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

A Retrospective study of anatomical differences in levator aponeurosis angle and length in East-Asian blepharoplasty

This study aimed to analyze the anatomical differences in levator aponeurosis angle and length between both sides in double eyelidplasty in East Asians. The retrospective study included patients with mild blepharoptosis who underwent upper blepharoplasty with levator aponeurosis. In the study, 140 patients were enrolled, 126 females and 14 males, with an age range of 16-73 years. The mean levator aponeurosis angle was 19.2 ± 2.9° on the right and 17.0 ± 3.8° on the left, which was significantly different (95% CI, p < 0.001). The mean length was 24.1 mm on the right and 23.2 mm on the left, a difference that was also statistically significant (95% CI, p < 0.001). The relationship between the dominant eye and levator aponeurosis prominence was also investigated, although there was no apparent correlation. Within the limitations of the study, it seems that this is the first study of the anatomical differences of the levator aponeurosis between both sides, leading to a greater predictability of surgery to maximize postoperative symmetry.

Correction of Asymmetry of Palpebral Folds by Adopting Interrupted and Continuous Buried Suture Techniques Respectively on Different Eyelid

People with an obvious palpebral fold on 1 eye and a narrow or no palpebral fold on the other eye are usually more satisfied with the shape of the obvious palpebral fold and want to acquire symmetry by minimally invasive surgical methods that preserve the shape of the original folds they are more satisfied with. This study introduced a minimally invasive approach using 2 different buried suture techniques on different eyelids to acquire symmetry. The continuous suture method aimed to build palpebral folds, whereas the 3-point interrupted suture method aimed to enhance naturally formed palpebral folds. The 3-point interrupted buried suture method was used on the eye with an obvious palpebral fold, and the continuous buried suture method was performed on the eye with a narrow or no palpebral fold. Twenty patients underwent this procedure to correct the asymmetry between June 2010 and July 2022. The mean follow-up period was 18.12 months. The average swelling period was 7 days on the side using the interrupted buried suture technique and 10 days on the side using the continuous suture method. It took ~3 weeks to recover a relatively natural appearance. According to postoperative follow-up data, all patients were satisfied with the results. Our surgical approach of adopting 2 different buried suture techniques on different eyelids allowed the building of the palpebral fold on one eyelid while enhancing the original fold on the other eyelid, leading to satisfactory results of palpebral fold symmetry.

Rejuvenating the aging upper periorbita

PURPOSE

To investigate the efficacy of a comprehensive surgical approach in rejuvenating the aging upper periorbita.

METHODS

Three hundred and twenty eyes of 160 patients who were treated for dermatochalasis(D), eyebrow ptosis (EP) and blepharoptosis (BP) were included in the study. One hundred and ninety-eight patients had only dermatochalasis, 74 patients had D and EP, 39 patients had D and BP, 7 patients had D, EP and BP and 2 patients had D, EP and blepharospasm. The patients were evaluated before surgery, at 1 week, 1 month and 6 months after surgery. Dermatochalasis was scored between 0 and 3 points according to upper lid laxity and IP drooping. EP was scored between 0 and 2 points as normal, lateral EP and total EP. Aging was classified as mild in those with a total score of less than 3 points, moderate in those with a score of 3-6 and severe in those above 6 points.

RESULTS

Of the patients, 121 were female and 39 were male, with a mean age of 52 (40-87) years. The surgeries were performed as follows: upper eyelid blepharoplasty (UEB) 197(61.6%) patients, UEB + browpexy(B) 77(24.1%) patients, UEB + B + levator resection(LR) 7(2.2%) and UEB + LR 39 (12.2%) patients. While a statistically significant improvement was observed in patients who underwent UEB + B (p < 0.001), postoperative improvements were not found statistically significant compared to preoperative scores in other surgeries. The postsurgical scores showed statistically significant improvement in all age groups (p < 0.001).

CONCLUSIONS

A comprehensive surgical treatment can provide effective results in upper periorbital rejuvenation for patients with varying degrees of upper periorbital aging.

Arcade Suture Upper Blepharoplasty Combined With the Forceps Technique

BACKGROUND

Double-eyelid blepharoplasty is the most popular cosmetic surgery in Taiwan. The creation of a small palpebral fold along with reduction of eyelid fullness makes the eye look slightly larger, thereby leading to an appearance of youthfulness, alertness, and vitality. Herein, we propose a method of combining the techniques of arcade buried suture and forceps, which is designed to create a more physiologically natural double eyelid.

