Double-eyelid Blepharoplasty Research Articles

A Reverse Orbicularis-Tarsus Fixation Technique in Double-Eyelid Blepharoplasty: A Novel Fixation Technique Different From Park's Technique.

Although Park's "orbicularis-levator fixation technique" has been widely used as a mature double-eyelid surgery in China recently. Shortcomings related to this method cannot be ignored. Thus, a reverse orbicularis-tarsus fixation technique in double-eyelid blepharoplasty has now been devised. The method is to create a physiological double-eyelid fold based on the formation mechanism of double-eyelid creases. A retrospective study of 112 Chinese patients who underwent double-eyelid surgery between October 2017 and September 2019 was undertaken through a review of medical records. All these patients underwent a reverse tarsus and orbicularis oculi muscle fixation technique, with postoperative follow-up ranging from 6 months to 2 years. Postoperative outcomes were reviewed, evaluated, and analyzed. Altogether, 112 patients who underwent the double-eyelid surgery were reviewed. Among them, the results were judged as excellent in 104 cases (92.9%), good in 4 cases (3.6%), fair in 3 cases (2.7%), and poor in 1 case (0.8%). Clinical effectiveness was satisfactory in most of the patients (104/112, 92.9%). Only 5 patients (4.5%) expressed subjective dissatisfaction with postoperative outcomes; of these, 3 patients complained of eyelids asymmetry (2.7%). Two patients complained of eyelids scar formation (1.7%); Whereas surgical revision was required in only 1 patient (0.8%). The reverse orbicularis-tarsus fixation technique for upper eyelid blepharoplasty is safe and effective, with better biomechanics and a satisfying aesthetic outcome. Therefore, this provides an alternative option in Chinese double-eyelid surgery.Level of Evidence: Level IV, case studies.

Will the patient's double eyelid shape be like that of the surgeon performing the procedure? A study of surgeons' aesthetics in East Asian Blepharoplasty.

No reports of the potential areas of surgeons' aesthetics in blepharoplasty. To explore the association between the surgeons' own double eyelid morphology and their aesthetics and surgical outcome. An investigation of 1605 patients was carried collecting the data of double eyelid shape, based on which to propose a preliminary double eyelid classification for analyzing the aesthetics of surgeons. Ten double eyelid surgical cases were randomly collected from each surgeon according to the inclusion criteria, whose double eyelid shape, ideal shape, the selection tendency of surgical approach, most cared factor during surgery, and design concept of eyelid shape were collected. Structural equation modeling (SEM) was performed to assess the association between participants' double eyelid shape, aesthetics, and blepharoplasty outcome. Fifty-three double eyelid surgeons were enrolled for study, whose double eyelids shapes mostly were obviously fan-shaped (37.74%) and low-parallel eyelid (26.42%), and the ideal shapes were obviously fan-shaped (41.51%) and high-parallel eyelid (24.53%). 54.72% of the subjects preferred to use the full-incisional method. 45.28% cared for long-term outcome most. Regarding blepharoplasty outcome style, 49.06% of the subjects preferred obviously fan-shaped type and 24.53% for high-parallel type. SEM showed that aesthetics rank increased by 0.692 points for surgeons' shape (P<.001), and surgical outcome rank increased by 0.861 points for aesthetics (P<.001). However, their eyelid shape had no direct contribution to surgical outcome (P=.96). The findings indicated that surgeons' double eyelid shape positively affected their aesthetics, which affected their surgical outcomes further, but their double eyelid shape failed to affect the surgical outcomes directly.

Impact of Full-Incision Double-Eyelid Blepharoplasty on Tear Film Dynamics and Dry Eye Symptoms in Young Asian Females.

