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Zhao Y, Shi J, Ren B, Jin S, Chen W. Recovery of subcutaneous orbital fascia under preserved skin below the original crease in the repair of excessively high double-eyelid folds. J Plast Reconstr Aesthet Surg 2024; 92:104-110. [PMID: 38513342 DOI: 10.1016/j.bjps.2024.02.068] [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: 09/29/2023] [Revised: 01/24/2024] [Accepted: 02/22/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND High-eyelid fold is a common complication of upper eyelid surgery. This study proposed a novel technique for correcting high-eyelid fold in Asian patients with little eyelid skin and thick orbital fascia to improve cosmetic outcomes and patient satisfaction. METHODS We retrospectively analysed the clinical data of 38 patients with high-eyelid fold repaired at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July 2017 to April 2022. All patients were treated using this method of preserving the high-eyelid fold and reconstructing the subcutaneous orbital fascia. Postoperative outcomes were reviewed and analysed using objective measures and subjective surgeon and patient evaluations. RESULTS Thirty-eight patients (71 eyes) were included. Postoperative follow-up was for 6-25 months. At 6 months postoperatively, the mean anatomic crease height decreased from 10.45 mm to 6.22 mm, mean pretarsal show decreased from 3.20 mm to 1.61 mm, and mean margin reflex distance in 1 of the 31 patients with ptosis increased from 2.93 mm to 3.87 mm (P < 0.001). The compliance rate between the surgeon's assessment and patient satisfaction was 89.5%, with 31 cases considered good by both the surgeon and patient and one case considered poor by both (undercorrected ptosis), though a satisfactory result was achieved after reoperation. Neither recurrence of the original crease nor serious complications were reported. CONCLUSION By preserving high-eyelid folds and reconstructing the subcutaneous orbital fascia, unnaturally high- and deep-eyelid folds were converted to lower, nondepressed folds.
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Affiliation(s)
- Yingnan Zhao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Jing Shi
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Boyang Ren
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Shengyang Jin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Wen Chen
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China.
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Wong CH, Hsieh MKH, Mendelson B. Subclinical Upper Eyelid Ptosis in Asian Patients: The Role of Levator Advancement in Optimizing Outcomes in "Cosmetic" Upper Blepharoplasty. Aesthetic Plast Surg 2024; 48:141-151. [PMID: 37821553 PMCID: PMC10912147 DOI: 10.1007/s00266-023-03697-1] [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: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Subclinical ptosis is prevalent in Asian patients presenting for aesthetic upper blepharoplasty. To achieve predictable and satisfactory results in these patients, addressing the ptosis component is critical. In this paper, we present a precision levator advancement technique that enabled us to predictably incorporate the levator advancement into our upper blepharoplasty to deliver more predictable results in these patients. MATERIALS AND METHODS Asian patients with normal or near normal margin to reflex distance 1 (MRD 1 of ≥ 3.5 mm) and symptoms and signs of straining of the frontalis with eyelid opening were diagnosed with subclinical upper eyelid ptosis and included in this prospective study. The advancement required was estimated pre-operatively using a formula that we developed. Our surgical technique is presented in detail here, and our long-term results were analysed. RESULTS From December 2019 to August 2022, 97 patients were included in this study. Sixty-five patients were primary cases and 32 were revision cases. The mean follow-up was 15 months. Of the 192 eyelids analysed, our formula was able to correctly identify the required fixation location in 69% of eyelids. In majority of the eyelids (94%), the correct location of fixation location within +/- 1 mm of the estimated location. All patients (100%) were satisfied with their long-term results. Our revision rate was 3%. CONCLUSIONS Incorporating a precisely done levator advancement into the upper blepharoplasty in patients with subclinical ptosis is critical for optimizing the aesthetic and functional outcomes. This approach has enabled us to perform this procedure greater predictably in this group of patients. 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 www.springer.com/00266 .
