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He Z, Gu X, Chen L, Liu W, Yi Y, Yang J. Clinical Efficacy of Bionic Blepharoplasty Using the Flexible Suspension and Semiflexible Suspension Double-Insurance Methods. J Craniofac Surg 2024:00001665-990000000-01910. [PMID: 39258914 DOI: 10.1097/scs.0000000000010614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/07/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVE To investigate the clinical effect of the double insurance method of flexible suspension and semiflexible suspension in bionic blepharoplasty. METHODS 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 2 mm 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Zhigang He
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Xianbin Gu
- Hongdu Hospital of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lisha Chen
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Wenjing Liu
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Yangyan Yi
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Juanmin Yang
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanchang University
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Zhou L, Liu L, Yang J, Cao Z, Fan J, Tian J, Yang Z, Gan C, Jiao H, Zeng Y. Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach in Double-Eyelid Blepharoplasty Revision. Aesthetic Plast Surg 2024; 48:835-841. [PMID: 37991537 DOI: 10.1007/s00266-023-03731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Incisional double-eyelid blepharoplasty is the main surgical technique to obtain an artificial crease. Postoperative complications decrease patients' satisfaction, and patients with prominent depressed groove and persistent pretarsal swelling (sausage phenomenon) usually need revision surgery. To resolve the sausage phenomenon after blepharoplasty, we adopt Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach to create natural double eyelids. METHODS We included 68 patients in the study. The inclusion criteria for revision surgery were as follows: (1) pretarsal OOM remained after primary surgery, (2) prominent depressed surgical scar/groove and persistent pretarsal bulge (sausage phenomenon), (3) postsurgical abnormally wide crease. The surgical procedure involved releasing the pretarsal OOM, forming OFOOM-OOM flap, and OFOOM-OOM flap fixed with aponeurosis. Outcome observations were assessed using the FACE-Q questionnaire, and the follow-up period ranged from 6 to 36 months (mean=18 months). RESULTS The depressed groove and pretarsal bulge showed significant improvements, and FACE-Q scores of the 68 patients before surgery (mean scores=66) compared with those after surgery (mean scores=90) were significantly different (P<0.01). Four patients with palpebral fold asymmetry and two patients with shallow eyelids received revision surgery, and patients were satisfied with the secondary surgery effects. Six patients presented with unnatural curves of folds and revision surgery alleviated these situations. CONCLUSIONS Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach is an effective way to resolve the sausage phenomenon. The OFOOM-OOM flap is a reliable and flexible structure to create natural double eyelids. 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 .
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Affiliation(s)
- Lu Zhou
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Liqiang Liu
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China.
| | - Jifan Yang
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zilong Cao
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jincai Fan
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jia Tian
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zengjie Yang
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Cheng Gan
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Hu Jiao
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Yan Zeng
- Cicatrice Treatment Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
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Lu X, Ye Y, Qian Y. A Modified Double-Eyelid Blepharoplasty: Tarsus Linkage Mechanism. Aesthetic Plast Surg 2023; 47:2440-2446. [PMID: 37386262 PMCID: PMC10784336 DOI: 10.1007/s00266-023-03444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/27/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Double-eyelid blepharoplasty is the most popular plastic surgery in East Asia. The incisional methods are divided into two schools. The traditional method produces a stable eyelid, but will leave a postoperative scar. The other is represented by "Park," creating dynamic double-eyelid technology. Its advantage is that there is only mild scarring, but its disadvantages are asymmetry, corneal exposure, and loss of the palpebral furrow. Due to these various complications, we here propose an improved incisional blepharoplasty with the tarsus linkage mechanism. METHODS This work covers 482 patients who underwent surgery from March 2018 to March 2022. All patients completed 6 months of postoperative follow-up. The basic procedure described here involves removing the pre-tarsal tissue without completely incising the orbicularis and suturing the orbicularis and the tarsus into a unit. This connection provides a more robust and stable eyelid adhesion. RESULTS As reported by physicians, 412 patients (85.5%) had satisfactory results, 69 patients (14.3%) had somewhat satisfactory results, and 1 patient (0.2%) had unsatisfactory results. As reported by the patients, 424 patients (88.0%) were satisfied, 57 patients (11.8%) were somewhat satisfied, and 1 patient (0.2%) was unsatisfied. CONCLUSION This study proposes a modified double-eyelid blepharoplasty with the tarsus linkage mechanism. It is suitable for most primary eye cases, particularly in patients with lax upper lid skin and high levels of upper orbital fat. 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 .