Dry eye symptoms as a complication of double-eyelid blepharoplasty are controversial. This article evaluates tear film dynamics and changes in dry eye symptoms after cosmetic double-eyelid blepharoplasty in young Asian female. One hundred and twenty patients underwent full-incisional double-eyelid blepharoplasty. Subjective and objective parameters were documented before surgery, at 1week, 1month and 3months post-surgery, which included Ocular Surface Disease Index questionnaire (OSDI), tear meniscus height (TMH), noninvasive breakup time (NIBUT), Schirmer I test, corneal and conjunctival fluorescein staining scores, and palpebral fissure height. Dry eyes were defined based on the DEWS II criteria: OSDI ≥ 13 points and NIBUT < 10s. Patients were divided into two groups, group A included patients with redundant skin, while group B included patients with absence of redundant skin. The incident rate of dry eyes preoperatively, and at 1week, 1month and 3months were 12.5%, 12.5%, 32.5%, and 16.67%. OSDI scores were significantly increased at 1 week (9.71 ± 10.07, P < 0.001) and 1 month (11.35 ± 12.28, P < 0.001) postoperatively. A significant increase in TMH, NIBUT and Schirmer's test I values were observed at 1 week post-surgery (P < 0.001). Patients in group A showed higher OSDI scores compared to group B at 1 week and 1 month (P = 0.051) post-surgery, and the other variables showed no difference between the groups. Cosmetic double-eyelid blepharoplasty may temporarily affect tear film dynamics and aggravate dry eye symptoms in young females. However, these changes generally recover 3 months postoperatively. 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 .

A Four-Step Technique for Creating Individual Double-Eyelid Crease Shapes: A Free-Style Design.

Double-eyelid blepharoplasty is the most frequently performed aesthetic surgery in the Asian population. However, the epicanthal fold has been a conundrum limiting the outcomes of Asian blepharoplasty. Furthermore, with the blending of Western and Asian cultures, patients have individual standards of beauty for the upper eyelids. Here, we developed a four-step technique to form infold or outfold double-eyelid creases to satisfy individual patient requirements. The medical records of patients who simultaneously underwent double-eyelid blepharoplasty and epicanthoplasty using this four-step technique from January of 2017 to January of 2019 were reviewed. The results were grouped by preoperative patient requirements for eyelid crease shapes. The rate of meeting patient expectations in each group was evaluated by two independent observers. Preoperative and postoperative photographs were collected, complications were identified, and postoperative results were assessed. In total, 285 consecutive patients were included in this study, with a mean follow-up period of 9 months. Of the 285 patients, 207 requested infold eyelid creases, and 190 (92 percent) procedures met patient expectations; and 78 patients requested outfold eyelid creases, and 69 (87 percent) procedures met patient expectations. A high rate of satisfaction with the final eyelid crease shape and resulting scarring was noted in both patient groups. The revision rate was 3 percent. No severe complications were observed. The four-step technique is a simple, flexible, and effective method for creating infold or outfold double-eyelid creases according to individual patient requirements and should be considered a routine method for patients who request double eyelids. Therapeutic, IV.

Conjoint fascial sheath suspension for early correction of severe blepharoptosis after double-eyelid blepharoplasty.

We aimed to investigate the feasibility and efficacy of early correction of severe blepharoptosis after double-eyelid blepharoplasty using conjoint fascial sheath (CFS) suspension. From July 2013 to July 2016, 23 patients (25 eyes) with severe blepharoptosis were treated with CFS suspension and followed up for 12-36 months. The levator function, margin reflex distance, patients' satisfaction with the appearance of the double eyelids, and complications were retrospectively analysed. Full correction was achieved in 24 eyes and overcorrection in one eye. No undercorrection was noticed. Postoperatively the mean levator function was significantly increased (from 1.5 to 10.2mm) and the margin reflex distance was significantly increased from -1.0 to 4.8mm. All patients were satisfied with the appearance of the double eyelids. No recurrence of blepharoptosis occurred postoperatively. One patient had postoperative chemosis and was well-managed with conservative treatments. CFS suspension is a safe and effective way to treat severe blepharoptosis after double-eyelid blepharoplasty. The treatment is effective in the long term.