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Affiliation(s)
- Chin-Ho Wong
- W Aesthetic Plastic Surgery, #06-28/29, Mount Elizabeth Novena Specialist Center, 38 Irrawaddy Road, Singapore, 329563, Singapore.
| | - Michael Ku Hung Hsieh
- Department of Plastic Reconstructive & Aesthetic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Bryan Mendelson
- The Centre for Facial Plastic Surgery, Toorak, Victoria, Australia
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Revisional Asian Blepharoplasty of the High Eyelid Fold: Tarsus-Orbicularis Fixation Combined With Orbital Fat Repositioning Technique. J Craniofac Surg 2023; 34:738-742. [PMID: 36042546 DOI: 10.1097/scs.0000000000008991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Abnormally high eyelid fold is a common unsatisfactory esthetic outcome after double eyelid surgery. At present, successful correction of high eyelid fold among Asians remains one of the most challenging procedures for eyelid plastic surgeons. OBJECTIVES This article aims to propose a novel technique for correcting high eyelid fold to improve the cosmetic outcomes and patient satisfaction. MATERIALS AND METHODS This is a retrospective study of 86 patients (154 eyelids) with high eyelid folds who underwent revision blepharoplasty. A new proper height incision line was designed during the operation, and the adhesion between skin and levator aponeurosis was fully released. The residual orbital fat was adequately separated. If necessary, orbital fat from lower eyelid will be harvested for free fat grafting. The tarsus-orbicularis fixation combined with orbital fat repositioning technique was used to create a double eyelid fold and reconstruct the gliding zone. The surgical outcome and patient satisfaction are reviewed. RESULTS Among the 154 eyelids with high eyelid fold, mean lid crease height decreased from 9.8 mm preoperation to 6.8 mm ( P <0.001) and mean pretarsal show decreased from 3.5 mm preoperation to 1.9 mm 6 months postoperation ( P <0.001). The esthetic outcome was fully satisfied in 78 patients (90.7%) and basically satisfied in 6 patients (7.0%). Two patients (2.3%) were unsatisfied because of ptosis undercorrection in 1 patient and asymmetry in the other. They both got satisfied results after reoperation. CONCLUSIONS The tarsus-orbicularis fixation combined orbital fat repositioning technique is a simple and effective method to correct high eyelid folds with high satisfaction and rare complications.
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Wong CH, Hsieh MKH, Wei FC. Asian Upper Blepharoplasty with the Hinge Technique. Aesthetic Plast Surg 2022; 46:1423-1431. [PMID: 35355108 DOI: 10.1007/s00266-021-02703-8] [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: 09/16/2021] [Accepted: 11/27/2021] [Indexed: 11/01/2022]
Abstract
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 .
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The Eyelid Crease Height, Depth, and Shape: A Scoring System for Revisional Asian Blepharoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2802. [PMID: 33154864 PMCID: PMC7605888 DOI: 10.1097/gox.0000000000002802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/06/2020] [Indexed: 11/26/2022]
Abstract
This study reports on a series of challenging revisional Asian blepharoplasty cases with various suboptimal factors, including high or low crease height, shallow or deep crease indentation (depth), and suboptimal crease shape. The study also presents a simple scoring scale that combines these challenges into a composite score, which has helped in the management of these cases. Methods Data on 64 revisional cases were collected between January 1, 2006, and June 30, 2019, with 126 upper eyelids. These were cases with little skin remaining after previous surgeries, and each eyelid was scored based on a height, depth, shape scoring method. A composite score (H + D + S) is then summed up, which ranged from 1 to 10, with the higher number being the most challenging. The logic and rules behind this scoring scale are explained. Results Data regarding age, gender, and eyelid crease characteristics of the cases were collected; photographs, notes, and diagrams in the medical records were used to complete each eyelid's scoring. The age of the patients (57 women and 7 men) ranged from 21 to 74 years. The revision score distribution, age distribution, and averaged scores within each age group were investigated for those starting at 24 years or younger, and for each added decade until over 65 years. Patients with revisional effort scores of 5-8 were found in all age groups surveyed. Conclusions In this study, the author presents a practical scoring scale that recognizes the factors responsible for the suboptimal results in double eyelid plasty and helps clinicians in management, patient-counseling, and planning of surgical solutions.
