Two modified techniques to decrease complications of buried suture double-eyelid blepharoplasty

Misdiagnosis and Treatment of Corneal Complications Caused by Suture Exposure After Buried-Suture Double-Eyelid Blepharoplasty

PURPOSE

The purpose of this study was to summarize the misdiagnosis and treatment of corneal complications associated with suture exposure in cases of buried-suture double-eyelid blepharoplasty.

METHODS

This study retrospectively analyzed 14 patients with palpebral conjunctival and corneal complications due to suture exposure after buried-suture double-eyelid blepharoplasty at the First Affiliated Hospital of Harbin Medical University from January 2020 to July 2022. The patients' clinical symptoms included photophobia, lacrimation, pain, foreign body sensation, swelling of the eyelids, conjunctival hyperemia, secretion, etc. We recorded the patient's sex, age, surgical method, length of exposed suture, suture type, number of double-eyelid surgeries, surgical site, timepoint when eye discomfort occurred, misdiagnosed disease and treatment.

RESULTS

Three patients were misdiagnosed with dry eye, nine patients were misdiagnosed with viral keratitis, and two patients were misdiagnosed with allergic conjunctivitis. All 14 patients had manifestations of photophobia, lacrimation, pain, foreign body sensation and conjunctival hyperemia. Eight patients had manifestations of swelling of the eyelids. Five patients had manifestations of eye secretions. There were 8 patients with corneal epithelial injuries and 6 patients with corneal ulcers. All patients underwent suture removal without further progression. Ten patients were treated with artificial tears, and 4 patients were treated with calf serum deproteinized gel after suture removal.

CONCLUSION

If there is postoperative eye discomfort caused by eyelid and corneal complications in patients after buried-suture double-eyelid blepharoplasty, clinicians should carefully check whether there is suture exposure and determine the cause in a timely manner. Suture removal is the best way to treat this complication.

LEVEL OF EVIDENCE IV

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 .

Comparison of the Clinical Effect of Double Eyelid Blepharoplasty with the Orbital Septum Method and the Classical Method

OBJECTIVE

To observe the clinical effect between orbital septum incision and classical incision of double eyelid plasty.

METHODS

We retrospectively analyzed 381 patients who underwent double eyelid blepharoplasty in the Department of Plastic and Laser Cosmetology of Hunan Provincial People's Hospital from January 2019 to December 2019. The patients were divided into two groups according to different surgical methods: group A (n = 146) received the classical method and group B (n = 235) received the orbital septum method. The incidence of early postoperative complications, scar depression from 6 months to 1 year after the operation, the condition of 'meat strip' (the accumulation of soft tissue in front of the tarsal plate after double eyelid surgery, including skin, muscle, and fascia fat, results in a hypertrophic appearance of the upper eyelid) below the double eyelid line, and the symmetry of double eyelids were analyzed and evaluated.

RESULTS

The total number of early postoperative complications in group A was seven cases (incidence rate: approximately 4.80%), and the total number of early postoperative complications in group B was two cases (incidence rate: approximately 0.85%), with a statistically significant difference (P < 0.05). The degree of scar depression in group B was significantly lighter than that in group A from 6 months to 1 year after the operation (P < 0.05). The score of 'meat strip' below the double eyelid line in group B was significantly lighter than that in group A (P < 0.05). The symmetry of double eyelids in group B was better than that in group A (P < 0.05) CONCLUSION: Compared to the classical double eyelid method, the orbital septum method has the advantages of reducing early postoperative complications, reducing the severity of the scar, slighting the 'meat strip,' and improving symmetry, which results in higher postoperative satisfaction LEVEL OF EVIDENCE III: 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 https://www.springer.com/00266 .

Arcade Suture Upper Blepharoplasty Combined With the Forceps Technique

BACKGROUND

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Cause and Management of Suture-related Ocular Complications after Buried-suture Double-eyelid Blepharoplasty

BACKGROUND

Buried-suture double-eyelid blepharoplasty is very popular in Asia, especially in China, but there are few reports related to the cause, management, and prevention of suture-related complications of corneal injury and other damages to the eye. The study aims to determine the cause, management, and prevention of suture-related complications after buried-suture double-eyelid blepharoplasty.