MATERIALS AND METHODS

We conducted a retrospective review of 45 patients who underwent double-eyelid surgery between December 2015 and December 2019. The procedures were performed by one senior surgeon using arcade suture upper blepharoplasty combined with the forceps technique. The patients' age ranged from 18 to 38 years (mean, 28 years). Ninety-one percent of the patients were women and were undergoing surgery for cosmetic reasons.

RESULTS

Of the 45 patients who underwent arcade suture upper blepharoplasty with the forceps technique, no patients developed stitch abscess or granuloma, obvious asymmetry, disappearance of line, chemosis, and corneal injury. The follow-up period ranged from 3 months to 4 years (mean, 32 months). Patient satisfaction was very high.

CONCLUSIONS

The arcade suture upper blepharoplasty combined with the forceps technique is a simple method for establishing a durable double eyelid without serious complication and providing excellent results.

Orbicularis-levator-tarsus fixation suturing in buried suture double-eyelid blepharoplasty

BACKGROUND

In buried suture methods, the levator aponeurosis is fixed to the subcutaneous tissue in the pretarsal region using a suture. However, loosening of the suture occurs frequently and causes regression or disappearance of the double-eyelid folds. To avoid potential loosening of the suture after surgery, we modified the horizontal suture technique commonly used in buried suture double-eyelid blepharoplasty.

METHODS

In our procedure, the levator aponeurosis was sutured horizontally, and then the subcutaneous tissue in the pretarsal region was sutured vertically by the same suture. After the two ends of the suture were tied, three tissue layers, namely, the levator aponeurosis, pretarsal fascia, and orbicularis oculi muscle, were fixed together in the pretarsal region.

RESULTS

A total of 873 Asian patients underwent double-eyelid blepharoplasty during the past 8 years. No loss of the double-eyelid folds occurred in 563 patients who were followed up for more than six months, and 531 patients, accounting for 94% of the sample, were satisfied with the postoperative results.

CONCLUSION

Since the suture was perpendicular to both the levator aponeurosis and the pretarsal orbicularis oculi muscle, pulling on the suture fixation site during blinking was effectively reduced. As a result, regression or disappearance of the double-eyelid folds due to loosening of the suture along the orientation of the muscle fibers was avoided, and the long-term stability of the double-eyelid folds was ensured.

A 10-min novel technique for involutional entropion: Mini-incisional continuous ligation everting sutures

PURPOSE

To introduce a novel technique of mini-incisional continuous ligation everting sutures for correction of involutional entropion and report the surgical outcome.

METHODS

A retrospective case series. Eighty-five eyelids of 77 patients who underwent correction of involutional lower lid entropion using mini-incisional continuous ligation everting sutures were included in this study. The medical records of patients with at least 24 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics, including sex, age at surgery, duration of follow-up, horizontal lid laxity, surgical outcomes, and complications. Main outcome measures were success of surgery, recurrence rate, time to recurrence, and risk factors for recurrence.

RESULTS

The median (interquartile range) age at the time of surgery was 72.0 (65.5-78.0) years and the median (interquartile range) follow-up duration was 24.0 (24.0-42.5) months. Thirty-seven eyelids (43.5%) showed horizontal eyelid laxity on a lid distraction test The surgical outcome was successful in the majority of patients (94.1%) with a recurrence rate of 5.9% in the 2 years after surgery. Only female sex was significantly correlated with recurrence of entropion (odds ratio 9.466, 95% confidence interval 1.022 to 87.670, P  =  0.048).

CONCLUSION

This novel technique is a promising surgical modality for correction of lower lid involutional entropion because of its ease of application, simplicity, compatibility with anticoagulants, and low recurrence rate.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A Six-Year Review of the Latest Oculoplastic Surgical Development

PURPOSE

The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral canthoplasty, and upper and lower blepharoplasty.

DESIGN

Systematic review of epicanthoplasty, lateral canthoplasty, upper and lower blepharoplasty in the period of 6 years.

METHODS

A systematic MEDLINE search by 2 independent reviewers was performed on PubMed using the search terms (blepharoplasty) OR double eyelid) OR lateral canthopexy) OR fat repositioning) OR epicanthoplasty) OR love band) AND (From January 2012 to January 2018).