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Affiliation(s)
- Xin Lu
- Department of Ophthalmology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, 315000, Zhejiang, People's Republic of China.
| | - Yunyan Ye
- Department of Ophthalmology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Yuxian Qian
- Ya Su Medical Beauty Clinic, Ningbo, 315000, Zhejiang, People's Republic of China.
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The Adherence of Skin and Levator Palpebrae Superior Is Not Necessary in Blepharoplasty of Asian Patients. Plast Reconstr Surg Glob Open 2023; 11:e4732. [PMID: 36699225 PMCID: PMC9833451 DOI: 10.1097/gox.0000000000004732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023]
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Chen B, Ma L. Small-incision, mini-dissection, orbicularis-preservation, and orbicularis-levator aponeurosis fixation technique: A modified partial-incision double-eyelid blepharoplasty. J Plast Reconstr Aesthet Surg 2023; 76:308-313. [PMID: 36428197 DOI: 10.1016/j.bjps.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/25/2021] [Accepted: 10/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The partial-incision double-eyelid surgery remains a popular esthetic procedure in Asia, most of the previous partial-incision double-eyelid operations involved resection of the pretarsal orbicular muscle, resulting in a depressed and firm eyelid crease. In order to create a more natural, dynamic, and durable double-eyelid crease with less visible scar and shorter postoperative recovery time, we describe a modified small-incision, mini-dissection, orbicularis-preservation, and orbicularis-levator aponeurosis fixation technique for Chinese patients. METHODS A total of 132 patients who underwent bilateral modified partial-incision double-eyelid surgery were retrospectively reviewed. In this technique, three 2 mm incisions were designed, the orbicularis oculi muscle was preserved and conservatively dissected to expose the levator aponeurosis, and buried suture was used to fix the orbicularis oculi muscle to levator aponeurosis. The skin and orbicularis oculi muscle were then sutured together with the levator aponeurosis. RESULTS With a follow-up period of more than 6 months, most of the double eyelids were natural and dynamic, and the crease was stable. The majority of the swelling faded in 2 weeks and completely faded in the first month for most patients. The scars of the small incision became invisible after 3 months of recovery. One patient (0.8%) complained of bilateral fold disappearance. Asymmetries occurred in 4.5% (6 of 132) patients. 97.7% (129 of 132) patients were satisfied with the postoperative appearance. No severe complications were reported during the follow-up period. CONCLUSION The modified small-incision, mini-dissection, orbicularis-preservation, and orbicularis-levator aponeurosis fixation double-eyelid blepharoplasty technique can create a more natural, dynamic, and durable double-eyelid crease with fast recovery and no visible scar or serious complications.
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Affiliation(s)
- Bo Chen
- Plastic Surgery Department, China Japan Friendship Hospital, Beijing, China.