改良眶隔法和传统睑板法切开重睑术的临床比较

改良眶隔法和传统睑板法切开重睑术的临床比较

Clinical efficacy of " flexible suspension technique" in double-eyelid blepharoplasty

Objective The mechanism of traditional double-eyelid blepharoplasty is adhering skin to tarsus, by which the skin below the incision could be elevated along with the tarsus and produce the crease. But the anatomic basis of native double-eyelids is not the same, which depends on the connection of levator aponeuroses with muscle and skin. That is, the elevations of tarsus and skin is based on the different branches of levator aponeuroses to skin. According to this, the authors have developed a modified blepharoplasty suturing levator aponeuroses to the obicularis occuli muscle to mimic the native double eyelid. Methods The surgical procedures were modified from traditional surgery. The major improvements were: keeping obicularis occuli muscles intact, dissecting the levator aponeuroses and suturing them together. Since the suturing was performed between mobilized tissues of muscle and aponeurosis, the method was named as flexible suspension . Five-hundred patients were performed with this method. Forty cases randomly selected from them were compared with 40 cases performed with traditional method, and the results were investigated using questionnaire survey. Results The results of the modified surgery were more natural than traditional technique. Majority of patients were satisfactory, whereas 15 cases (3%) had asymmetry, narrowing and even fold loss. All these 15 cases were puffy eyelids. Statistical results indicated that the satisfaction rate was significantly high (P=0.003), and the adverse effects (edema, bruise and scar) were significantly lighter than traditional technique; whereas the asymmetry and fold loss were higher than traditional technique. Conclusions The flexible suspension technique of blepharoplasty can obtain more natural double eyelid appearance, and is suitable for primary blepharoplasty but not applicable for severe puffy eyelids. Key words: Blepharoplasty; Questionnaires; Obicularis occuli; Levator aponeuroses; Suspension

A practical technique combining orbicularis oculi muscle resection-based epicanthoplasty and orbicularis-tarsus fixation double-eyelid plasty for cosmetic blepharoplasty

A plump single eyelid with medial epicanthal fold is the morphological feature of the East Asian population. This study describes a practical technique that combines orbicularis oculi muscle resection-based epicanthoplasty and orbicularis-tarsus fixation double-eyelid plasty for cosmetic blepharoplasty and reports on surgical outcomes in a large number of Chinese patients. For supratarsal crease formation, the soft tissue was removed in a conservative manner and the orbicularis oculi muscle was anchored on the tarsus to build a reliable attachment. To correct the epicanthal fold, a modified redraping technique was used for the design of skin incision, and most importantly, a triangular muscle block composed of the orbicularis oculi muscle was selectively removed to release the abnormal tension in the epicanthal fold. From January 2015 to February 2019, 475 patients underwent double-eyelid blepharoplasty combined with epicanthoplasty using this technique. The follow-up period ranged from 2 to 38 months, with a mean period of 16 months. Of these, 97% of the patients were satisfied with surgical outcomes, presenting well-defined palpebral folds and naturally improved inner canthus contour, with no conspicuous scar. The photographic analysis in 84 patients showed significant improvement in palpebral fissure proportion postoperatively. No supratarsal crease drooping or recurrence of the epicanthal fold was observed up to 38 months after the surgery. This method is a safe and reliable technique to achieve an elongated and more balanced eye shape in Chinese patients, with minimal scarring and a low risk of postoperative complication in a long follow-up period.

Transconjunctival Müller's muscle Tucking Method for Non-incisional Correction of Mild Ptosis: The Effectiveness and Maintenance.

