Double Eyelid Research Articles

Combined Sub-Brow Lift and Upper Blepharoplasty to Minimize the Supratarsal Fold Thickness and Lateral Hooding: A Concept and Review of Cases

Despite upper blepharoplasty being the most popular periorbital rejuvenation surgical procedure, in Asians with moderate to severe blepharochalasis, the occurrence of postoperative puffy supratarsal fold (double eyelid) and residual lateral hooding is not uncommon. A qualitative retrospective analysis of before and after photos of 268 cases of combined sub-brow lift and upper blepharoplasty was done. A substantial number of cases had satisfying supratarsal fold thickness and improvement in lateral hooding. A combined sub-brow lift and upper blepharoplasty is an effective method to reduce the supratarsal fold thickness and lateral hooding in Asians with moderate to severe blepharochalasis.

Tarsus-Orbicularis-Septum Fixation in Double-Eyelid Blepharoplasty: A Reliable and Flexible Technique.

PurposeIncisional double eyelid blepharoplasty is the most common cosmetic operation in East Asia. Although numerous articles on surgical techniques have been published, complications, such as fold loss, asymmetry, and visible scars, still exist. To create a stable and dynamic double-eyelid crease, the author has introduced a modified technique of double-eyelid blepharoplasty.Patients and MethodsThe authors introduced a new surgical technique to reduce complications and create reliable and dynamic double eyelids. The orbicularis oculi muscle of the lower flap was anchored on the tarsus and sutured with the distal part of the septal flap. The skin incision was closed by skin–septal flap–skin suture. Postoperative evaluations were assessed at the twelfth postoperative month.ResultsOne hundred ninety-three patients underwent double eyelidplasty with the TOS fixation technique. The mean follow-up duration was 18.6 months (range, 12–30 months). In the aesthetic outcome evaluation, 88 (45.6%) patients had very much improved results, 56 (29.0%) had much improved results, 29 (15.0%) had improved results, 8 (4.1%) had no change and 12 (6.2%) had worse results. Complications included crease asymmetry (n=7, 3.6%), partial fold loss (n=8, 4.1%) and complete fold loss (n =5, 2.6%).ConclusionTarsus-orbicularis-septum (TOS) fixation is a reliable and flexible surgical technique for creating stable and dynamic double-eyelid creases.

Ropivacaine and Lidocaine in Double Eyelid Blepharoplasty: A Comparative Analysis.

Double eyelid blepharoplasty is an operation of changing the structure of the eyelid and reshaping the eyelid to form a new upper eyelid fold. This prospective randomized controlled study aimed to compare and evaluate the effect of ropivacaine and lidocaine in double eyelid blepharoplasty. A total of 120 patients who underwent double eyelid blepharoplasty in the beauty department of our hospital from January 2019 to July 2021 were enrolled and randomized (1 : 1) into the control group (1% lidocaine-epinephrine mixture) and the study group (0.75% ropivacaine-epinephrine mixture) via the random number table method. The 0.75% ropivacaine-epinephrine mixture led to lower Wong-Baker FACES Pain Rating visual analog scale score from 2 h to 1 d after surgery versus 1% lidocaine-epinephrine mixture (all P < 0.05). The operation time, intraoperative anesthetic drug dosage, and intraoperative blood loss were similar in the two groups (all P < 0.05). The 0.75% ropivacaine-epinephrine mixture resulted in a lower postoperative swelling score, but a higher patient satisfaction score versus 1% lidocaine-epinephrine mixture (all P < 0.05). The safety profiles of the two groups were similar (all P < 0.05). Both lidocaine and ropivacaine produce desirable anesthesia effects in double eyelid blepharoplasty. Ropivacaine can significantly reduce postoperative pain and mitigate postoperative swelling, with better satisfaction, and is thus worthy of further promotion.