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Steinsapir KD, Kim YD. Pathology Of "Post-Upper Blepharoplasty Syndrome": Implications For Upper Eyelid Reconstruction. Clin Ophthalmol 2019; 13:2035-2042. [PMID: 31802837 PMCID: PMC6802536 DOI: 10.2147/opth.s211289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background The anatomical basis for eyelid changes after upper blepharoplasty is largely uninvestigated. The post upper blepharoplasty syndrome (PUBS) is here defined as upper eyelid ptosis, hollow sulcus, high or absent upper eyelid crease, eyelash ptosis, loose eyelid platform skin, and compensatory brow elevation. Objective The anatomical basis for the post-upper blepharoplasty syndrome was investigated. Methods A retrospective, case-controlled, consecutive series of patients was explored for blepharoptosis after cosmetic blepharoplasty (cases) or ptosis surgery (controls). The upper eyelid crease was lowered, blepharoptosis was corrected by anterior levator aponeurosis resection ptosis surgery, eyelash ptosis was corrected with anchor blepharoplasty, and upper eyelid fold volume was restored using anterior orbital fat. Morphologic and anatomical findings were compared between case and control eyelids. Results Data were available for 42 patients (81 eyelids). Case and control eyelids presented with a clinically similar appearance but internally had a marked difference in their anatomical findings. Eyelids with post-upper blepharoplasty syndrome (n= 24 patients, 48 eyelids) were internally found to have a white-line disinsertion of the levator aponeurosis. The disinserted, central levator aponeurosis was bound into the septal scar created by removal of anterior orbital fat at blepharoplasty. Among the 18 controls (33 eyelids), levator disinsertion was not identified. Conclusion Hollowness and ptosis in post-upper blepharoplasty syndrome eyelids are related to a white-line disinsertion of the levator aponeurosis and matting of anterior orbital fat in the internal septal scar created during fat removal with blepharoplasty. Knowing where to look for the disinserted central levator is critical to surgically repairing these post-blepharoplasty eyelids.
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Affiliation(s)
- Kenneth D Steinsapir
- Orbital and Ophthalmic Plastic Surgery Division, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yoon-Duck Kim
- Oculoplastic and Orbital Surgery Division, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Guo S, Yang M, Zhou C, Lv W, Zhang J, Gu C, Fang X. Corrective Strategies for a Complex Deformity Caused by "European-Style Double Eyelid" Blepharoplasty in Asians. Aesthetic Plast Surg 2019; 43:395-403. [PMID: 30456638 DOI: 10.1007/s00266-018-1262-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND "European-style double eyelid" blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity. METHODS During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively. RESULTS The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory. CONCLUSIONS The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function. 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)
- Shiwei Guo
- Minimally Invasive Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China.
| | - Mingyong Yang
- Minimally Invasive Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China.
| | - Chuande Zhou
- Minimally Invasive Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Wei Lv
- Minimally Invasive Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jiaqi Zhang
- Minimally Invasive Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Congmin Gu
- Minimally Invasive Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Xuan Fang
- Department of Anatomy and Histo Embryology, School of Basic Medical Science, Peking University, Beijing, China
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Young SM, Kim YD, Kim JH, Lang SS, Woo KI. Lowering of the High Eyelid Crease in Revision Upper Eyelid Surgery. Aesthetic Plast Surg 2019; 43:139-146. [PMID: 30276454 DOI: 10.1007/s00266-018-1235-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND High placement of the lid crease is a common complication in upper eyelid surgery. Correction of the high crease by revision surgery is challenging and has not been well-reported. METHODS This is a retrospective interventional study of patients who underwent revision eyelid surgery with lowering of the lid crease from 2008 to 2016 at a tertiary institution. Main outcome measures were pretarsal show (PTS) distance, lid crease symmetry, margin reflex distance 1 (MRD1), and lid height symmetry. Lid crease symmetry was graded as symmetrical, mild asymmetry (PTS difference ≤ 0.5 mm), moderate asymmetry (PTS difference > 0.5 mm but ≤ 1 mm), or obvious asymmetry (PTS difference > 1 mm). Lid height symmetry was graded as symmetrical, mild asymmetry (MRD1 difference ≤ 1 mm), moderate asymmetry (MRD1 difference > 1 mm but ≤ 2 mm), or obvious asymmetry (MRD1 difference > 2 mm). RESULTS There were a total of 69 patients and 100 eyes. The majority (n = 42, 60.9%) of patients were females. The mean age was 38.3 ± 17.3 years, and mean follow-up was 16 months. Mean PTS decreased from 3.1 mm pre-surgery to 2.0 mm 2 years post-surgery. The proportion of patients with moderate or severe lid crease asymmetry decreased from 81.1% pre-surgery to 6.7% 2 years post-surgery. The mean MRD1 difference decreased from 1.54 mm pre-surgery to 0.23 mm 1 year post-surgery. The proportion of patients with moderate or severe lid height asymmetry improved from 64.5% preoperatively to 4.5% 1 year postoperatively. CONCLUSION Revision eyelid surgery to correct a high crease is a challenging procedure. We present a technique that is effective in correcting the high lid crease, while simultaneously improving the lid height and lid crease symmetry. 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)
- Stephanie M Young
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea.
