Double-eyelid Line Research Articles

Clinical Efficacy of Bionic Blepharoplasty Using the Flexible Suspension and Semiflexible Suspension Double-Insurance Methods.

To investigate the clinical effect of the double insurance method of flexible suspension and semiflexible suspension in bionic blepharoplasty. Between January 2020 and January 2022, a total of 115 patients (230 eyes) underwent double eyelid plastic surgery with flexible suspension and semiflexible suspension. Herein, we present a new type of double eyelid surgery that preserves the orbicular muscle of the anterior tarsus without removing the tissue. First, the loose fatty fascia layer between the anterior tarsus and the orbicularis oculi muscle was completely removed to a distance of 2mm from the base of the eyelashes, leaving the compact pretarsal levator aponeurosis. Then, the anterior tarsus orbicularis oculi muscle and the upper levator aponeurosis were sutured and fixed (flexible suspension). Finally, the skin and the upper levator aponeurosis were sutured in the flexible suspension space (semiflexible suspension). Six months after surgery, the patient's double eyelid shape had recovered well, and the satisfaction rate reached 97.3%. Among the unsatisfied patients, 1 patient had a single-focused shallow eyelid line which was associated with postoperative hematoma, and 2 patients felt that the double eyelid line was narrow. All 3 patients achieved satisfactory results after reoperation. The bionic double eyelid method with flexible suspension and semiflexible suspension can restore the natural double eyelid anatomy very well by reconstructing the connection between the orbicularis oculi muscle or skin and the upper palpebral levator aponeurosis. After the operation, the incisions healed quickly and smoothly. The eyelid depression and fleshy feeling were not obvious when the eyes were closed. Consequently, the patient's satisfaction was very high.

Skin-Tarsus-Skin Combined with Orbicularis-Tarsus-Orbicularis Fixation Technique Creates a Double Eyelid: A Case Series.

The skin-tarsus-skin and orbicularis-tarsus-orbicularis fixation methods are widely used in double-eyelid surgery. Both methods have limitations. In this study, the two surgical methods were integrated and applied to form a stable double eyelid that mimics the natural physiological structure with minimal visible scarring. At the inner, middle, and outer sites of the double-eyelid line, 7-0 silk sutures were passed successively through the orbicularis oculi muscle at the lower edge of the incision, the tarsus/anterior tarsus tissue, and the orbicularis oculi muscle at the upper edge of the incision, and the skin was sutured with 8-0 thread. The remaining parts were fixed with 8-0 silk sutures successively passed through the skin at the lower edge of the incision, tarsus/anterior tarsus tissue, and skin at the upper edge of the incision. Scar formation, incidence of complications, and patient satisfaction were observed and recorded during follow-up. Fifty-eight patients were included. The follow-up ranged from 3 to 24 months (mean, 8 months) with 47 patients undergoing primary and 11 secondary/revision surgery. Twelve cases showed slight linear scars and in 46 cases, surgical marks were almost invisible, and there were no dynamic depressed scars. Evaluation of patient satisfaction showed high satisfaction scores (VAS score, 8.56 ± 0.51). The main reason for dissatisfaction was asymmetry of the double eyelid. There were no significant complications. A skin-tarsus-skin combined with orbicularis-tarsus-orbicularis fixation technique can produce a long-lasting, natural-looking double eyelid.

Recurrent Squamous Cell Carcinoma of the Upper Eyelid Treated With Combination Therapy of ALA Photodynamic Therapy and Surgery With Secondary Healing

Background. Cutaneous squamous cell carcinoma (cSCC) frequently occurs in photoexposed areas. Surgery remains the mainstay of treatment in attempts to reduce recurrence, but it must be combined with other therapy because of the limited excision possible in the region of the eyelid, lip, and nose. Photodynamic therapy (PDT) is a relatively new treatment modality that involves the administration of a photosensitizing drug and its subsequent activation by specific wavelengths of light to produce reactive oxygen species that specifically destroy target cells. Case Report. An 87-year-old female presented 4 weeks after initial resection with recurrent medium-differentiated cSCC measuring 5.2 cm × 3 cm × 2 cm in the left upper eyelid. Subsequent treatment involved palliative resection with an additional 1 cm at 3 margins of the tumor (excluding the bottom edge of the double eyelid line) and 3 applications of PDT using 5-aminolevulinic acid as the photosynthesizing agent in the open wound over a 2-week period. The wound healed well within 6 weeks. During the following 4 years, the patient showed satisfactory progress in both aesthetics and function, with no sign of recurrence or metastasis. Conclusion. Refractory cSCC was successfully managed using a combination of PDT and secondary healing, and functions of the head and face were well protected. These results suggest that such management warrants consideration in clinical settings.