Blinking and upper eyelid morphology

PurposeTo explore blinking patterns and sagittal eyelid misalignment in the East Asian eye. MethodsForty-four participants (22 females; age 26 ± 5 years; 52% of East Asian ethnicity) were enrolled in this pilot study and subdivided, based on upper eyelid crease presence and extent, into single (n = 10), partial (n = 11) or double (n = 23) eyelid crease groups. Blinking was filmed surreptitiously with high-speed video simultaneously from an inferior temporal and frontal view. Spontaneous blink rate and type (incomplete, almost complete, or complete) were assessed over a 30 s period. Sagittal misalignment of the lids on closure was graded during complete spontaneous blinks, voluntary lid closure and voluntary maximal lid contraction (squeezing). A 0.15 µL drop of lissamine green was placed on the central lower lid margin and the number and type of blinks required to eliminate the drop informed complete palpebral apposition during blinking. ResultsMean ± SD blink rates averaged 16.9 ± 10.5 blinks/minute. The proportion of incomplete blinks was 83 ± 22% in single, 58 ± 35% in partial and 59 ± 30% in double eyelid crease groups. The sagittal misalignment of the lid margins during blinking was limited to approximately one-third of the lid margin width; this was similar for all lid morphologies and blink types. The lissamine green drop was eliminated only by voluntary maximal lid contraction, and was similar in all groups (p = 0.97). ConclusionsIncomplete blinking and sagittal lid misalignment of the central eyelid margin predominate in habitual blinking, irrespective of lid morphology.

A novel preoperative analysis method of upper blepharoplasty: Movable pulley concept.

Up to date, many surgical techniques have been introduced for upper eyelid rejuvenation. Despite those technical advances, little attention has been put on objective preoperative analysis methods. The current study introduces our simplified, versatile, and predictable upper eyelid analysis method for upper blepharoplasty patients. A total of 1509surgeries were performed from March 2017 to May 2021 using our preoperative analysis method. As a result of the operation based on this new analysis method, it was possible to individualize the plan according to the patient's needs and obtain satisfactory outcomes. Using our simplified, versatile, and predictable upper eyelid analysis method, we could counsel the surgical result with high predictability. In addition, it is a highly recommended method for beginners as it is easy to understand the mechanism of double eyelid surgery.

Usefulness of the eyeball exposure area as an eye measurement modality through a comparison between eyes with inborn double eyelids and operated double eyelids

Background Many Korean women with single eyelids wish to have their eyes enlarged through double eyelidplasty, and many of them also want to have additional procedures in order to have a larger perceived size of their eyes, with the desire for their eyes to resemble those with inborn double eyelids. Thus, in this study, we performed eye measurements and evaluated the usefulness of the eyeball exposure area to differentiate the overall eye size according to the nature of double eyelids (inborn or operated).Methods This study involved 92 eyes with natural double eyelids (group A) and 76 eyes with only double eyelidplasty (group B). The two groups were compared through measurements of the exposed eyeball area (EEA) and palpebral fissure height (PFH). To compare the usefulness of the EEA for the perceived eye size, the PFH value was also measured by adjusting it to a percentage value.Results The mean value of the PFH was 9.95±0.67 mm in group A and 8.48±1.04 mm in group B. The adjusted percentage value of the PFH relative to the corneal diameter (11.3 mm) was 88.05% in group A and 75.04% in group B. The EEA was 85.59%±3.25% in group A and 82.89%±6.36% in group B. The difference between the two groups was 13.01% in terms of PFH and only 2.7% in terms of EEA.Conclusions The values of PFH and EEA were higher in group A, but EEA was more useful for evaluating the perceived eye size between the two groups.

Review of complications in double eyelid surgery.

Double eyelid surgery is popular worldwide, especially in East Asia. Although double eyelid surgery seems simple, it comes with numerous complications. These complications can be divided into disordered complications and esthetic complications. Plastic surgeons pay more attention to the esthetic aspect. In our long-term clinical work, we have repeatedly observed that many patients with overactive facial muscles (frontalis muscle or corrugator supercilii muscle) often develop esthetic complications after surgery. These patients present with an appearance of a double eyelid fold that is either too high, too low, or absent. However, some plastic surgeons have not realized this, and most of them believe that esthetic complications are caused by improper techniques during surgery. Therefore, it is necessary for us to share our experience in this field with our peers.

Double Eyelid Shape Preference: A Large Sample Survey.