| | - Li Ma
- Plastic Surgery Department, China Japan Friendship Hospital, Beijing, China
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Pan E, Wang BL, Zhang SC, Yu JG, Chen Y, Liu ZH. Re-positioning pretarsal tissue layers for double-eyelid surgery: 6-year experience. Medicine (Baltimore) 2022; 101:e30409. [PMID: 36107593 PMCID: PMC9439816 DOI: 10.1097/md.0000000000030409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Double-eyelid surgery is a very common practice in East Asian patients. The differential distribution of pretarsal tissue layers is considered to be the anatomical mechanism of natural Asiatic single eyelid, it is possible to form double-eyelid crease by re-positioning the pretarsal structure layers. The author presents a new double-eyelid surgery based on re-positioning of the pretarsal structure layers without tissue removal. Over a 6-year period, 1440 patients underwent new double-eyelid surgeries. With the pretarsal orbicularis oculi muscle incised, the pre-pretarsal levator aponeurosis fascia fibroadipose was first dissected to form a fibroadipose flap, and then repositioned with the eyelid lower lip orbicularis oculi muscle flap. The new composite structure was anchored at 3 points on the pretarsal levator aponeurosis fascia; the skin was sutured to form a smooth crease. Post-operative outcome and follow-up data were analyzed. Patients were followed up for an average of 2 years. esthetic outcomes were satisfactory for 97.91% of patients, who enjoyed new double upper eyelids with smooth creases and invisible incision lines. Outcomes were unsatisfactory for 2.08% of patients (double-eyelid regression, 0.76%; asymmetric creases, 1.32%). All patients who were not satisfied with their esthetic outcomes underwent second correction surgery. This new Pan-flap technique focuses on the correct dissection and repositioning of differentially thickened pre-pretarsal levator aponeurosis fascia fibroadipose tissue in East Asian patients. This new technique can generate broader and tighter attachment between pretarsal orbicularis oculi muscle and levator aponeurosis fascia, and form smooth double-eyelid crease without pretarsal soft tissue removal.
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Affiliation(s)
- Er Pan
- Department of Aesthetic Plastic Surgery, Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital, Guangzhou, China
- Aesthetic Medical School, Yichun University, Yichun, China
- *Correspondence: Er Pan, Department of Aesthetic Plastic Surgery, Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital, 5 Tianyuan Road, Guangzhou, Guangdong, China and Aesthetic Medical School, Yichun University, 576 Xuefu Road, Yichun, Jiangxi, China (e-mail: )
| | - Bu-Lin Wang
- Department of Aesthetic Plastic Surgery, Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital, Guangzhou, China
| | - Sheng-Chang Zhang
- Department of Aesthetic Plastic Surgery, Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital, Guangzhou, China
| | - Jian-Gang Yu
- Department of Aesthetic Plastic Surgery, Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital, Guangzhou, China
| | - Yi Chen
- Aesthetic Medical School, Yichun University, Yichun, China
| | - Zhi-Hong Liu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou, China
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Sun Y, Liu R, Yu N, Zhang D, Chen J, Huang J, Long X. Tarsus-Orbicularis-Septum Fixation in Double-Eyelid Blepharoplasty: A Reliable and Flexible Technique. Clin Cosmet Investig Dermatol 2022; 15:1125-1132. [PMID: 35761857 PMCID: PMC9233541 DOI: 10.2147/ccid.s367202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 12/05/2022]
Abstract
Purpose Incisional 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 Methods The 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. Results One 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%). Conclusion Tarsus-orbicularis-septum (TOS) fixation is a reliable and flexible surgical technique for creating stable and dynamic double-eyelid creases. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/boWOhOeVnJA
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Affiliation(s)
- Yixin Sun
- Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Runzhu Liu
- Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Nanze Yu
- Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Dingyue Zhang
- Department of Clinical Medicine, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Juan Chen
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Jiuzuo Huang
- Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiao Long
- Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Wang Y, Sun G, He Y, Zhou K, Zhu L. Octopus-inspired sucker to absorb soft tissues: stiffness gradient and acetabular protuberance improve the adsorption effect. BIOINSPIRATION & BIOMIMETICS 2022; 17:036005. [PMID: 35235920 DOI: 10.1088/1748-3190/ac59c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Rigid suckers commonly used in surgical procedures often cause absorption damage, while their soft counterparts are difficult to handle due to their weak anchoring. Alternatively, the octopus sucker is both soft and has strong suction power. Further observation revealed that its structure is self-sealing and that the tissues are layered in hardness. Inspired by said structure and the characteristics of associated materials, a bionic soft sucker with stiffness gradient and acetabular roof structure was proposed, made of silicone with varying hardness including structures such as acetabular roof and circle muscles. The automatic tensile force measurement system was used to experimentally analyze the adsorption performance of the suckers to the soft curved contact surface. Both dry and wet conditions were tested, along with practical tests on organisms. The bionic sucker adsorption force was increased by 25.1% and 34.6% on the cylindrical surface, and 45.2% and 7.3% on the spherical surface for dry and wet conditions, respectively. During the experiment, the bionic suckers did not cause notable suction damage to the contact surfaces. Thus, this type of bionic sucker shows good application prospects in the field of surgery.