A modified Park's technique for creating a natural-looking double eyelid.

This study aimed to evaluate an improved park's technique to create a natural double eyelid and reduce scar formation. The levator aponeurosis, orbicularis oculi muscle, and dermis were fixed using subcutaneous intermittent sutures, and then the skin and the levator aponeurosis were sutured. Postoperative evaluation included double-eyelid stability, symmetry, double-eyelid curve, scar formation, and patient satisfaction. Between January 2021 and August 2021, a total of 89 patients (178 eyes) underwent double-eyelid blepharoplasty by the same surgeon using this improved technique. The mean follow-up period was 15.5 months (range 10 to 18 months). Seventy-six patients were very satisfied with this surgical method, six patients were rather satisfied, and seven patients were dissatisfied. The overall satisfaction rate was 92.1%. This new blepharoplasty method generates a stable, natural double-eyelid line with minimal scarring.

Comprehensive management for complex complications after periumbilical fat implantation into the upper eyelid

BackgroundRecently, periumbilical fat (PF) mass, an autologous material with a high survival rate, has been transplanted to treat sunken or dissatisfactory double eyelids. However, the intricate complications of PF grafts and associated reconstructive strategies are infrequently discussed.MethodsDuring 3 years, 20 patients (33 eyes) with eyelid malformations caused by PF grafts into the orbital septum or on the surface of the levator aponeurosis underwent corrective blepharoplasty. We recorded patients’ subjective feelings and identified deformities from crease abnormalities, bloated appearance, and problems with the eyelid’s height. Then, we categorize them into three types based on their complexity: type I, swollen appearance; type II, obvious adhesion; type III, severe comprehensive damage. The relevant management included removing fat implants, releasing the adhesion, and rebuilding the physical structure according to the anatomic damage mechanism. The improvement effect was assessed with a satisfaction survey from patients and doctors at 6 months of follow-up.ResultsThe swollen appearance was observed in 26 eyes (78.8%), an unsmooth double-eyelid line was in 23 eyes (69.7%), and the incidence of adhesion was in 22 eyes (66.7%). Following a comprehensive evaluation, 15 eyes (45.5%) and 13 (39.4%) were classified as type I and type II respectively. After the 6-month follow-up, 22 eyes (66.7%) showed exceptional aesthetic results, whereas only 2 eyes as type III had a poor outcome.ConclusionsThe deformities emerging from periumbilical fat into the upper eyelid are associated with the shape of the fat and the adhesion in tissues. Graft removal, adhesion release, and restoration of the natural anatomic structure can have positive outcomes.

A Novel Strategy to Achieve Stable and Lasting Double Eyelids in Upper Blepharoplasty.

Incision blepharoplasty is very common among aesthetic surgery, but the effect of it varies considerably. The quality of incision blepharoplasty is mainly defined by operator's ability, which will result in the uncertainty of operation result. We are committed to seeking a principle to guide every operator to achieve optimum success. A retrospective study of 150 patients experienced the new method from January 2020 to May 2022. This method was mainly divided into 4 steps. Firstly, released adhesion between the orbital septum and the levator aponeurosis and the connection between the orbital septum and the pretarsal fascia. Then, dealt with the epicanthus to reduce the resistance. Third, improve the lifting force of opening eyes or decrease the resistance of opening eyes to keep the balance of biomechanics in the upper eyelid. Last, sutured and closed the incision. The postoperative outcomes were assessed by "Global Aesthetic Improvement Scale." The follow-up period at last for 3 months.-The results showed that the rate of "Very much improve" was 88% (132 patients); that of "Much improve" was 9.3% (14 patients); that of "Not change" was 0.6% (1 patient); and that of "Worse" was 2% (3 patients). The recovery time of patients varied from 2 weeks to 1 month. And the complications of the narrowing and lightening of the double-eyelid line decreased. Applying the biomechanical balance principle to incision blepharoplasty can generate a more beautiful double-eyelid line and is less likely to trigger off complications.