In patients with a mild degree ptosis who undergo non-incisional double-eyelid blepharoplasty, simultaneous correction of ptosis is needed to prevent loosening. The transconjunctival Müller's muscle tucking (TMMT) method may be useful in these cases. The authors performed this study to present the details of the current use of the TMMT method and to provide objective evidence for ptosis correction and its sustained effect. A total of 322 eyelids in 161 patients who underwent mild ptosis correction with the TMMT method from July 2012 to December 2017 were retrospectively examined. The continuous suture method using a single stitch was used for double-fold formation, and the TMMT method was used for ptosis correction for the other incision. The margin to reflex distance (MRD) 1 was evaluated at pre-operation, immediate post-operation, and at 2, 6 months post-operation. A total of 34 patients who had more than 6months of follow-up were included. Right-side MRD1 values were 2.08 (± 0.19) mm before the surgery, 3.49 (± 0.16) mm immediately after the surgery, 3.33 (± 0.14) mm at postoperative 2months, and 3.22 (± 0.17) mm at postoperative 6months (p < 0.001). The difference of MRD1 between immediate post-operation and at 6months was 0.25mm without statistical significance (p > 0.05). Complications (fold loosening, asymmetry, and ptosis recurrence) occurred in three cases (8.8%), all of which were re-corrected by applying the TMMT method. The TMMT method was useful for correction of mild ptosis, showed little recurrence, and prevented loss of fold by giving a vertical force to the double-fold. 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 .

Aging Blepharoplasty, Supraciliary Approach.

If the upper eyelid skin appears saggy in the elderly, it may not only hinder vision but also cause skin diseases such as eczema. Therefore, it is necessary to excise the saggy skin to improve the symptom. Double eyelid blepharoplasty may change the impression by newly forming or altering a double eyelid line. In particular, middle-aged men want to enlarge their eyes by improving the saggy skin, but they do not wish to undergo double eyelid blepharoplasty. Instead, they hope to look natural. Subbrow lifting surgery may leave a wound, so we applied supraciliary approach when the patients did not want subbrow lifting. As a result, we observed desired results, so we report a case of supraciliary approach.

Clinical effects of upper eyelid blepharoplasty using the dermis orbicularis muscle flap technique

Objective To develop a new technique of upper eyelid blepharoplasty for reducing surgical complications and improving cosmetic results. Methods In this study, 721 cases (9 males and 712 females, range in age 17-32 years) with single eyelid were performed with double eyelid blepharoplasty using this method (dermis orbicularis muscle flap technique, DOMF), 698 cases of which were simultaneously operated with epicanthoplastic surgery. In the operation, DOMF was harvested in the dermis edge in lower incision margin. The flap was sutured to levatoraponeuros at the superior border of the tarsus. Patients were followed up for three months to three years. Results It was concluded that unfavorable results included low fold in 12 cases, relapse in 3 cases, asymmetric crease in 4 cases, puffy eyelids in 5 cases, and sunken appearance in 4 cases. The physicians and patients were satified with the results. The eyelid appeared smooth without fold depression on downward gaze or eyes closed, and it was gentle and not overly puff as eyes opening. Conclusions The DOMF technique mimics the movement of congenital crease fold, which is easy to perform, creating a delicate, firm and smooth upper lid orientation. Key words: Blepharoplasty; Surgery, plastic; Dermis; Immobilization; Orbicularis muscle flap

A New Method for Double-Eyelid Blepharoplasty Using Orbital Septum.

This article presents a new method using orbital septum for double-eyelid blepharoplasty. During double-eyelid blepharoplasty, we incised the orbital septum horizontally. Using the attachment site of the levator aponeurosis as a pedicle, the lower part of the dissected orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the efficacy of this double-eyelid surgical procedure in patients undergoing the procedure from December 2015 to October 2017. We included 462 eyes of 231 patients in the final analysis. Sutures were removed 7 days after surgery. All double-eyelid creases were well formed, and the eyelids closed well. Six-month follow-up results revealed that the double-eyelid shape was natural looking, and no patients experienced upper eyelid retraction or incomplete eye closure. Notched scars did not occur, and patient satisfaction was achieved in all cases. Two hundred eleven patients were fully satisfied with the surgical results, and 20 were basically satisfied with the surgical results. Using the orbital septum is a good approach for double-eyelid blepharoplasty.