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Affiliation(s)
- Yi Wang
- Beijing Engineering Research Center of Optoelectronic Information and Instruments, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
- Bionic and Intelligent Equipment Lab, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
| | - Guangkai Sun
- Beijing Engineering Research Center of Optoelectronic Information and Instruments, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
- Bionic and Intelligent Equipment Lab, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
| | - Yanlin He
- Beijing Engineering Research Center of Optoelectronic Information and Instruments, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
- Bionic and Intelligent Equipment Lab, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
| | - Kangpeng Zhou
- Beijing Engineering Research Center of Optoelectronic Information and Instruments, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
- Bionic and Intelligent Equipment Lab, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
| | - Lianqing Zhu
- Beijing Engineering Research Center of Optoelectronic Information and Instruments, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
- Bionic and Intelligent Equipment Lab, Beijing Information Science and Technology University, Beijing 100192, People's Republic of China
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Mini-Incision Eyelidplasty in Single Eye to Correct Congenital Upper Eyelid Crease Asymmetry. J Craniofac Surg 2021; 32:2528-2531. [PMID: 34183636 DOI: 10.1097/scs.0000000000007734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the clinical effect of mini-incision double eyelidplasty in single eye for correcting congenital upper eyelid crease asymmetry. METHODS Mini-incision double eyelidplasty was performed on 24 patients in single eye to treat congenital upper eyelid crease asymmetry between May 2016 and September 2018. The postoperative surgical results were classified as "excellent," "fair," and "poor." The subjective satisfaction and incidence of complications were documented. RESULTS The mean patient age at the time of surgery was 24.6 ± 3.1 years (21-28 years), and the mean follow-up time was 15.4 ± 8.7 (12-34 months). All patients showed "excellent" surgical outcomes according to symmetry of upper eyelid creases. All patients are "very satisfied" with the cosmetic outcomes. There were no cases of recurrence or other complications. CONCLUSIONS Mini-incision double eyelidplasty method in single eye was effective and endurable in the treatment of congenital upper eyelid crease asymmetry. The recovery rate was fast, and no cases of upper eyelid crease disappearance were observed in this study.
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Fu X, Zhou X, Sun D, Gu C. A Composite Tissue Flap for Double-Eyelid Blepharoplasty in Asian Patients: A Retrospective Study. J Craniofac Surg 2021; 32:2508-2511. [PMID: 33770031 DOI: 10.1097/scs.0000000000007642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Double-eyelid blepharoplasty, the procedure to create supratarsal crease, has been one of the most popular cosmetic operations in Asia for many years. This study aimed to assess the effectiveness and safety of a surgical procedure using a composite tissue flap for double-eyelid blepharoplasty. A surgical technique was introduced and patients having blepharoplasty with this technique from January 2017 to August 2019 were retrospectively studied. In this technique, a composite tissue flap consisted of the posterior septum and levator aponeurosis was formed and fixed with orbicularis oculi muscle and tarsus. The cosmetic outcomes, patient satisfaction, and complications from the documented medical records were analyzed. Eighty female and 1 male patients had blepharoplasty with the proposed technique and were followed up from 6 months to 42 months. Six patients were found to have mild blepharoptosis. As for cosmetic outcomes, 71patients were graded as good, 7 patients were graded as fair, and only 1 patient was graded as poor. Those patients who were not graded as good had visible scarring, shallow eyelid crease, or asymmetry. The overall patient satisfaction was as high as 95.1%. Mild hematoma formation occurred in 3 patients and no infection or blepharoptosis was observed. One patient complained of asymmetry and 2 patients complained of unilateral crease fading as the complications. The technique is effective to develop durable and natural-looking double eyelids with minimal complications. It could also be an option for mild ptotic patients who ask for double-eyelid blepharoplasty.
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Affiliation(s)
- Xiujun Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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A Reverse Orbicularis-Tarsus Fixation Technique in Double-Eyelid Blepharoplasty: A Novel Fixation Technique Different From Park's Technique. J Craniofac Surg 2021; 32:1157-1161. [PMID: 33405459 DOI: 10.1097/scs.0000000000007367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%). CONCLUSIONS 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.