Removal of Autogenous Fat Filling in Double Eyelid Operation by Artificial Intelligence (AI) Algorithm-Based Computerized Tomography (CT) Image Features

The effect of autogenous fat filling was evaluated by computerized tomography (CT) image features based on the symmetric extended convolutional residual network image denoising algorithm in this research, and the pathological examination was conducted for the lesions of patients with complications. The examination provided more valid research basis for the clinical application of autogenous fat filling. 60 patients who received double eyelid operation were selected as the research objects, and the patients were randomly divided into the control group and the experimental group, where each group included 30 cases. The conventional double eyelid operation was adopted in treating the cases in the control group, while autogenous fat filling was adopted in the treatment of the cases in the experimental group. All patients in two groups were examined by CT images based on the symmetric extended convolutional residual network image denoising algorithm, and the therapeutic effects on patients in two groups and the evaluation of complications were compared. Next, the lesions of the complications of patients in the experimental group were examined pathologically. Besides, the efficacy and security of the pathological examination were assessed. The result showed that the values of peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) (σ (noise level) = 60 : 24.78 dB, 0.7022) in different noise images of the artificial intelligence algorithm adopted in the research were obviously higher than those obtained by the convolutional neural network (CNN) and deep convolutional neural network (DCNN) algorithms (P < 0.05). The therapeutic efficacy of patients in the experimental group was higher than that in the control group (68.67% vs 60%). In addition, eyelid swelling scoring, double eyelid line width, and upper eyelid muscle strength of patients in the experimental group were all better than those of patients in the control group (P < 0.05). Besides, the incidence of complications (10%) of patients in the experimental group was significantly lower than that (30%) of patients in the control group. The pathological results of patients in the experimental group demonstrated that the lesion tissues might denature in future. As a result, the CT image processing of the algorithm adopted in this research could denoise effectively, and PSNR and SSIM values were high. In terms of the treatment by double eyelid operation, autogenous fat filling was effective, noninvasive, simple and resulted in low incidence of complications with a certain degree of security.

Double-Eyelid Blepharoplasty: Dermis-Outer Orbicularis Fascia-Orbicularis-Levator Fixation Technique with Preorbicular Venous Network Preservation.

This article presents a new method using a dermis-outer orbicularis fascia-orbicularis-levator (DOOL) fixation technique for double-eyelid blepharoplasty. Our surgical technique preserves the preorbicular venous network (POVN) and uses mattress sutures to fix the dermis, outer fascia of the orbicularis oculi muscle, and orbicularis oculi muscle with pretarsal levator aponeurosis (DOOL). Between January 2016 and July 2018, 335 patients were treated with this POVN-preserving DOOL technique (321 women and 14 men; mean age, 29.6 y). The patients were followed up for 6-30 months. The complications were documented, and the overall outcomes of the upper eyelid folds were evaluated by both surgeons and patients as good, fair, or poor. Among 335 patients, 307 (91.6%) had good results, 17 (5.1%) had fair results, and 11 (3.3%) had poor results. Postoperative complications included partial (n=4) or complete (n=3) loss of the double-eyelid line and asymmetric folds (n=4). Hypertrophic/depressed scars did not occur. With less invasiveness and secure internal fixation, the DOOL fixation technique with POVN preservation can achieve a stable and natural double-eyelid appearance. 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 45-degree Upward Tension-Releasing Epicanthoplasty Performed in 712 Consecutive Cases

Medial epicanthoplasty is commonly used to enhance the aesthetic outcomes of double-eyelid operations in Asia. However, epicanthoplasty can cause problems such as scarring and excessive exposure of the lacrimal lakes. To resolve the problems associated with epicanthoplasty and to create more natural and long-lasting double-eyelid fold lines while minimizing incisions, we performed a 45-degree upward tension-releasing epicanthoplasty. A total of 712 patients underwent 45-degree upward tension-releasing epicanthoplasty, with or without double eyelidplasty. A triangular skin flap was elevated at a 45-degree angle from the epicanthal fold. The surrounding area was dissected to eliminate the rigid connective tissue between the orbicularis muscle and the skin, which creates skin tension. The incisions were sutured, and a small incision toward the medial canthus was added to further decrease tension and create space for the triangular flap to be transposed. A total of 707 patients underwent 45-degree upward tension-releasing epicanthoplasty with the double-eyelid procedure, and 5 patients underwent 45-degree upward tension-releasing epicanthoplasty alone. No complications were observed for any patients, and 95% of patients were satisfied with this technique. The 45-degree upward tension-releasing epicanthoplasty can release the tension in the epicanthal fold, minimize scarring, and control lacrimal lake exposure. In particular, this method was effective for creating an in-out double-fold line starting from the epicanthus and for maintaining the double-eyelid line, which can reduce unnecessary incisional double-eyelid surgery.