Individualized small-incision orbicularis-levator fixation blepharoplasty for unilateral single-eyelid Asians

Unilateral double-eyelid blepharoplasty is often required by people with unilateral single eyelid. The full incisional method may cause permanent skin scar formation, and the buried suture method may lead to early eyelid fold loosening, which could not reduce the soft tissue thickness of eyelid. A total of 85 patients (8 males and 77 females) with unilateral single eyelids were studied between January 2015 and January 2016, with a mean age of 25.57±6.5 years. Small-incision orbicularis-levator fixation blepharoplasty was performed on all patients on the single eyelid side. During surgery, the orbicularis oculi (OO) muscle and the orbital fat (OF) were selectively removed through the small skin incisions. The thicknesses of upper eyelid were measured preoperatively and at 6 months postoperatively. The position and tension of the eyelid creases, eyelids symmetry, and satisfaction status were also evaluated. Eighty patients (10 left eyes and 70 right eyes) were followed up for 19±3.4 months. Before surgery, the average thickness of OO muscle is 0.895±0.199mm (left) and 0.970±0.185mm (right) (P = 0.0127), the thickness of OF is 0.717±0.154mm (left) and 0.867±0.143mm (right) (P = 0.0187). Six months postsurgery, the average thickness of OO muscle is 0.894±0.199mm (left) and 0.907±0.188mm (right) (P = 0.293), the thickness of OF is 0.703±0.143mm (left) and 0.747±0.0957mm (right) (P = 0.534). In conclusion, small-incision orbicularis-levator fixation blepharoplasty can produce a desired aesthetic effect for unilateral single-eyelid patients as its personalized designing, symmetrical eyelid thickness, and slight skin scar formation.

A Modified Double Eyelid Plastic Surgery Method: Continuous Buried Suture Method Accompanied by Simultaneous Correction of Mild Blepharoptosis.

Double eyelid surgery with a buried suture is a popular plastic surgery procedure in Asia owing to the relatively minor scarring and quick recovery associated with it. In this article, we present a new approach involving a continuous single-loop buried suture method, which expands the operating site to the conjunctiva and the aponeurosis-Müller's muscle complex. The medical records of 42 patients (80 eyes) who underwent double-eyelid blepharoplasty were retrospectively reviewed. We performed double-eyelid blepharoplasty with a single-knot continuous buried suture method, along with the resection of a small piece of the orbicularis oculi muscle. The formation of a double eyelid was achieved through traction of the aponeurosis-Müller's muscle complex from the medial conjunctiva and penetration of the upper eyelid. The majority of patients achieved the expected cosmetic effect of double eyelid formation after the procedure. In the subsequent follow-up period of 2-30months, no complications, such as loosing or sagging of the double eyelid or granuloma formation, occurred. The mean recovery time ranged between one and 6weeks. The pre-operative margin reflex distance (MRD1) was 2.36 ± 0.61mm, and the post-operative MRD1 was 3.72 ± 0.63mm, (p < 0.001). The Wilcoxon signed rank test was used for nonparametric, paired comparisons. We proposed a modified technique involving a continuous buried suture method to create a better cosmetic effect through the formation of a double eyelid and simultaneous correction of mild blepharoptosis. This modified procedure is simple, fast, and effective, with limited adverse effects. 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 .

Modifications of Z-Epicanthoplasty Combined with Double-Eyelid Blepharoplasty in Asians.