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Dong Z, Meng P, Zhang L, Chen Z. Fixation of orbicularis oculi muscle and orbital septum to pretarsal fascia and correction of blepharoptosis in construction of double eyelids. J Int Med Res 2020; 48:300060519870417. [PMID: 32308080 PMCID: PMC7171992 DOI: 10.1177/0300060519870417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study was performed to evaluate a novel method of constructing double eyelids by fixation of the orbicularis oculi muscle and orbital septum to the pretarsal fascia and correction of blepharoptosis. Methods In total, 285 patients requesting aesthetic construction of double eyelids were divided into three groups: those treated by the modified method (Group A, n = 108), those treated by traditional construction of the upper eyelid (Group B, n = 85), and those treated by the Park method (Group C, n = 92). The patients were followed up for 3 to 12 months (average, 6 months). The surgical effects and degree of satisfaction were compared among the three groups. Results In Group A, the mean operative time was 1.0 ± 0.2 hours. The degree of satisfaction with the surgical effect was significantly different between Group A (95.37%) and Group B (87.06%). However, no significant difference in satisfaction was noted between Group A (95.37%) and Group C (91.30%) or between Group B (87.06%) and Group C (91.30%). Conclusions The modified technique is simple and effective for construction of double eyelids and correction of blepharoptosis. All patients were satisfied with the surgical and aesthetic effects.
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Affiliation(s)
- Ziying Dong
- Cosmetic Surgery, Rizhao People's Hospital, Rizhao, China.,Cosmetic Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Pingping Meng
- Cosmetic Surgery, Rizhao People's Hospital, Rizhao, China
| | - Lei Zhang
- Cosmetic Surgery, Rizhao People's Hospital, Rizhao, China
| | - Zhenyu Chen
- Cosmetic Center, Affiliated Hospital of Qingdao University, Qingdao, China
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A Modified Procedure for Blepharoplasty: Physiological Structure Reconstruction of Upper Eyelids. J Craniofac Surg 2020; 31:456-459. [PMID: 31977692 DOI: 10.1097/scs.0000000000005962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Double eyelid operation has become the most popular cosmetic procedure in China, while how to make sure the acquired double eyelids the same as congenital ones is still a problem. OBJECTIVE This study aimed to explore a design and operation procedure to obtain natural and dynamic double eyelids, which are accordant with the congenital double eyelids both in appearance and movement. METHODS The authors conducted a retrospective review of 352 patients who underwent our operation from October 2012 to October 2018. The procedures were performed by one senior surgeon. First, design the incision line 7 to 8 mm distance parallel to the ciliary margin. Then, cut down the skin and orbicularis muscle, and dissect the orbicularis myocutaneous flap from the anterior surface of the tarsal plate. Next, expose the orbital septum transversely in the lowest site from lateral to medial direction, and dispose of the fat tissue herniated spontaneously. Subsequently, suture the upper margin of pretarsal orbicularis myocutaneous flap to the levator aponeurosis. Finally, the skin edge of incision was closed interruptedly. The patients were followed up from 6 to 30 months after surgery by 2 surgeons to evaluate the long-term results. RESULTS A total of 352 patients with 704 eyes were operated on and followed up in our study. There were 29 patients (8.2%) that showed slight asymmetry, and 7 eyes (2.0%) showed shallow creases. Besides that, all the creases were symmetry, parallel and natural. Just as congenital double eyelids, when opening eyes there was no sausagelike appearance, and when closing eyes there were no depressed scars. CONCLUSIONS By reconstructing the physiological structure of upper eyelids, our double eyelid operation creates dynamic double eyelids, which are accordant with the congenital ones both in appearance and movement.