Medial Epicanthoplasty Using a Lower Palpebral Margin Incision Combined With a Tiny Triangular Flap.

The incidence of epicanthus is extremely high in Asians. Although many techniques have been introduced to remove the epicanthus, there are still some complications. Herein, we introduced a method involving an incision on the lower palpebral margin combined with a tiny triangular flap for correction of epicanthal folds, which is always performed in combination with double eyelid plasty. After making an incision, the ectopic medial canthal ligament was removed. The ligament pulling the medial canthus was cut along the lower palpebral margin incision, so the medial canthus could be repositioned upward. The tiny triangular flap of the medial canthus would naturally move downward and cover the lower palpebral margin incision. The skin folds on the lower palpebral margin were trimmed and sutured. After epicanthoplasty was completed, double eyelid plasty was performed using the incision or non-incision method. A total of 547 epicanthoplasties were performed during the past 7 years. The follow-up time ranged from 1 month to 5 years. Ninety-eight percent of the patients were satisfied with the results of the epicanthoplasty. The scars in the medial canthal area were tiny, the enlargement of the medial canthus was obvious, and the double eyelid line in the medial canthal area was natural and smooth. The introduced method is simple in design and can preserve the original shape of the medial canthus while widening the palpebral fissure, which is a particularly suitable approach for epicanthoplasty in Asian patients. 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 .

Efficacy of double-eyelid plasty: a clinical analysis of 162 cases

Objective To discuss one double-eyelid surgery which is conformed to the anatomy characteristics of the asian upper eyelid. Methods A total of 162 cases were performed blepharoplasty for double eyelids, who aged 19 to 33 years with average 24.22±3.05 years, including 28 men and 134 women. Double eyelid line was designed according to the overall characteristics of eyebrows and eyes of beauty seekers combined with aesthetic standards. The surgery was performed to restore the anatomical characteristics of natural double eyelids as far as possible. Results The double eyelid surgery was designed and performed in 162 cases based on this method. All the patients underwent suture removal 7 days after operation, none of them had postoperative infection, and 15 patients had the bruising during the first week. After symptomatic treatment, the bruising had gone in 1 month. All the cases were followed up for more than six months postoperatively, and eight cases presented shallow double eyelid and the satisfactory results were achieved after the second operation of small incision. Conclusions The double-eyelid line should be designed individually before operation and the surgery done according to the natural characteristics of Asian upper eyelid. It will get coherent double eyelid without obvious scar or depression at resection margin, with high satisfactory rate. Key words: Esthetics; Blepharoplasty; Double lid blepharoplasty; Upper eyelid; Epicanthal folds

Biomechanics of double eyelid and clinical application in mild blepharoptosis

Objective To investigate biomechanical properties of double eyelid surgery and its clinical application in upper blepharoplasty. Methods In the mild ptosis correction combined with double eyelid surgery, the main force from levator was assigned to upper tarsus to open eyes. At the same time, not only it could ensure the enough height of palpebral fissure, but also had relatively stable and persistent double eyelid. For those who had sunken upper eyelid, were given fat transposition and/or autologous fat grafting. For those who had medial epicanthal fold, to achieve a pleasing eye appearance, we performed epicanthoplasty. Results After 6 months to 2 years of follow-up, 15 cases had unsatisfactory results and underwent secondary surgery. The revision reason was as follows: 7 patients had asymmetry double eyelid width, 3 patients had insufficient correction for ptosis, 2 patients had shallower and narrower double eyelid line. In 3 cases, the correction of the upper sunken was insufficient. The remaining 164 patients with mild ptosis were well corrected, and the double eyelid was stable and natural, and the results were satisfactory. There were no major complications. Conclusions During mild blepharoptosis correction combined with double eyelid surgery, reasonable treatment of the biomechanical balance has certain clinical significance for avoiding postoperative complications and improving the effect of double eyelid surgery. Key words: Blepharoptosis; Blepharoplasty; Biomechanics; Balance; Eyelid fissure height

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.

Repair Techniques for Failed Double-Eyelids Involving Restoration of Eyelid Anatomical Structure and Function.