RESULTS

After screening 1456 abstracts from search results, 1377 were eliminated due to irrelevant content. Full text of the remaining 79 articles and relevant cross-references were reviewed and summarized. Studies on cosmetic epicanthoplasty reported Z-plasty or modifications (n=8), advancement flap (n=4) or skin redraping procedures (n=1), removal or release of the orbicularis muscle (n = 14), with (n = 6) or without (n = 11) tightening medial canthal tendon. In lateral canthoplasty, approaches to preserve continuity of eyelid margin prevent lateral canthal deformity with inconspicuous incision via gray line (n = 2) or upper eyelid (n = 2) were described. Techniques of upper blepharoplasties described included open incision method (n = 9) with (n = 5) or without (n = 3) orbicularis resection, subbrow approach (n = 1), nonincisional suture blepharoplasty (n = 2), or partial incision blepharoplasty (n = 1). For lower blepharoplasties, techniques described included blepharoplasty with fat transposition (n = 7), transconjunctival blepharoplasty (n = 3), transcutaneous blepharoplasty and canthopexy (n = 1) or orbicularis flap (n = 2), minimally invasive or laser-assisted blepharoplasty (n = 2).

CONCLUSIONS

The recent trend of periocular surgical rejuvenation focuses on preserving soft tissue volume, avoiding skin or use hidden incision, taking the eyebrow and midface position into account, and measures to minimize iatrogenic eyelid malposition.

Transconjunctival Müller's muscle Tucking Method for Non-incisional Correction of Mild Ptosis: The Effectiveness and Maintenance

BACKGROUND

In patients with a mild degree ptosis who undergo non-incisional double-eyelid blepharoplasty, simultaneous correction of ptosis is needed to prevent loosening. The transconjunctival Müller's muscle tucking (TMMT) method may be useful in these cases.

OBJECTIVES

The authors performed this study to present the details of the current use of the TMMT method and to provide objective evidence for ptosis correction and its sustained effect.

METHODS

A total of 322 eyelids in 161 patients who underwent mild ptosis correction with the TMMT method from July 2012 to December 2017 were retrospectively examined. The continuous suture method using a single stitch was used for double-fold formation, and the TMMT method was used for ptosis correction for the other incision. The margin to reflex distance (MRD) 1 was evaluated at pre-operation, immediate post-operation, and at 2, 6 months post-operation.

RESULTS

A total of 34 patients who had more than 6 months of follow-up were included. Right-side MRD1 values were 2.08 (± 0.19) mm before the surgery, 3.49 (± 0.16) mm immediately after the surgery, 3.33 (± 0.14) mm at postoperative 2 months, and 3.22 (± 0.17) mm at postoperative 6 months (p < 0.001). The difference of MRD1 between immediate post-operation and at 6 months was 0.25 mm without statistical significance (p > 0.05). Complications (fold loosening, asymmetry, and ptosis recurrence) occurred in three cases (8.8%), all of which were re-corrected by applying the TMMT method.

CONCLUSIONS

The TMMT method was useful for correction of mild ptosis, showed little recurrence, and prevented loss of fold by giving a vertical force to the double-fold.

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 .

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

BACKGROUND

Double eyelid surgery with a buried suture is a popular plastic surgery procedure in Asia owing to the relatively minor scarring and quick recovery associated with it. In this article, we present a new approach involving a continuous single-loop buried suture method, which expands the operating site to the conjunctiva and the aponeurosis-Müller's muscle complex.

METHODS

The medical records of 42 patients (80 eyes) who underwent double-eyelid blepharoplasty were retrospectively reviewed. We performed double-eyelid blepharoplasty with a single-knot continuous buried suture method, along with the resection of a small piece of the orbicularis oculi muscle. The formation of a double eyelid was achieved through traction of the aponeurosis-Müller's muscle complex from the medial conjunctiva and penetration of the upper eyelid.

RESULTS

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

CONCLUSIONS

We proposed a modified technique involving a continuous buried suture method to create a better cosmetic effect through the formation of a double eyelid and simultaneous correction of mild blepharoptosis. This modified procedure is simple, fast, and effective, with limited adverse effects.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Orbicularis-Tarsus Fixation Approach in Double-Eyelid Blepharoplasty: A Modification of Park's Technique

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 .

[Clinical efficacy analysis of myocutaneous flap in blepharoplasty]

Objective

To introduce the myocutaneous flap in blepharoplasty and summarize its clinical efficacy.