Double eyelid blepharoplasty is a popular procedure among Asian population. Double eyelid shape is important to achieving high satisfaction rate. Currently, there lacks large sample survey and detailed analysis on preferred double eyelid shape. This study aims to investigate the double eyelid shape preference using the "in-fold," "on-fold," and "out-fold" classification and analyze the preferred shape of different demographic groups. A large sample survey was conducted with a questionnaire of nine questions in three sections: demographic characteristics, desired double eyelid shape, and assessment of the classification. The preference for each type of double eyelid shape was analyzed and compared among different groups. A total of 11153 (9698 female and 1455 male) respondents finished the questionnaire, including 382 plastic surgeons. In-fold double eyelid was the most popular choice overall. Out-fold was the least preferred, except for specific groups such as actors and heavy makeup wearers. No significant difference was observed between the preference of patients and plastic surgeons. The majority of respondents cared much about postoperative double eyelid shape and considered the classification useful. In-fold was the most preferred double eyelid shape, especially for patients who met one or more of the following criteria: male, older than 40, divorced, or housewives. However, heavy makeup wearers or actors/actresses tend to prefer out-fold double eyelids. The "in-fold," "on-fold," and "out-fold" classification was precise and beneficial to doctor-patient communication. 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 .

Could routine forensic STR genotyping data leak personal phenotypic information?

The application of forensic genetic markers must comply with privacy rights and legal policies on a premise that the markers do not expose phenotypic information. The most widely-used short tandem repeats (STRs) are generally viewed as ‘junk’ DNA because most STRs are located in non-coding regions and therefore refrain from leaking phenotypic traits. But with a deepening understanding of phenotypes and underlying genetic structure, whether STRs could potentially reflect any phenotypic information may need re-examining. Therefore, we performed the following analyses. First, we analyzed the association between 15 STRs and three facial characteristics (single or double eyelid, with or without epicanthus, unattached or attached earlobe) on 721 unrelated Han Chinese individuals. Then, we collected 27199 individuals’ STRs and geographic data from the literature to investigate the association between STRs and bio-geographic information, and predict geographic information by STRs on additional 1993 unrelated individuals. We found that there was scarcely any association between STRs with studied facial characteristics. Although allele19 in D2S1338 and allele 18 in FGA (P = 0.0032, P = 0.0030, respectively after Bonferroni correction) showed statistical significance, the prediction effectiveness was very low. For the STRs and bio-geographic information, the principal component analysis showed the first three components could explain 87.7% of the variance, but the prediction accuracy only reached 25.2%. We demonstrated that the forensic phenotypes are usually complex traits, it is hardly possible to uncover phenotypic information by testing only dozens of STR loci.

Asian Upper Blepharoplasty with the Hinge Technique.

Asian upper blepharoplasty is one of the most commonly requested procedures in Asian patients. Many incisional and suture methods have been described in the literature. While the suture method is advantageous for its simplicity and quick recovery, the incision method is more versatile and able to deliver predictable and reproducible results for Asian patients presenting with a diverse range of anatomy and requests. Accordingly, the incision method remains the preferred approach for many surgeons performing Asian upper blepharoplasty. In this paper, we detail our open incision hinge upper blepharoplasty technique to create dynamic upper eyelid creases in Asian patients. The surgical videos associated with this paper present our surgical technique in detail, highlighting technical refinements and surgical nuances to perform the surgery precisely and predictably. The conceptual core of our approach is the use of a vascularized orbital septum as a flap to create a fibrous extension from the levator aponeurosis to the dermis at the location of eyelid crease. This vascularized flap securely connects the posterior lamella with the anterior lamella to securely form the eyelid crease with eye opening. This most accurately recreates the anatomy that is present in attractive Asian patients with naturally occurring double eyelid and predictably creates a dynamic and crisp upper eyelid crease. LEVEL OF EVIDENCE V: 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 .

Ocular phenotype related SNP analysis in Southern Han Chinese population from Guangdong province

Ocular phenotype is recognizable among Asians, including eyelid fold, fissure inclination, and canthal index. Here we screened 27 facial phenotype-associated SNPs and reported a preliminary study in 246 Chinese individuals of Han origin in Guangdong province. Results showed that rs17760296 could explain 6.2% of the eyelid fold variation and double eyelids were more likely to appear when one’s genotype was TT. With respect to the canthal index, rs4791774 and rs642961 were significantly associated with it. However, no individual SNP was associated with fissure inclination. We further constructed two models to predict eyelid fold and canthal index and evaluated them with receiver operating characteristic (ROC) curves and support vector machine (SVM) regression, respectively. The models showed a moderate-to-high predictive capacity (AUC = 0.75, sensitivity = 76%, and specificity = 72%) for the eyelid fold while a mild performance (R2 = 0.1074, MSE = 0.0005, P-value = 0.024) for the canthal index. In conclusion, our study indicates that rs17760296 could be selected into the facial phenotype prediction system for the Southern Han Chinese population. More SNPs are encouraged to improve the prediction accuracy of the canthal index besides rs4791774 and rs642961.