This study aimed to evaluate techniques for repairing previously failed double-eyelid surgeries based on different anatomical structure injuries. A total of 120 patients with failed double-eyelids in our hospital were enrolled and classified into four types according to their anatomical structure damage: type I, unsmooth radians of the double-eyelid line; type II, upper socket depression; type III, iatrogenic ptosis; and type IV, comprehensive damage. Accordingly, methods of restoration included orbital septum fat supplement, repair of levator palpebrae superioris, and treatment of scar. Postoperative follow-up time points were 1week, 1month, and 6months. Outcome observations were binocular symmetry, fluency of double-eyelid, scar recovery, height and contour profile of the upper eyelid margin, and plumpness of the upper eyelid. The eyelid morphological score was evaluated using photographs of preoperative and 6-month postoperative data, and the effect of eyelid repair was evaluated objectively by statistical analysis. At 1month after surgery, the height of the upper palpebral margin was maintained in most patients and located at 1-2mm below the superior limbus. At 6months after surgery, most patients had better restorative effects. Comparison of mean eyelid morphological scores showed a statistically significant improvement following surgery (P < 0.001). The technique of restoring eyelid anatomical structure in failed double-eyelids not only recovered the normal function of injured eyelids but also produced satisfactory aesthetic 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 .

The Boomerang Epicanthoplasty: A Technique That Avoids Hooding.

Redraping is an increasingly common epicanthoplasty method. However, hooding usually remains at the medial part of the upper eyelid. The authors innovated a modification of redraping epicanthoplasty using excision, resulting in a boomerang-shaped defect that does not lead to hooding of the medial upper eyelid.Medial line (M-line) was drawn at the most medial point of the palpebral fissure. The canthus point (C-point) was marked approximately 1 to 3 mm laterally from the M-point, depending on the amount of widening needed. From the C-point, upper incision was designed to meet the double eyelid line. A V-shaped lower incision was designed 3 to 4 mm below the ciliary margin. A flap was elevated about 7 mm superiorly, 10 mm medially, and 5 mm inferiorly. The elevated skin flap was redraped and the M'-point, which reflected the M-point on the redraped skin, was marked. A curvilinear incision line reflecting previous incision lines was drawn. The crescent-shaped excess skin was excised and the medial canthus was retracted medially, and then the boomerang-shaped defect was observed. The M-point and M'-point were coapted with a suture. The dog-ear at the lower side was trimmed.The 525 patients were followed up for ≥3 months postoperatively. The average increase in the palpebral fissure length was 1.2 ± 0.5 mm. The average decrease in the interepicanthal distance was 2.4 ± 0.9 mm. The average satisfaction score was 4.6 ± 0.6.Boomerang epicanthoplasty can prevent hooding on the medial aspect of the upper eyelid. It is easy to design, requires marking only 1 point, and is tension-free, thereby reducing scar widening.

Clinical efficacy analysis of myocutaneous flap in blepharoplasty

To introduce the myocutaneous flap in blepharoplasty and summarize its clinical efficacy. Between January 2013 and March 2016, 1 560 patients underwent blepharoplasty with myocutaneous flap. Of them, 158 patients were followed up over 6 months and included in the study. There were 18 males and 140 females with the average age of 23.4 years (range, 18-35 years). The unilateral side was involved in 13 cases and bilateral sides in 145 cases. The patients had narrow double eyelid, shallow double eyelid, single eyelid, bloated upper eyelid, and upper eyelid skin relaxation. During operation, the tissue between the orbicular muscle of eye and the tarsus was trimmed layer by layer; the orbicularis oculi muscle, capillary network, and the front fascia of tarsus were retained, and the full-thickness skin, muscle, and the front fascia of tarsus were sutured by anatomical apposition. Incision healed at stage I. All patients were followed up 6 months to 2 years (mean, 8.3 months). During follow-up period, shallow or extinctive double-eyelid line was observed in 9 cases (12 eyes), and satisfactory results were achieved after trimming front fascia of tarsus and suturing. Good clinical results were obtained in the other patients, who had natural and coherent double eyelid without obvious scar or depression at resection margin. Myocutaneous flap for blepharoplasty has many advantages of fast recovery, little wound, light swelling, permanent effects, and good appearance.

A modified mini-incisional technique for double-eyelid blepharoplasty

Background Double-eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia. Objective To introduce a modified mini-incisional technique to form a double eyelid. Methods A total of 372 patients (325 women, 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years, with a mean age of 24 years. All patients underwent the modified mini-incisional upper blepharoplasty. In the technique, four 2 mm incisions were made along the designed fold. The orbicularis muscle overlying the levator aponeurosis was removed. The removal of the lateral fat pad was completed accordingly. The medial fat pad was also removed if necessary. Suture was used to fix the skin to pretarsal fascia along the double-eyelid line. The double-eyelid crease was formed after the operation. Results The follow-up period was three to 12 months (mean nine months). Most of the double eyelids were natural. During the follow-up period, 92% (342 of 372) patients were satisfied with the blepharoplasty. The most common complications were swelling within first week after the operation, which subsided spontaneously. Asymmetries occurred in 17 patients; six patients had multiple eyelids and seven patients experienced shifting of the fold. These were corrected six months after the operation. Disappearance of the fold was not observed. The scars of the stab incision became invisible after one full year of recovery. No other severe complications were found. Conclusion The four mini-incisional blepharoplasty technique was successful for the formation of a natural-appearing and long-lasting double eyelid. Except for individuals with obvious skin redundancy, patients with a single eyelid are suitable candidates for the technique.