| | - Jeong Hee Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea
| | - Stephanie S Lang
- Clinical Audit, Singapore National Eye Centre, Singapore, Singapore
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea
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Upper blepharoplasty revision technique: Correction of the high eyelid fold using the pretarsal orbicularis oculi flap. J Plast Reconstr Aesthet Surg 2019; 72:125-130. [DOI: 10.1016/j.bjps.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/02/2018] [Accepted: 08/19/2018] [Indexed: 11/21/2022]
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Zhao JY, Guo XS, Song GD, Zong XL, Yang XN, Du L, Lai CZ, Qi ZL, Jin XL. Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty. Int J Ophthalmol 2018; 11:1922-1925. [PMID: 30588423 DOI: 10.18240/ijo.2018.12.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate surgical outcomes of modified Z-epicanthoplasty with blepharoplasty that we previously reported from the patient's perspective using patient-reported outcome measures (PROMs) and patient satisfaction scores. METHODS A total of patients (n=180) who underwent the surgery between January 2013 and June 2016 were randomly selected. Standardized patient satisfaction forms (total score, 40) and validated PROMs questionnaires (total score, 12) were sent to patients for completion. PROMs assesses the severity of scarring, pain and asymmetry, as well as functional and appearance issues. RESULTS All patients were female, ranging from 18 to 35 years old (mean=24). The response rate was 73.3% (n=132). The majority of patients reported good or excellent outcomes based on PROM analysis. Patients reported minimum or non-visible scarring at both the double eyelid surgical scar (85.6%) and the inner canthus (80.3%). Issues concerning function and appearance were minimal as 80.3% reported satisfaction with both domains. Notably, the majority of patients reported either a high or very high satisfaction rate to yield a mean score of 104 out of 120 (P<0.05). CONCLUSION Integration of our modified Z-epicanthoplasty with blepharoplasty produces good outcomes based on PROM results, which shows a positive linear relationship with patient satisfaction scores.
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Affiliation(s)
- Jing-Yi Zhao
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Xiao-Shuang Guo
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Guo-Dong Song
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Xian-Lei Zong
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Xiao-Nan Yang
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Le Du
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Chen-Zhi Lai
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Zuo-Liang Qi
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Xiao-Lei Jin
- Department No.16, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
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Chen's Double Eyelid Fold Illusion: An Eye Size Assimilation Illusion Induced by a Supratarsal Fold in the Brow-Eye Unit, A Preliminary Report. Aesthetic Plast Surg 2017; 41:1375-1381. [PMID: 28842754 DOI: 10.1007/s00266-017-0961-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Double eyelidplasty can enhance the eye size and facial attractiveness of Asian individuals with single eyelids. The authors hypothesize that a supratarsal fold can induce an eye size assimilation illusion to enhance eye dimensions and aesthetics, and seek to define the optimum vertical proportion between a supratarsal fold and the eye fissure associated with maximal induction of the size assimilation illusion. METHODS A photometric study of the replicated photographs of ten female Taiwanese patients after double eyelidplasty was designed. Each photograph was edited by shifting the supratarsal folds vertically at a regular fold/eye ratio increment of 0.1. The perceived attractiveness of edited photographs of each patient was rated by 100 adult observers using a score of 1-5. The palpebral parameters were measured and analyzed. RESULTS The mean rating score increased gradually when a supratarsal fold was added and peaked when the fold/eye ratio was 0.3 and the mean Chen's double eyelid fold ratio was 0.631 ± 0.023. After the peak, the mean score decreased gradually and was lower than the photograph without a fold when the fold/eye ratio exceeded 0.5 and the mean Chen's ratio exceeded 0.729 ± 0.027. CONCLUSION Within the optimal ranges of the fold/eye ratio and Chen's double eyelid fold ratio, eyes are perceived as larger and more attractive due to a hybrid presentation of two interdependent eye size assimilation illusions induced by a supratarsal fold in the brow-eye unit. "Chen's double eyelid fold illusion" is proposed to describe this complex visual phenomenon. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abstract
