Trapezoid Excision Upper Blepharoplasty for Chinese Women with Severe Laxity of Pretarsal Skin

Abstract

With socioeconomic standards and life spans increasing, upper blepharoplasty is becoming one of the most popularly performed rejuvenation operations in China. Classic upper blepharoplasty includes analogic long-spindle excision of redundant skin and muscle with or without creation of a new lid fold (Fig. 1), this procedure has been the primary solution to the common problem of blepharochalasia. However, many plastic surgeons have ignored the shortcomings of the postoperative results for this surgical technique [1–3]. A less than excellent surgical appearance after upper blepharoplasty has resulted from a faulty operative design. It is commonly observed that as the severity of pretarsal skin laxity increases, the design for long-spindle excision of redundant skin often results in inadequacy of blepharal skin excision near the internal canthus, which causes a remaining postoperative wrinkle. Trapezoid excision upper blepharoplasty addresses these shortcomings of the conventional blepharoplasty operation in a very straightforward and simple manner. To our knowledge, this is the first report of this technique. We have used the technique in our hospital for 3 years. The idea of the procedure rests on alleviation of the lid redundancy through trapezoid excision of blepharal skin. The technique thoroughly eliminates the wrinkle in the upper blepharal skin, especially the wrinkle near the internal canthus. From March 2006 to August 2008, 100 lids in 50 patients were subjected to this operation. Most of the patients were women, and the average patient age was 55.5 years. The primary indication for the procedure was the most severe form of blepharochalasia, especially skin laxity near the internal canthus. The key to postoperative success of upper eyelid blepharoplasty is preoperative design. With the patient supine on the operating table, the design for the incision must be planned carefully according to the patient’s selection of the upper eyelid crease. A low line is drawn following the place at which the upper eyelid crease would be formed. The extension of the low line must exceed the anodic of the internal canthus so that enough blepharal skin near the internal canthus can be resected. It should roughly parallel the slightly downward curvature of the wrinkle to Z. Xiao (&) M. Zhang Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, 194 xuefu road, Harbin City, People’s Republic of China e-mail: xiaozhibodoctor@yahoo.com.cn Fig. 1 Operative design for analogic long-spindle excision of redundant skin. The red area represents the skin resection. This technique, used by many plastic surgeons, has become the primary method for treating blepharochalasia