Purpose: To investigate whether phacoemulsification (PE) experience impacts and transfers to the skill acquisition of novices in manual small-incision cataract surgery (MSICS) within a simulation environment. Setting: Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark. Design: Prospective controlled experimental study. Methods: The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to have either (1) proficiency on the EyeSi surgical simulator (PE group [PG]) or (2) no prior extensive exposure to the EyeSi simulator or any PE surgery experience as a primary surgeon (control group [CG]). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including 9 modules and 30 steps (points). A pass/fail score was determined at 20 points (of 30 points). Performance scores were analyzed using independent samples t tests, pass rates using the Fisher exact test, and individual modules using Fisher-Freeman-Halton analysis. Results: The PG performed significantly better in overall performance score (mean ± SD, PG; 21.8 points ± 2.3 vs CG; 18.9 points ± 2.2, P = .002, t-value = −3.39) and pass rates (PG; 72% vs CG; 22%, P = .018). The subanalysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. Conclusions: The results suggest a positive interprocedural transfer of skills between PE and MSICS. Pretraining and experience in PE demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that PE experience provides an advantage before MSICS training in surgical residency programs.

Background: Upper eyelid blepharoplasty is one of the most common aesthetic surgeries performed worldwide. The procedure consists of removing excess skin with or without muscle and/or fat from the upper eyelid by a transcutaneous approach and placement of a supratarsal crease. The surgery is performed in a cosmetically sensitive area and every attempt to avoid poor scar formation should be made. Methods: This review presents a conspectus of the existing medical literature regarding scar-avoiding strategies in upper blepharoplasty with the aim of contributing to the reduction in postoperative scar formation. The Medline, Embase, and Cochrane databases were searched on 2 September 2025. Results: The search yielded a total of 562 records, and, following screening, eleven publications were included. Conclusions: A systematic approach to pre-, intra-, and postoperative measures to minimize scarring are presented. There is a need to standardize scar assessment and reporting to facilitate inter-study comparison of effects, as well as prospective, randomized studies comparing suture materials and techniques.

Purpose: To compare Manual Small Incision Cataract Surgery (MSICS) microsurgical performance in course participants who received virtual reality simulation‐based training by either a surgical expert or a non‐ophthalmologist instructor.Setting: Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.Design: Randomized controlled trial.Methods: Residents and specialists in ophthalmology with no prior MSICS experience were included to receive virtual reality simulation training in MSICS using the HelpMeSee simulator. The participants were randomly allocated to receive training from either an experienced MSICS surgeon or a non‐ophthalmologist, also known as near‐peer teaching. The performances of the participants were evaluated at baseline and post‐training using a MSICS proficiency‐based test with evidence of validity.Results: Thirty participants were included in the study and 29 completed the course. There was no significant difference in final test score between the two groups (p = 0.13). The performance score of both groups of participants increased significantly after receiving the training (p < 0.001). All participants passed the proficiency‐based test after receiving the training.Conclusion: We found no significant difference in surgical proficiency‐level whether the participants were trained by a surgical expert or a non‐ophthalmologist instructor for MSICS in a virtual‐reality based setting. The findings of this study suggest that near‐peer teaching within microsurgical performance potentially could be applied with teaching outcomes comparable to a surgical expert‐instructor.

Background: Despite the rise of endoscopic approaches, the direct brow lift remains one of the most effective procedures for correcting brow ptosis for both functional and cosmetic indications. It continues to offer superior control when correcting brow shape, height, and asymmetry. However, visible scarring remains a concern. This systematic review was conducted to synthesize recent evidence on strategies that minimize visible scarring in direct brow lift surgery. Methods: A systematic literature search was performed to retrieve English-language publications from the past decade, discussing scar-minimization strategies in direct brow lift. A total of 124 records were identified through database searches in Ovid MEDLINE and Embase. Records were screened manually according to predetermined criteria, and those not in English, not addressing scarring, or not focused on direct brow lift were excluded. After this process, ten publications were included in the final qualitative synthesis. Results: The qualitative synthesis of all included publications (together comprising data on approximately 900 patients) revealed several strategies for scar minimization. (1) Incision beveling: A shallow cranially directed bevel between 20° and 45° preserves brow hair follicles and allows hair regrowth through the scar, providing natural camouflage. (2) Undermining: Gentle subcutaneous undermining in a limited 1–2 cm field, while preserving subcutaneous fat, allows tension-free advancement and maintains brow volume. (3) Periosteal suspension: Anchoring the mobilized brow flap to the frontal periosteum redistributes tension away from the dermal closure, maintaining elevation and improving scar quality. (4) Layered closure: Two- or three-layered wound closure with deep dermal anchoring and fine everting skin sutures minimizes dermal traction and scar widening. (5) Adjunctive measures: Evidence for topical silicone gel was inconclusive, whereas postoperative laser therapy and perioperative neuromodulator use demonstrated improved scar appearance. Across studies, outcomes were consistent, with high patient satisfaction, inconspicuous scars in over 85% of cases, and low complication or revision rates. Conclusions: Direct brow lift has historically been criticized for conspicuous scarring, contributing to the popularity of endoscopic techniques. Nevertheless, the traditional direct brow lift remains a fundamental skill in the oculofacial plastic surgeon’s armamentarium, offering unmatched accuracy in brow repositioning, reliability, and symmetry. Contemporary evidence demonstrates refinements that can markedly minimize scar visibility. This systematic review and qualitative synthesis allow us to continue to refine and improve our techniques to minimize scarring in direct brow lift to the benefit of our patients.