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Sun W, Yin N, Song T, Wu D, Li H, Wang Y. A practical technique combining orbicularis oculi muscle resection-based epicanthoplasty and orbicularis-tarsus fixation double-eyelid plasty for cosmetic blepharoplasty. J Plast Reconstr Aesthet Surg 2019; 72:2009-2016. [PMID: 31607593 DOI: 10.1016/j.bjps.2019.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Weiyi Sun
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, No. 33 of Badachu Road, Shijingshan District, Beijing, China.
| | - Ningbei Yin
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, No. 33 of Badachu Road, Shijingshan District, Beijing, China.
| | - Tao Song
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, No. 33 of Badachu Road, Shijingshan District, Beijing, China.
| | - Di Wu
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, No. 33 of Badachu Road, Shijingshan District, Beijing, China.
| | - Haidong Li
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, No. 33 of Badachu Road, Shijingshan District, Beijing, China.
| | - Yongqian Wang
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, No. 33 of Badachu Road, Shijingshan District, Beijing, China.
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Pan L, Sun Y, Yan S, Shi H, Jin T, Li J, Zhang L, Wu S. A Flexible Suspension Technique of Blepharoplasty: Clinical Application and Comparison with Traditional Technique. Aesthetic Plast Surg 2019; 43:404-411. [PMID: 30756143 DOI: 10.1007/s00266-019-01317-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/20/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Double-eyelid blepharoplasty is one of the most popular aesthetic surgeries in China. But the traditional method produces a hidebound double eyelid due to its rigid suturing between the skin and the tarsus. The authors of this article concluded a novel technique of "flexible suspension technique" compared with traditional blepharoplasty which is considered as a "rigid fixation technique." METHODS This is a retrospective study of two groups of 100 Chinese Han females, on whom double-eyelid blepharoplasty was performed, 50 cases by "flexible suspension technique" and the other 50 by "rigid fixation technique." The basic procedure of "flexible suspension technique" is suturing the orbicularis oculi muscle to the septal extension. Thus, the surgical connection between skin and tarsus is flexible. The surgical results were evaluated and compared using the Global Aesthetic Improvement Scale and Visual Analogue Scale/Score. RESULTS The "very much improved" rate in the "flexible suspension technique" group was higher than that in the "rigid fixation technique" group (p < 0.05). Postoperative appearances of the "flexible suspension technique" group were also better than the "rigid fixation technique" group with less edema (p < 0.05) and slighter incision scars (p < 0.05). However, the incidences of asymmetry and fold loss were higher in the "flexible suspension technique" group (p < 0.05). CONCLUSION The flexible suspension technique blepharoplasty can obtain a more natural appearance and has less adverse effects and shorter recovery time. 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 .
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Affiliation(s)
- Lei Pan
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Sheng Yan
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Hangyan Shi
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Tingting Jin
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Jingyu Li
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Lei Zhang
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Sufan Wu
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China.
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Zhang Y, Zhou Q, Niu G, Huang X, Zhang J, Bi Y. Individualized small-incision orbicularis-levator fixation blepharoplasty for unilateral single-eyelid Asians. J Plast Reconstr Aesthet Surg 2019; 72:317-321. [DOI: 10.1016/j.bjps.2018.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
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Sun W, Wang Y, Song T, Wu D, Li H, Yin N. Orbicularis-Tarsus Fixation Approach in Double-Eyelid Blepharoplasty: A Modification of Park's Technique. Aesthetic Plast Surg 2018; 42:1582-1590. [PMID: 30191281 DOI: 10.1007/s00266-018-1218-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incisional double-eyelid blepharoplasty is widely applied because of its extensive indications and robust results. The orbicularis-levator fixation method is an incisional approach that provides stronger adhesion than traditional techniques. However, there remains the risk of postoperative relapse or suture spitting out. METHODS The authors introduced a modified technique for supratarsal crease formation. When necessary soft tissue removal was completed, the orbicularis oculi muscle was anchored on the tarsus. Then the muscle edges near canthus were reattached to prevent muscle retraction. For skin closure, the skin-pretarsal fascia-skin maneuver was adopted to enhance cicatricial adhesion. RESULTS Six hundred and fifty-nine patients underwent double eyelidplasty by the same surgeon using this modified technique. Patients were followed up from 2 to 38 months, with a mean period of 15 months. Short-term complications included mild edema, bruising or reddish change of the upper eyelid, yet all gradually relieved in 6-8 weeks. Fourteen cases of palpebral fold asymmetry and nine cases of unsatisfactory fold formation near the inner canthus were encountered, and all the defects had been well improved by revision surgeries. Ninety-five percent of the patients were satisfied with the long-term outcomes, which showed as natural and well-defined palpebral folds without scar hypertrophy, suture spitting out or crease depression. Besides, no supratarsal crease drooping or disappearing was observed 3 years postoperatively. CONCLUSIONS The authors introduced an orbicularis-tarsus fixation method for upper eyelid blepharoplasty. It is a reliable technique that enables high feasibility and long-lasting result, and with lower risk of suture spitting out. 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 .
