Double Eyelidplasty Research Articles

Epicanthoplasty with double eyelidplasty incorporating modified Z-plasty for Chinese patients

Blepharoplasty, without correction of the epicanthal folds, weakens the aesthetic appearance of the results. Hence, a modified Z-plasty procedure with double eyelidplasty was carried out for different degrees of epicanthus. From 2005 to 2010, the authors performed epicanthoplasties using the modified Z-plasty and double eyelidplasty for 322 Chinese patients. The conventional double eyelidplasty incisions were made with conterminous modified 'Z' formation on the medial canthus as well as cutting off the malpositioned superficial head of preseptal musculus orbicularis oculi. Epicanthoplasty, using this technique, showed good results in most cases. There were no recurrences of the epicanthal fold and the scars were inconspicuous. The modified 'Z' plasty is indicated for all types and degrees of medial epicanthi, except epicanthus inversus. The easy design and operation, and the excellent and reproducible results satisfy both the plastic surgeons and the Chinese patients.

Application of mini-incision combined with buried suture in double eyelid plasty

Objective To explore the advantage of the mini-incision doubling eyelid operation comparied with buried suture method.Methods 201 single eyelid cases were randomly divided into 2 groups:group A(101 cases)using mini-incision doubling eyelid operation,and group B(100 cases)using the double eyelid plasty with buried suture.Their effect was comparied.Results 157 cases were received postoperative follow-up.Group A(81 cases)contained 45 thin eyelids and 36 thick eyelids.Group B(76cases)included 32 thin eyelids and 44 thick eyelids.The postoperative follow-up for 1 month revealed that there was no statistically significant difference in the rate of satisfaction between group A and group B among the thin eyelid patients(P＞0.05).But statistic difference was found between A and B group among the thick eyelid patients(P＜0.05).The follow-up period for group A and group B was in the range of 2.5 to 3.5 years.The maintenance-well rate between the thin eyelid and the thick eyelid patients in both groups was significantly different(P＜0.05).Conclusion The mini-incision doubling eyelid operation is superior to the double eyelid plasty with buried suture in the rate of postoperative satisfaction and long-term effect.It is deserved to have more applications. Key words: Doubling eyelid operation; Mini-incision; Plasty with buried suture

A New Z-Epicanthoplasty and a Concomitant Double Eyelidplasty in Chinese Eyelids

A New Z-Epicanthoplasty and a Concomitant Double Eyelidplasty in Chinese Eyelids

Double eyelid blepharoplasty incorporating epicanthoplasty using Y-V advancement procedure

Ethnic characteristics of the Asian upper eyelid include the lack of a superior palpebral fold, excessive fat, laxity of pretarsal skin, and medial epicanthal fold. Historically, these features have characterised a unique beauty in Asians. With the increase of cultural exchange, the sense of beauty has changed greatly among Asians and most Asians regard eyes with double eyelids as beautiful. Therefore, surgical creation of a superior palpebral fold (so-called double eyelidplasty) has become the most common cosmetic operation in Asia. However, the presence of an epicanthal fold weakens the aesthetic results of the operation. The size of the epicanthal fold in Asians, whilst varying widely among individuals, is usually relatively small, and thus aesthetically successful effacement rarely requires more complex procedures as performed in the West. The incision for epicanthoplasty should therefore be as simple as possible and be confined to the eyelid area. From October 2001 to May 2006, Y-V advancement procedure for epicanthoplasty was used in combination with double eyelid surgery in 92 cases. Most of the patients attained satisfactory results. There were few complications in our series. A hypertrophic scar was recorded in three early cases and faded within 2 to 3 months with satisfactory results. This procedure is simple and more suitable for people of oriental origin.

A New Z-Epicanthoplasty and a Concomitant Double Eyelidplasty in Chinese Eyelids

Patients with no double eyelid folds and with a mild or moderate medial epicanthus are most typically Asians. After only receiving double eyelidplasty, they often complain that their eyes look round and their eyelid fissures are shorter because their medial epicanthi still exist. In this article, according to the authors' surgical findings, it is reasoned that the malpositioned portion of the orbicularis oculi muscle fibers is the main cause of congenital medial epicanthus. Several design principles for performing the Z-epicanthoplasty concomitant with a double eyelidplasty were advanced: (1) removal of the main deformity-formed cause, (2) correcting the pretarsal skin shortage in the medial upper eyelid, (3) preventing the prominent scarring in the medial canthal area, and (4) achieving other advantages (i.e., easy design and operation, precision of performance with a concomitant double eyelidplasty, and excellent and reproducible results). Epicanthoplasty only was performed in six patients. An epicanthoplasty concomitant with a double eyelidplasty was performed in 230 cases with congenital or traumatic medial epicanthi. Sixty-seven cases in this series were followed up for 4 to 23 months (average, 7 months). The contours of the double eyelids were natural. Mild scar proliferation was observed in all of the patients in the early postoperative period and then would diminish and become a gray-white line. Some skin wrinkles and skin shadow on the B flap could be seen. The indications for this procedure are all types of medial epicanthi but the inversus type. Older age is a relative contraindication.