Background The ability to correct unnatural-appearing, high, and deep double eyelid folds has been limited by the lack of redundant upper eyelid skin and the presence of prior incision line scars in patients. Methods From January 2000 to September 2011, 256 patients with high and deep double eyelid folds underwent our fold-lowering procedure. The first dissection was made at the superficial layer between the orbicularis oculi muscle and orbital septum/retroorbicularis oculi fat. The second dissection was at a deeper layer between the preaponeurotic fat and levator aponeurosis. The dissection proceeded 7 to 8 mm farther cephalad to the prior fold line to separate the upper flap and the floor from the prior fold line. The lower flap was undermined caudally to obtain normal skin tension, and the lower flap was secured to the septoaponeurosis junctional thickening or pretarsal tissue. Six months after surgery, the correction of the high fold scar and change in fold height (with eyes closed) was documented. Results Using the authors' technique, unnatural-appearing, high, and deep double eyelid folds were converted to lower nondepressed folds. Although prior high fold incision scars could be seen postoperatively on close examination, they were not easily visible. Complications included fold height asymmetry in 10 cases, persistence of the prior fold in 5 cases, and redundant upper flap skin that needed further excision in 25 cases. Conclusions Using a wide double-layer dissection, high folds were lowered successfully even in situations where there was no redundant upper eyelid skin for excision.
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Wang C, Pu LLQ. Commentary on: Visual, Physiological, and Aesthetic Factors and Pitfalls in Asian Blepharoplasty. Aesthet Surg J 2016; 36:284-6. [PMID: 26843098 DOI: 10.1093/asj/sjv233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chunmei Wang
- Dr Wang is Chair, Department of Plastic and Aesthetic Surgery, Dongguan Kanghua Hospital, Dongguan, Guangdong Province, P.R. China. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California at Davis, Sacramento, CA, USA
| | - Lee L Q Pu
- Dr Wang is Chair, Department of Plastic and Aesthetic Surgery, Dongguan Kanghua Hospital, Dongguan, Guangdong Province, P.R. China. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California at Davis, Sacramento, CA, USA
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Orbicularis–levator–tarsus composite suture technique in double-eyelid operation. J Plast Reconstr Aesthet Surg 2015; 68:1079-84. [DOI: 10.1016/j.bjps.2015.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 03/04/2015] [Accepted: 04/06/2015] [Indexed: 11/30/2022]
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15
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Ahn JH, Han SY, Jang JW. Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.11.1579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Hyo Ahn
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Yoon Han
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Woo Jang
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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16
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Zhou Q, Zhang L, Wang P, Yang S, Bi Y. Preoperative asymmetry of upper eyelid thickness in young Chinese women undergoing double eyelid blepharoplasty. J Plast Reconstr Aesthet Surg 2012; 65:1175-80. [DOI: 10.1016/j.bjps.2012.03.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 11/30/2022]
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17
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Abstract
Currently, postoperative evaluation of aesthetic results of blepharoplasties mainly consists of subjective assessment by patients, surgeons, or others. We present an objective photo-assisted evaluation for preoperative planning and postoperative evaluation of blepharoplasties. Thirty-one female patients underwent aesthetic blepharoplasty. All types of blepharoplasties were included. An analysis of standardized pre- and postoperative photographs included measurements of eye fissure height, eye fissure width, lid sulcus height, upper lid height, upper iris coverage, scleral show, position of cornea to palpebra inferior, canthal tilt, an analysis of the architecture, and correction of wrinkles of the upper eyelid. Patients' satisfaction was investigated by a standardized questionnaire. All measured data showed postoperative changes to standard values. Upper eyelid wrinkles showed a significant decrease postoperatively. Most patients were highly satisfied with their results. The methods described in the present study help to evaluate the pre- and postoperative situation in blepharoplasty surgery.