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Affiliation(s)
- Weiyi Sun
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Yongqian Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
| | - Tao Song
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Haidong Li
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Ningbei Yin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
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Three Skin Zones in the Asian Upper Eyelid Pertaining to the Asian Blepharoplasty. J Craniofac Surg 2017; 28:892-897. [DOI: 10.1097/scs.0000000000003511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhu L, Chen X. Mechanical analysis of eyelid morphology. Acta Biomater 2013; 9:7968-76. [PMID: 23597858 DOI: 10.1016/j.actbio.2013.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/10/2013] [Accepted: 04/02/2013] [Indexed: 12/01/2022]
Abstract
From a mechanical instability perspective a double eyelid is a double-folded thin film structure on a curved substrate, caused by compression as the film "slides" on the substrate. The underlying mechanics issues, in particular the requirements for forming a double folded structure, are studied using a modeling/simulation framework. A minimalist model is employed to explore the wrinkle to fold transition. Refined and enriched models are further developed based on anatomical structures, which demonstrate three critical factors for the formation of double layer folding of the eyelid. First, a crease line in the eyelid is essential where the local bending rigidity is relatively weak. Second, the skin above the crease line should be thin and wide enough. Third, the skin below the crease line should have a relatively large effective stiffness so it can be lifted as a whole when the eyes open. When the eye is opened beyond about 40% of its initial wrinkle wavelength, the double-folded structure emerges. Various types of eyelid morphologies are discussed based on the mechanistic model. The study provides useful insights for surgery, cosmetics, and morphogenesis, as well as microfabrication.
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Affiliation(s)
- Liangliang Zhu
- International Center for Applied Mechanics, SV Laboratory, School of Aerospace, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
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Bi YL, Zhou Q, Hu XS, Xu W. Small-incision orbicularis-levator fixation technique: a modified double-eyelid blepharoplasty for treating trichiasis in young Asian patients. J Plast Reconstr Aesthet Surg 2011; 64:1138-44. [PMID: 21524949 DOI: 10.1016/j.bjps.2011.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 03/17/2011] [Accepted: 04/01/2011] [Indexed: 11/19/2022]
Abstract
Upper-eyelid trichiasis often occurs with a single puffy eyelid or shallow eyelid crease in young Asian patients. This study presents a novel modified trichiasis correction method to simultaneously treat trichiasis and create a natural eyelid crease. It combines the modified small-incision debulking procedure and the orbicularis-levator fixation technique. The eyelash lift angle (LA), body curl angle (BCA) and end curl angle (ECA) were quantitatively analysed. A total of 90 patients (152 trichiasis eyelids) were followed up for approximately 22 months. The LA changed from 24.32° ± 9.21°-54.12° ± 10.32° in the nasal section of the eyelid (section 1), from 21.03° ± 11.34°-52.03° ± 10.56° in the middle section of the eyelid (section 2) and from 23.31° ± 8.12°-63.15° ± 8.43° in the temporal section of the eyelid (section 3). All patients were satisfied with the eyelid-fold appearance. In conclusion, for young Asian patients with upper-eyelid trichiasis, the small-incision orbicularis-levator fixation technique is able to acquire a stable up-curved position of the eyelashes and satisfactory aesthetic results.
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Affiliation(s)
- Y L Bi
- Division of Ophthalmic Plastic Surgery, Department of Ophthalmology, Tongji Hospital, Affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China.
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CHO MINHEE, GLAVAS IOANNISP. Anatomic Properties of the Upper Eyelid in Asian Americans. Dermatol Surg 2009; 35:1736-40. [DOI: 10.1111/j.1524-4725.2009.01285.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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