Refinement of double eyelidplasty in Asian patients: Attachment of the septoaponeurotic union to the pretarsal dermis

Background: Standard approaches for creating a double eyelid in Asian patients may cause hematoma, asymmetry, early release of the fold, or an unsatisfactory appearance. Objective: We report an approach to creating a double eyelid based on integration of the septoaponeurotic union into the dermis of the pretarsal skin. Methods: A preoperative design was drawn with the patient in the supine and sitting positions, with the fold level always located 8 to 10 mm from the lid margin. An incision was made and deepened by removal of a narrow strip of the orbicularis muscle until the anterior orbital septum was identified. The entire length of the anterior orbital septum was opened, and a dissection was performed along the avascular plane between the orbital fat and the posterior orbital septum. The septoaponeurotic union was sutured to the lower edge of the incised pretarsal dermis. The levels of the double-fold line were checked with the patient in the supine and sitting positions. Results: Results in a series of 610 patients treated between March 1996 and March 1999 were satisfactory. Complications included a 2% rate of diminution of the double fold occurring in patients treated early in the series, probably caused by loose sutures between the septoaponeurotic union and the lower edge of the incised pretarsal skin. In 10 patients, the fold line was asymmetric or too high. All patients with complications were treated successfully by reoperation with use of the same technique. Conclusions: Creation of a double eyelid through attachment of the septoaponeurotic union to the pretarsal dermis can provide a secure double eyelid with a more aesthetic appearance. ( Aesthetic Surg J 2002;22:154-161.)

Anchor epicanthoplasty combined with out-fold type double eyelidplasty for Asians: do we have to make an additional scar to correct the Asian epicanthal fold?

The epicanthal fold along with a lack of a superior palpebral fold, excessive fat, and laxity of pretarsal skin represent the ethnic characteristics and a traditional sense of beauty in the Asian upper eyelid. But, too prominent an epicanthal fold may ruin an otherwise beautiful eye; furthermore, it becomes a restriction that makes the out-fold type double eyelidplasty, one of the two main types of double eyelidplasty, impossible. If a double eyelid as an out-fold type is desired, a concomitant epicanthoplasty should be performed with the possibility of hypertrophic scarring of the medial canthal area in Asians. To address the Asian epicanthal fold without danger of hypertrophic scarring, the authors developed an anchor epicanthoplasty technique that leaves no additional scar when combined with a double eyelidplasty. This technique is based on the concept of trimming of muscle and soft tissue under the Asian epicanthal fold and downward medial advancement and anchoring of the medial canthal skin to the deep tissue. The technique consists of five procedures based on the assumed causes of the Asian epicanthal fold: (1) augmentation rhinoplasty, (2) downward medial advancement of the medial upper lid skin, (3) removal of the superficial insertion of the medial canthal ligament and selective removal of the orbicularis oculi muscle, (4) subcutaneous contouring of the thick nasal skin, and (5) anchoring of the medial end of the incision to the deep tissue. During the past 12 years (1988 to 1999), 67 anchor epicanthoplasty procedures have been performed. Twenty-eight cases were followed up for more than 3 months, and all of the patients were satisfied with the results. There were only a few minor complications, which could be corrected with minimal revision. As an ancillary procedure to a double eyelidplasty, this anchor epicanthoplasty can reduce the Asian epicanthal fold and make a double fold as an out-fold type without an additional scar. In terms of hypertrophic scarring and compatibility with out-fold type double eyelidplasty, this anchor epicanthoplasty is the best method for correcting Asian epicanthal fold compared with other preexisting procedures. Other advantages of this technique are a wide range of applications and no compromise of medial, canthal skin to interfere with other epicanthoplasty techniques. Some disadvantages of this technique are technical difficulty and the possibility of active bleeding.

The significance of fascial tissue of the upper eyelid in double eyelidplasty. (Chinese)

The significance of fascial tissue of the upper eyelid in double eyelidplasty. (Chinese)