisfaction scores (1–10) were compared between diabetic and non-diabetic cohorts.

The study population comprised 59 patients with DM and 331 without DM. Diabetic patients were older and had higher rates of comorbidities, including hypertension, anticoagulant use, and hypercholesterolemia, whereas other baseline characteristics were comparable. Operative time, surgical technique, estimated blood loss, and time to return to work did not differ between groups. Follow-up duration was longer in the non-diabetic cohort (4.9 vs. 2.1 months, p = 0.006). Complication rates were similar between diabetic and non-diabetic patients. The odds ratio for any postoperative complication in diabetic patients was 1.93, and for postoperative infection 1.88, without statistical significance. Patient and surgeon satisfaction scores were comparable.

Upper eyelid blepharoplasty appears to be safe in patients with diabetes mellitus, with complication rates and aesthetic outcomes comparable to those of non-diabetic individuals. These findings add to the limited evidence regarding periorbital surgery in diabetic patients and support more inclusive surgical decision-making. Future prospective studies with larger cohorts and stratification by glycemic control are needed to further clarify risk profiles and optimize perioperative management.

Reconstructive facial surgery has traditionally focused on neuromuscular restoration and/or defect closure. However, facial function is inseparable from vector alignment, structural balance and eventually symmetry. Evidence from facial reanimation series, deep-plane vector surgery, and multimodal vascular malformation management suggests that aesthetic principles directly influence functional outcomes.
This case series evaluates the concept that principles of aesthetic surgery are not adjunctive but fundamental to advanced reconstructive facial surgery.

A retrospective case series of four patients was analyzed to evaluate the integration of aesthetic surgical principles in complex reconstructive facial procedures.

The following clinical scenarios were included:
• Facial paralysis after dynamic reanimation using innervated gracilis transfer where hemi-facelift and periorbital aesthetic correction enabled complete eyelid competence.
• Severe post-burn scarring where deep-plane vector release restored mobility beyond what grafting alone could achieve.
• Hemifacial hyperplasia where functional muscle atrophy induced aesthetic imbalance requiring structural correction.
• Vascular malformation with oral incompetence successfully managed through minimally invasive volumetric support when surgery had reached its limits.

Across these cases, three core principles emerged:
- Vector dominance determines function.
- Symmetry restoration improves dynamic performance.
- Volume modulation can substitute for structural loss when surgery is exhausted.

In all cases, integration of aesthetic concepts was directly associated with functional improvement beyond conventional reconstructive measures alone.

Reconstructive facial surgery must evolve beyond defect repair toward structural aesthetic integration. The boundary between aesthetic and reconstructive surgery is artificial, functional excellence requires both.

The coronal forehead lift has progressively been supplanted by endoscopic and minimally invasive approaches in aesthetic surgery. Nevertheless, concerns regarding limited correction, relapse, and suboptimal management of significant skin redundancy have prompted renewed interest in traditional open techniques. This presentation aims to reevaluate the coronal forehead lift and to highlight its continued relevance in contemporary aesthetic forehead rejuvenation.

A detailed description of the surgical technique is provided; Through a coronal incision placed posterior to the hairline, a wide subgaleal and above the periosteum dissection is performed extending beyond the supraorbital rims. Careful identification and preservation of the supraorbital and supratrochlear neurovascular bundles are ensured throughout the procedure. Muscular modification includes selective resection of the corrugator supercilii and procerus muscles, along with controlled weakening of the frontalis muscle when indicated. A deep temporal fascia graft is harvested and interposed in the glabellar region, anterior to the supratrochlear neurovascular pedicle, to correct glabellar hollowing and soft-tissue deficiency resulting from muscular excision. Fixation is achieved by suspending the forehead flap to the deep temporal fascia using resorbable sutures to maintain brow elevation. Following superior redraping of the forehead flap, excess skin is excised as needed.

Patients undergoing the coronal forehead lift demonstrated substantial elevation of the brows, reduction of horizontal forehead lines, and improvement in overall upper-face harmony. Complications were uncommon and typically minor, including transient paresthesia or localized edema, resolving within weeks postoperatively.

Despite the rise of minimally invasive alternatives, the bicoronal forehead lift remains an established and valuable technique in contemporary aesthetic forehead rejuvenation. In appropriately selected patients, it offers durable, reproducible, and anatomically comprehensive correction, maintaining its role as a technique of choice in selected clinical scenarios