Unilateral Orbital Lipoma in Young Woman Occurred 5 Years after Autologous Fat-graft

Purpose: To report a case of unilateral orbital lipoma in a 22-year-old woman after an autologous fat graft.Case summary: A 22-year-old woman visited our clinic with the chief complaint of persistent ptosis of the left upper eyelid for 6 months. Five years prior, she had undergone double eyelid surgery on both eyes, in which autologous fat grafting was performed. She had experienced swelling of the left upper eyelid that began 6 months prior to her visit. Examinations of her visual acuity, intraocular pressure, pupil reflex, extraocular movement, and fundus revealed no abnormal findings. Sagittal images from orbital contrast computed tomography scans revealed a translucent lesion in the posterior space of the orbital septum of the left upper eyelid. Histological examination of excisional biopsy specimens showed mature adipose cells surrounded by a fibrous capsule. The patient remained disease-free at the 3-month follow-up.Conclusions: Lipoma can occur both during and after autologous fat grafting. It is important that the patient is well-informed of this issue before surgery and that the appropriate treatment is provided when it occurs.

Impact of Single Eyelid on Superior Visual Field.

A puffy eyelid without a crease, also known as single eyelid, is a common characteristic in East Asians. Existence of a lid crease is generally considered an aesthetic concern for both patients and surgeons, and postoperative evaluations have mainly focused on the appearance of the eye. The aim of this study was to clarify the functionality of the superior visual field (SVF) with single eyelid.This prospective cohort study compared edge of the upper eyelid to central corneal light reflex distance (edge reflex distance [ERD]) preoperatively and postoperatively and examined the SVF, as measured by Goldmann perimetry, in single-eyelid patients who underwent blepharoplasty.Twenty patients (40 eyelids) with a median age of 21 years were examined. The median preoperative and postoperative ERDs were 1.45 and 3.4 mm, respectively. The median areas of the SVF preoperatively and postoperatively were 34,443 and 50,796 degrees2, respectively. Although a positive correlation existed between preoperative ERD and SVF, no correlation was observed between postoperative ERD and SVF.The SVF of the single eyelid is narrower than that of the double eyelid, even under circumstances of equivalent palpebral fissure height. The single eyelid commonly found in East Asian populations is associated with both cosmetic and functional issues.

Arcade Suture Upper Blepharoplasty Combined With the Forceps Technique.

Double-eyelid blepharoplasty is the most popular cosmetic surgery in Taiwan. The creation of a small palpebral fold along with reduction of eyelid fullness makes the eye look slightly larger, thereby leading to an appearance of youthfulness, alertness, and vitality. Herein, we propose a method of combining the techniques of arcade buried suture and forceps, which is designed to create a more physiologically natural double eyelid. We conducted a retrospective review of 45 patients who underwent double-eyelid surgery between December 2015 and December 2019. The procedures were performed by one senior surgeon using arcade suture upper blepharoplasty combined with the forceps technique. The patients' age ranged from 18 to 38 years (mean, 28 years). Ninety-one percent of the patients were women and were undergoing surgery for cosmetic reasons. Of the 45 patients who underwent arcade suture upper blepharoplasty with the forceps technique, no patients developed stitch abscess or granuloma, obvious asymmetry, disappearance of line, chemosis, and corneal injury. The follow-up period ranged from 3 months to 4 years (mean, 32 months). Patient satisfaction was very high. The arcade suture upper blepharoplasty combined with the forceps technique is a simple method for establishing a durable double eyelid without serious complication and providing excellent results.

Review: Crying in H Mart: A Memoir, by Michelle Zauner

Review: <i>Crying in H Mart: A Memoir</i>, by Michelle Zauner

Simultaneous Double Eyelid Blepharoplasty and Blepharoptosis Correction With Levator Aponeurosis Plication Technique: Clinical Experience of 108 Cases.