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18
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Abstract
The face-lift procedure (rhytidectomy) is increasingly popular in Asia. There is extensive literature on different techniques in Western patients. Cultural and anthropomorphologic differences between Asian and Caucasians require the adaptation of current techniques to obtain a satisfactory outcome for both the patient and the surgeon. This article therefore attempts to define important differences between Asians and Caucasians in terms of signs of facial aging, perception of beauty, and surgical goals. Our face-lift technique, a modified deep-plane face lift for Asians, is detailed and cases are presented.
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Affiliation(s)
- Léonard Bergeron
- Department of Plastic and Reconstructive Surgery, Chang Gung Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
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19
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Abstract
One of the defining features between an individual of Asian descent and someone of Western descent is the presence of an upper eyelid crease. Approximately 50% of Asians do not have an upper eyelid crease. The double eyelid operation, or creation of a supratarsal crease, is the most common cosmetic procedure requested in Asia and the third most common procedure requested by Asian Americans. In this comprehensive article, we explore the art of creating an eyelid crease in the individual who either does not have a crease or has an indistinct crease. We will review the history of the development of Asian blepharoplasty, explain the anatomy of the Asian eyelid and how it differs from the Caucasian eyelid, and clarify how this anatomy then translates to differences in external appearance. The two main schools of surgical techniques will be discussed along with pearls, pitfalls, and personal observations.
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Affiliation(s)
- Marilyn Q Nguyen
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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20
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Abstract
Aesthetic surgery of the upper eyelids is a very common procedure performed in cosmetic practices around the world. The word blepharoplasty, however, has a different meaning in Asia than it does elsewhere. Orientals have different periorbital anatomic characteristics, their motivations for seeking eyelid treatment are different, and operative techniques have been adapted consequently. There are also many eyelid shapes among Orientals, mostly with regard to the presence and location of the supratarsal fold and/or presence of an epicanthal fold. The surgeon must therefore master a range of surgical procedures to treat these variations adequately. It is critical to know the indications for each blepharoplasty technique as well as their complications to select the right surgery and avoid unfavorable results. Epicanthoplasty performed on the right patient can greatly improve aesthetic results while retaining ethnic characteristics. This article will discuss Oriental eyelid characteristics, preoperative patient assessment, commonly used corrective techniques for the "double-eyelid" creation, and complications and how to avoid them.
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Affiliation(s)
- Chau-Jin Weng
- Department of Plastic Surgery, Chung Shan Hospital, Taipei Chung Shan Medical University, Taichung, PCC Private Clinic, Taipei, Taiwan
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21
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Intratarsal Fixation at the Same Level as the Skin Incision to Reduce Asymmetric Double Eyelids. Ann Plast Surg 2010; 64:265-9. [DOI: 10.1097/sap.0b013e3181b022e3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
Upper-eyelid blepharoplasty in the Asian patient poses unique challenges. The anatomy is complex and highly variable, and the esthetic goals vary from patient to patient. The surgeon must perform more complicated maneuvers than in Caucasian blepharoplasty in an anatomic field with features that predispose for complications. The successful surgeon must identify the features of the eyelid to be modified through a detailed consultation with the patient, formulate a sound surgical plan based on a mastery of the complex anatomy, and execute all maneuvers with conservatism and exact precision.
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Affiliation(s)
- David W Kim
- Division of Facial Plastic and Reconstructive Surgery, University of California-San Francisco, 2330 Post Street, 5th Floor, San Francisco, CA 94115-1809, USA.
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23
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Abstract
Upper eyelid blepharoplasty is a major component of cosmetic surgery in the Asian face. The complicated and variable anatomy of the Asian upper eyelid is reviewed, stressing the major differences between Asian and Caucasian eyes. The authors' preferred surgery for the creation of a double eyelid is discussed, including the preoperative assessment, intraoperative maneuvers, and laser techniques. The article concludes with a discussion of the complications specifically related to Asian blepharoplasty and strategies to avoid them.
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Affiliation(s)
- David W Kim
- Division of Facial Plastics and Reconstructive Surgery, University of California-San Francisco, 2330 Post Street, 5th Floor, San Francisco, CA 94115-1809, USA.
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