Epicanthoplasty combined with double-eyelid blepharoplasty is one of the most popular cosmetic procedures in Asians. However, the postoperative medial canthal scar is a concerned issue. Here the authors adopted some modifications of Z-epicanthoplasty to minimize the canthal scar. Modifications of Z-epicanthoplasty were mainly in three aspects. First, supratarsal creases were created before epicanthoplasty to prevent the impact of tension variation on epicanthal incisions, caused by elevating and tightening of the upper eyelid skin. Second, one triangle flap was determined according to the transposition of another one in Z-plasty, and hence, it can be guaranteed that the incisions were closed free of tension with more accuracy and less injury to surrounding tissues. Third, linear scar contracture was avoided by adopting discontinuous incisions, and the resulting skin bulge was eliminated by making an additional stitch to anchor the pretarsal skin on the tarsal plate. The follow-up interval was 1month to 2years, with a median of 6.5months. From January 2012 to December 2015, 237 female and 4 male patients received the surgery. Except five (2.07%) patients, who were not satisfied with the color of incision scars in medial canthal area, none complained about scars 6months after surgery. The appearance of the supratarsal crease was natural, and the medial canthal scar was inconspicuous in close observation at 2years. The modifications of Z-epicanthoplasty are safe and effective. It is potentially helpful to minimize postoperative medial canthal scars. 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 .

Application of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design

Objective To explore the clinical effect of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design. Methods We retrospectively reviewed the application and effect of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design between January 2015 and June 2016. There were 36 cases of severe epicanthus in this group, including 20 cases of thin eyelid, 13 cases of mild swollen eye and 3 cases of moderate swollen eye. Results Follow-up by telephone or WeChat, satisfactory for the 26 cases, the basic satisfaction of 9 cases, 1 case of dissatisfaction, moderate swollen eye and severe epicanthus. Conclusions In the case of severe epicanthus with a single eyelid and a mild swollen eyelid without thinning of the eyelid, the use of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design is one of good choices of methods for the correction of epicanthus. Key words: Double-eyelid blepharoplasty; Three-point; Asymmetric Z-plasty; Epicanthal

Sentinel Artery in Double Eyelid Blepharoplasty

In double eyelid blepharoplasty, unexpected bleeding may cause intraoperative hematoma, swelling, and temporary ptosis, which could cause asymmetry and prolong recovery time. In 1725 patients (3450 eyes), double eyelid blepharoplasties were performed on Chinese patients from January 2014 to July 2016 by our senior author. In 36 eyes, the authors identified a variant artery, which the authors named the "sentinel artery," located in the inferolateral superficial orbital septum. The sentinel artery courses between the orbital septum and the levator palpebrae finally drain into the peripheral arcade. This artery is uncommon since only 1.04% of eyes have it. If the artery is severed accidentally, the cleaved arterial end will retract into the levator palpebrae and bleed causing a large hematoma to rapidly form posterior to the levator palpebrae. The authors actively avoided unexpected bleeding caused by tearing up this artery while opening the orbital septum during double eyelid blepharoplasty procedure.

Measuring satisfaction with appearance: Validation of the FACE-Q scales for double-eyelid blepharoplasty with minor incision in young Asians- retrospective study of 200 cases

Double eye-lid surgery is one of the most popular performed aesthetic procedures in young Asians. Reliable measurement of patient reported outcomes is crucial for facial aesthetics. The FACE-Q is a new patient-reported outcome tool (PRO) composed of numerous independently functioning scales and checklists designed to measure outcomes. Here we described FACE-Q scales for double eye-lid surgery with minor incision in young Asians. 200 patients (400 eyes) aged from 21 to 30 years-old were recruited from 2012 to 2014. They underwent minor incision procedure for double-eyelid blepharoplasty, epicanthic fold correction, excessive orbit fat removal and blepharoptosis correction simultaneously. An incision of 1cm long in the middle of upper eyelid and modified Park's Z-plasty for epicanthus correction were designed. Three stitches were carried out in levator aponeurosis-inferior dermis procedure. By the middle incision in the upper eyelid, blepharoptosis correction and excessive orbit fat removal can be executed. Those patients were asked to complete anonymously the FACE-Q by e-mail. FACE-Q scores were assessed for each domain (range, 0 to 100), with higher scores indicating greater satisfaction with appearance or superior quality of life. After a mean of 2 years' follow-up, postoperative complications included partial or complete loss of the double-eyelid fold in 8 and 0 cases, respectively, no hypertrophic scar formation, and asymmetric fold in four cases. One patient received re-operation on blepharoptosis correction. Except hematoma occurring in one female case, no obvious edema was observed. Patients demonstrated high levels of satisfaction with eye appearance overall (mean±SD, 81.7±18.3). Quality of Life Patients exhibited high levels of quality of life, including in social confidence (95.4±12.6), psychological well-being (97.8±10.3), and early life impact of the procedure (90.2±13.4). Patients reported high satisfaction with the decision to undergo and the outcome of the procedure. Minimally invasive procedure is a reliable tool for correcting disfigurement in double-eyelid blepharoplasty. However, this method is not suitable for those cases whose upper eyelids are featured by relaxation. Excessive amount of skin must be removed. Patients who responded in this study were extremely satisfied with their decision to undergo double-eyelid surgery and the outcomes and quality of life following the procedure.

Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians.

Background:Double-eyelid blepharoplasty is a popular aesthetic surgery in Asians. However, the buried suture technique is associated with complications related to implantation of the suture thread. The present study was performed to identify optimal surgical suture removal techniques in Japanese patients with suture-related complications after buried suture double-eyelid blepharoplasty.Methods:This retrospective study included 210 upper eyelids of 116 consecutive Japanese patients who had undergone buried suture double-eyelid blepharoplasty at other clinics. All patients underwent suture removal surgery at the author's institution for treatment of suture-related complications. Although 12 patients (10.3%) underwent suture removal surgery alone, 104 (89.7%) underwent secondary double-eyelid blepharoplasty. The outcomes of 3 techniques were evaluated: the small skin incision method, the full skin incision method, and the conjunctival method.Results:The small skin incision method was performed in 46 patients, the full skin incision method in 63, and the conjunctival method in 7. The success rate of the full skin incision method was significantly higher than that of the small skin incision method (4.8% vs 37.0%, respectively; p < 0.0001). Patients with an uncomfortable pulling sensation exhibited a linear scar or depressive deformity without inflammation of the tarsal plate and impingement on the subconjunctival capillary vessels of the tarsal plate or a depressive deformity of the levator muscle. Patients with corneal irritation exhibited chronic inflammation of the conjunctival surface of the tarsal plate.Conclusions:Suture-related complications of buried suture double-eyelid blepharoplasty in Asians must be treated with suture removal surgery. The full skin incision method is more reliable than the small incision method for such patients.

A Novel U-Flap Epicanthoplasty for Asian Patients.

The epicanthal fold is a distinct characteristic of the Asian upper eyelid, which may impair the beauty of the eyes and the outcome of double eyelid blepharoplasty. Although many surgical procedures have been reported, their main drawbacks include a conspicuous scar in the medial canthal area and an unnatural palpebral contour. We devised a novel surgical approach to correct the epicanthal fold with acceptable scarring. From June 2011 to October 2014, U-flap epicanthoplasty was performed on 118 Chinese patients in our department. The U-flap was designed on the medial canthal skin. After complete dissection of the flap from the dislocated orbicularis muscle and underlying connective tissue, the flap naturally rotated upward to a line consistent with the direction of the palpebral fold. The flap was then subcutaneously fixed to the medial part of the medial canthal ligament. Finally, the redundant skin was trimmed off and the incision was sutured without tension. Patients were evaluated before and 12months after surgery. The average decrease in the intercanthal distance was 4.36±0.32mm. The general satisfaction rate was 97.5%. Three patients showed bilateral hypertrophic scar formation on both bilateral medial canthal incisions and palpebral incisions; however, the scarring subsided after three triamcinolone acetonide injections. No epicanthal fold recurrence or other complications were observed during the 12-month follow-up period. U-flap epicanthoplasty is a simple and effective method for elimination of types I-III epicanthal folds. However, its long-term effects require further study. 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 .