METHODS

A retrospective study was conducted from January 2016 to January 2019 on 12 patients with corneal and other injuries to the eye after they underwent buried-suture double-eyelid blepharoplasty. The study included patients who underwent intermittent and continuous buried-suture double-eyelid blepharoplasty with the following symptoms: red eye, foreign body sensation, photophobia, pain, tears, and decreased vision. The clinical characteristics, examination method, and treatment were noted.

RESULTS

The patients were all females. Ocular injuries included: corneal epithelial punctate or diffuse injury in nine patients, corneal ulcer in two patients, and a perforating eye injury in one patient. The corneal injury was repaired after exposed nylon thread ends were removed. A suture on the surface of the eye penetrating the sclera was detected in one patient, who then had a vitrectomy caused by endophthalmitis.

CONCLUSION

Suture-removal surgery is indicated to treat suture-related complications. Less experienced clinicians should use an eyelid protection plate to protect the cornea and eyeball during surgery. The conjunctiva of the fornix should be examined after surgery. The clinician should inquire about the operation history in detail and check the conjunctiva of the fornix with an eyelid retractor to avoid misdiagnosis.

Complications of Asian Double Eyelid Surgery: Prevention and Management

Double eyelid surgery remains one of the most popular aesthetic surgeries, especially among East Asian populations. Complications related to double eyelid surgery can be divided into various categories: (1) patient dissatisfaction, (2) problems with the eyelid crease, (3) problems with the eyelid height, (4) suture-related complications, and (5) complications related to eyelid surgery in general. As with all eyelid surgeries, it is important to understand and appreciate the normal and abnormal function and anatomy of the Asian eyelid to reduce the risk of complications. It is also important to recognize the various complications and their underlying causes so that the surgeon can confidently revise the surgery to achieve optimal outcomes.

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

BACKGROUND

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.

METHODS

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.

RESULTS

The majority of patients achieved the expected cosmetic effect of double eyelid formation after the procedure. In the subsequent follow-up period of 2-30 months, no complications, such as loosing or sagging of the double eyelid or granuloma formation, occurred. The mean recovery time ranged between one and 6 weeks. The pre-operative margin reflex distance (MRD1) was 2.36 ± 0.61 mm, and the post-operative MRD1 was 3.72 ± 0.63 mm, (p < 0.001). The Wilcoxon signed rank test was used for nonparametric, paired comparisons.

CONCLUSIONS

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.

LEVEL OF EVIDENCE IV

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 .

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.

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

BACKGROUND

Non-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.

METHODS

A 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.

RESULTS

A 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.

CONCLUSIONS

THE 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.

Modified double-eyelid blepharoplasty using the single-knot continuous buried non-incisional technique

Background

Buried non-incisional double-eyelid blepharoplasty is a popular aesthetic procedure. Although various modified continuous suture techniques have been used to create a more natural appearance and to reduce downtime, complications such as loosening of the double fold, asymmetry, and foreign body reactions have been observed.

Methods

This study included 250 patients who underwent double-eyelid blepharoplasty between March 1997 and November 2012 using a modified single-knot continuous buried non-incisional technique. With 4 stab incisions in the upper eyelids, one of two needles loaded with double-armed 7-0 nylon was passed in one direction alternately through the dermis and the conjunctiva, while the other needle was passed subconjunctivally in the opposite direction. Both ends of the sutures were knotted within a lateral stab incision of the upper eyelids and were buried in the orbicularis oculi muscle.

Results

Most patients displayed satisfactory aesthetic results, and no significant complications occurred. There was no obvious regression of the double fold; however, 3 patients required reoperation to correct loosening of the fold on one side during the follow-up period. One patient presented with the suture knot subcutaneously, and the knot was removed in the clinic.

Conclusions

The modified single-knot continuous buried non-incisional technique is a simple and less time-consuming method for a durable double fold and provides satisfactory aesthetic results.