Fifty percent of Asians are born without a supratarsal fold (also called single eyelid), and double eyelid blepharoplasty is one of the most commonly performed and most popular facial cosmetic surgeries in the Asian population. However, patients with single eyelid frequently present with concomitant mild blepharoptosis (degree of ptosis, ≤2 mm), which often fails to cause the attention of surgeons and misses correction. A retrospective study of all patients who underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique was performed from June of 2017 to June of 2020. A total of 108 patients (155 eyelids) underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique and were enrolled in the study. The average follow-up period was 11.8 ± 4.5 months. There was a statistically significant difference between the preoperative margin reflex distance 1 (MRD1) and postoperative MRD1 (2.93 ± 0.37 vs 4.21 ± 0.39 mm, P = 0.000), and the mean MRD1 improvement was 1.28 ± 0.50 mm. Sufficient correction was obtained in 148 eyelids (95.5%), whereas undercorrection was observed in 5 eyelids (3.2%) and overcorrection was observed in 2 eyelids (1.3%). One hundred two patients (94.4%) were completely satisfied with the final result.All patients had smooth and elegant upper eyelid margin curve, and no patients complained of distortion of the eyelid margin contour and foreign body sensation.There were no cases of hematoma, infection, suture exposure, corneal abrasion, and keratitis in any patient. This modified levator aponeurosis plication introduced in this study is a simple and effective method for creating double-eyelid crease and correcting mild blepharoptosis simultaneously, and provides a satisfactory outcome. As such, we recommend this method in treating patients with both single eyelid and mild blepharoptosis.

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 &lt; 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 &lt; 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.

Autologous Fine Particles Fat Filling Under Direct Vision in the Repair of Sunken Upper Eyelid After Double Eyelid Surgery.

To explore the clinical effect of filling the preaponeurotic fat with autologous fine particles fat under direct vision to correct the sunken upper eyelid after double eyelid surgery. From June 2017 to May 2020, 134 cases of sunken upper eyelid after double eyelid surgery were treated by sharp needle injection of autologous fine particles fat under direct vision, and the surgical effect of each case was analyzed and evaluated. The sunken upper eyelid was corrected, the appearance was satisfactory, the shape was in good state, and there was no lump and obvious displacement of the transplanted fat. And in the sunken upper eyelid group after double eyelid surgery, 5 patients had severe upper eyelid adhesions and lost plenty of preaponeurotic fat; among them, 4 patients underwent secondary repair surgery, and one did not. The sharp needle injection method of filling autologous fat in the preaponeurotic fat under direct vision can accurately correct the sunken upper eyelid and replenish the preaponeurotic fat. The positioning is accurate, the filling amount is easy to control, and the transplanted fat particles survive well. 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 and Safety Analysis of Mini-incision Degreasing and Minimally Invasive Double Eyelid Surgery with Partial Thread Embedding in the Treatment of Patients with Asymmetric Double Eyelid

Objective: To analyze the effect of mini-incision degreasing and minimally invasive double eyelid surgery with partial thread embedding in the treatment of patients with asymmetric double eyelid. Methods: A total of 122 patients with asymmetric double eyelid treated in our hospital from February 2020 to February 2021 were selected as the research objects, and divided into a study group and a control group according to the Excel random function method, with 61 cases in each group. The control group received traditional blepharoplasty by incision method, and the study group received mini-incision degreasing and minimally invasive double eyelid surgery with partial thread embedding. The surgical indicators (operation time, postoperative healing time, intraoperative blood loss), complications and aesthetic satisfaction were statistically compared between the two groups. Results: The postoperative healing time of the study group was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group (P<0.05). The aesthetic satisfaction of the research group was 98.36% higher than that of the control group 86.89% (P<0.05). Conclusion: Mini-incision degreasing and minimally invasive double eyelid surgery with partial thread embedding in the treatment of patients with asymmetric double eyelid can improve the healing time and intraoperative blood loss, improve aesthetic satisfaction, and reduce the incidence of complications.

五点式眶隔法全切重睑术的临床应用

五点式眶隔法全切重睑术的临床应用