Clinical effects of modified construction of double eyelid

Objective To explore the application of the part of the orbicularis oculi muscle above the cutting margin and the orbital septum fixed to pretarsal fascia in construction of double eyelid. Methods We selected 30 aesthetic seekers asking for construction of double eyelid. We fixed the part of the orbicularis oculi muscle above the cutting margin and the orbital septum to pretarsal fascia in double eyelid operation and then evaluated the surgical effects, complications and satisfaction. Results 30 cases were successfully operated in this group, and the operation time was 1.0±0.2 hour. Five days after operation, we removed upper eyelid skin suture and observed that wound healing was good and double eyelid line was natural and smooth. Postoperative follow-up of 1 to 6 months, the effects were satisfactory. Conclusions This method is simple and effective in producing a satisfactory eye shape. Key words: Orbital septum; Orbicularis oculi; Double eyelid blepharoplasty

A modified mini-incisional technique for double-eyelid blepharoplasty.

Double-eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia. To introduce a modified mini-incisional technique to form a double eyelid. A total of 372 patients (325 women, 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years, with a mean age of 24 years. All patients underwent the modified mini-incisional upper blepharoplasty. In the technique, four 2 mm incisions were made along the designed fold. The orbicularis muscle overlying the levator aponeurosis was removed. The removal of the lateral fat pad was completed accordingly. The medial fat pad was also removed if necessary. Suture was used to fix the skin to pretarsal fascia along the double-eyelid line. The double-eyelid crease was formed after the operation. The follow-up period was three to 12 months (mean nine months). Most of the double eyelids were natural. During the follow-up period, 92% (342 of 372) patients were satisfied with the blepharoplasty. The most common complications were swelling within first week after the operation, which subsided spontaneously. Asymmetries occurred in 17 patients; six patients had multiple eyelids and seven patients experienced shifting of the fold. These were corrected six months after the operation. Disappearance of the fold was not observed. The scars of the stab incision became invisible after one full year of recovery. No other severe complications were found. The four mini-incisional blepharoplasty technique was successful for the formation of a natural-appearing and long-lasting double eyelid. Except for individuals with obvious skin redundancy, patients with a single eyelid are suitable candidates for the technique.

Tarsodermal suture fixation preceding redundant skin excision: a modified non-incisional upper blepharoplasty method for elderly patients.

BackgroundNon-incisional blepharoplasty is a simple, less invasive method for creating a more natural-appearing double eyelid than classical incisional blepharoplasty. However, in aging patients, non-incisional blepharoplasty is not effective due to more severe blepharochalasis. Traditionally, incisional blepharoplasty is a common surgical method used for older patients, but blepharoplasty in elderly patients typically results in prolonged recovery times, and final blepharoplasty lines may be located in unintended or asymmetrical positions. Here, we introduce a new modified combination technique for geriatric blepharoplasty.MethodsA total of ten patients were treated from July 2010 through July 2012 using the combination method. First, we performed non-incisional blepharoplasty using tarsodermal fixation. Then, incisional blepharoplasty with additional elliptical excision of the upper eyelid skin was performed. We removed pretarsal tissue, fat, the orbicularis oculi muscle, and orbital fat. Telephone surveys were administered to all patients for follow-up. The questionnaire was composed of eight questions that addressed recurrence and satisfaction with aesthetics and the procedure.ResultsA total of nine patients (90%) responded to the telephone survey. All cases of moderate to severe blepharochalasia were corrected and there were no major complications. Patients who underwent blepharoplasty had higher satisfaction scores. All patients were satisfied with the postoperative shapes of their eyelids.ConclusionsThe advantages of the proposed technique include: ease of obtaining a natural-looking fold with symmetry at the desired point; reproducible methods that require short operation times; fast postoperative recovery that results in a natural-appearing double-eyelid line; and high patient satisfaction.