Double Eyelid Blepharoplasty With Palpebral Margin Incision in Asian Eyelids

Application of retaining the vessels around the orbicularis oculi muscle in blepharoplasty

OBJECTIVE

To investigate the effect of retaining the vessels around the orbicularis oculi muscle on reducing local swelling after blepharoplasty.

METHODS

A total of 309 patients undergoing blepharoplasty (total incision) were observed and randomly assigned to three groups; (A) conventional operation; (B) preservation of deep vessels; (C) preservation of anterior vessels of orbicularis oculi muscle. The groups were compared based on intraoperative blood loss, operation time, swelling, satisfaction, and complications.

RESULTS

Among the 309 patients, 39 were lost to follow-up. c Additionally, A had the shortest operation time, followed by C with slightly longer duration. On the 7th day, 15th day, and 1 month after surgery, both B and C demonstrated significantly lower levels of swelling compared to A. Moreover, patient satisfaction was higher in B and C than in A.

CONCLUSION

Retaining either superficial or deep veins of the orbicularis oculi muscle can effectively reduce short-term postoperative swelling. However, when retaining the superficial central group of this muscle during surgery, it is crucial to strictly control the amount of surrounding tissue around vessels.

Analysis of risk factors for quality management to blepharoplasty based on DEMATEL-ISM

OBJECTIVE

Blepharoplasty is a typical complex structural system, which involves many factors and the interaction among them. Therefore, it is the basis of controlling the occurrence of medical complications in blepharoplasty to clarify the hierarchical relationship of various risk factors and find out the key risk factors.

METHODS

On the basis of identifying the risk factors for quality management of blepharoplasty by means of literature research, questionnaire survey and expert interview, the risk factor model of blepharoplasty quality management were analyzed and constructed. The relationship between the risk factors and the degree of influence on the risk factors was studied using Decision-Making Trialand Evaluation Laboratory and Interpretative Structural Modeling Method, and the hierarchical structure model of the risk factors for blepharoplasty quality management was obtained.

RESULTS

Six levels of risk factors in quality management of blepharoplasty were identified and classified, and the causal attributes among risk factors were determined. Six key risk factors in quality management of double eyelid surgery were determined according to centrality, and finally the above risk factors were divided into three categories: direct cause, excessive cause, and essential cause.

CONCLUSIONS

This study realizes the comprehensive risk factor analysis of the complex system of quality management of blepharoplasty, which can provide reference for plastic surgeons to make safety decisions of blepharoplasty.

A Modified Palpebral Marginal Incision Technique Using Levator Aponeurotic Flap in Blepharoplasty

BACKGROUND

Double-eyelid surgery is one of the most common cosmetic surgeries performed in Asians. The palpebral marginal incision technique (PMIT) conceals the incision scar and creates natural-looking double eyelids. However, the amount of eyelid skin removed by conventional PMIT is limited, which potentially results in an unnatural crease or swollen-like inferior skin below the palpebral crease.

OBJECTIVES

To introduce a modified PMIT which creates scarless, dynamic and natural double eyelids with a limited amount of eyelid skin excision.

METHODS

From January 2018 to December 2020, 382 patients (764 eyelids) underwent double eyelid surgeries using the described technique. The key point was to form a pretarsal levator aponeurotic flap, acting as a soft motor transmission to bridge tarsus, orbicularis oculi muscle (OMM), and skin dermis. The overall aesthetic outcomes, which are indicated by surgeon and patient self-assessed satisfaction, and complications, were postoperatively evaluated at different follow-ups.

RESULTS

The mean follow-up period was 7.6 months (range, 6-12 months). Of the patients, 332 (86.9%) reported a satisfactory self-assessment of outcomes and 37 (9.7%) as fair. Secondary operations were required for 13 (3.4%) patients for double-eyelid asymmetry or crease curve malformations. Early-stage hematoma (12 cases) and lagophthalmos (19 cases) were observed and completely recovered within 1 month.

CONCLUSIONS

Our modified PMIT technique was capable of achieving scarless and natural-looking double eyelids with biomimetic anatomical structure.