Methods

Between January 2013 and March 2016, 1 560 patients underwent blepharoplasty with myocutaneous flap. Of them, 158 patients were followed up over 6 months and included in the study. There were 18 males and 140 females with the average age of 23.4 years (range, 18-35 years). The unilateral side was involved in 13 cases and bilateral sides in 145 cases. The patients had narrow double eyelid, shallow double eyelid, single eyelid, bloated upper eyelid, and upper eyelid skin relaxation. During operation, the tissue between the orbicular muscle of eye and the tarsus was trimmed layer by layer; the orbicularis oculi muscle, capillary network, and the front fascia of tarsus were retained, and the full-thickness skin, muscle, and the front fascia of tarsus were sutured by anatomical apposition.

Results

Incision healed at stage I. All patients were followed up 6 months to 2 years (mean, 8.3 months). During follow-up period, shallow or extinctive double-eyelid line was observed in 9 cases (12 eyes), and satisfactory results were achieved after trimming front fascia of tarsus and suturing. Good clinical results were obtained in the other patients, who had natural and coherent double eyelid without obvious scar or depression at resection margin.

Conclusion

Myocutaneous flap for blepharoplasty has many advantages of fast recovery, little wound, light swelling, permanent effects, and good appearance.

Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians

Background:

Double-eyelid blepharoplasty is a popular aesthetic surgery in Asians. However, the buried suture technique is associated with complications related to implantation of the suture thread. The present study was performed to identify optimal surgical suture removal techniques in Japanese patients with suture-related complications after buried suture double-eyelid blepharoplasty.

Methods:

This retrospective study included 210 upper eyelids of 116 consecutive Japanese patients who had undergone buried suture double-eyelid blepharoplasty at other clinics. All patients underwent suture removal surgery at the author's institution for treatment of suture-related complications. Although 12 patients (10.3%) underwent suture removal surgery alone, 104 (89.7%) underwent secondary double-eyelid blepharoplasty. The outcomes of 3 techniques were evaluated: the small skin incision method, the full skin incision method, and the conjunctival method.

Results:

The small skin incision method was performed in 46 patients, the full skin incision method in 63, and the conjunctival method in 7. The success rate of the full skin incision method was significantly higher than that of the small skin incision method (4.8% vs 37.0%, respectively; p < 0.0001). Patients with an uncomfortable pulling sensation exhibited a linear scar or depressive deformity without inflammation of the tarsal plate and impingement on the subconjunctival capillary vessels of the tarsal plate or a depressive deformity of the levator muscle. Patients with corneal irritation exhibited chronic inflammation of the conjunctival surface of the tarsal plate.

Conclusions:

Suture-related complications of buried suture double-eyelid blepharoplasty in Asians must be treated with suture removal surgery. The full skin incision method is more reliable than the small incision method for such patients.

Simultaneous Double Eyelid Blepharoplasty and Ptosis Correction with a Single-Knot, Continuous, Nonincisional Technique: A Five-Year Review

BACKGROUND

Double eyelid blepharoplasty is one of the most popular facial cosmetic surgeries performed in patients with Asian eyelids. Although most patients choose to undergo blepharoplasty for cosmetic purposes, rather than functional reasons, these patients frequently present with concomitant mild-to-moderate blepharoptosis.

OBJECTIVES

Performing nonincisional double eyelid surgery without correcting the ptosis tends to lead to unsatisfactory results. The authors introduce our new method for simultaneous correction of blepharoptosis during double eyelid blepharoplasty.

METHODS

For 5 years, the authors have performed a single-knot continuous nonincisional technique for simultaneous correction of blepharoptosis during double eyelid blepharoplasty. The medical charts of 127 patients (254 eyelids) were retrospectively reviewed. Müller muscle tagging suture was utilized to achieve the accurate amount of Müller tucking during the surgery.

RESULTS

There was a statistically significant difference between pretreatment MRD1 (1.62 ± 0.57 mm), and postoperative MRD1 (3.97 ± 0.81 mm; P < .001, Wilcoxon signed rank test, nonparametric paired comparison). The mean duration of surgery for both eyelids was 14.8 minutes (range, 14.1-19.7 minutes), and the mean extent of Müller muscle tucking was 7.8 mm (range, 6.0-10.0 mm). The majority of patients showed favorable results during long-term follow-up, with minimal complications.

CONCLUSIONS

There are no previously published articles documenting simultaneous double eyelid blepharoplasty and ptosis correction, using a single-knot continuous nonincisional technique. The authors suggest our simple and effective method is a good option for double eyelid blepharoplasty in cases with mild-to-moderate blepharoptosis.' LEVEL OF EVIDENCE 4: Therapeutic.