[Research progress of iatrogenic blepharoptosis repair after double eyelid surgery].

Objective: To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia. Methods: To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications. Results: Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion. Conclusion: When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.

Does Double-Eyelid Blepharoplasty Improve Forehead Wrinkles? A Prospective Study Using FACE-Q Scale and Anthropometric Measurements.

BACKGROUND: Single eyelids are common among Asians. It is not uncommon to see people with single eyelids raise their eyebrows to wide open their eyes. This results in frequent compensatory contraction of the frontalis muscle and thus leads to deep forehead wrinkles. Double-eyelid blepharoplasty creates a larger visual field. In theory, patients who receive the surgery will stop overusing the frontalis muscle. Therefore, the forehead wrinkles can be improved. METHODS: 35 patients who underwent double-eyelid blepharoplasty were enrolled. FACE-Q forehead wrinkle assessment scale was adopted to evaluate the forehead wrinkles preoperatively and postoperatively. In addition, anthropometric measurements were taken to indirectly evaluate frontalis muscle contraction in maximum eye-opening position. RESULTS: According to the FACE-Q scale, forehead wrinkles were improved after double-eyelid blepharoplasty, and the improvement was long-lasting in the 3-month follow-up. This was because the frontalis muscle contraction reduced after the surgery, as shown by the anthropometric measurements. CONCLUSION: This study used subjective and objective methods to prove that double-eyelid surgery improves forehead wrinkles. 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 .

Brow Position Change and its Potential Risk Factors Following Upper Blepharoplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Eyebrow position affects human facial expression and aesthetic appearance. However, upper-eyelid surgeries may cause brow position changes and affect the function and aesthetics of the eyebrow. The purpose of this review was to assess the influence of upper-eyelid surgeries on brow position and morphology. METHODS: PubMed, Web of Science, Cochrane Library, and EMBASE were searched for clinical trials and observational studies published between 1992 and 2022. The brow height from the center of the pupil is analyzed to show the brow height change. The change in brow morphology is measured by the change in brow height from the lateral palpebral and the medial palpebral. Studies are further divided into subgroups according to different surgical techniques, author locations, and whether to conduct skin excision. RESULTS: Seventeen studies met the inclusion criteria. Nine studies and 13 groups were included in the meta-analysis, indicating that brow height decreased significantly after upper-eyelid surgeries (MD = 1.45, 95% CI [0.87, 2.07], P < 0.0001), and simple blepharoplasty, double-eyelid surgery, and ptosis correction can cause the brow position to drop by 0.67, 2.52, and 2.10 mm, respectively. East Asian authors group had a significant decrease in brow height compared with the non-East Asian authors group (28 groups, p = 0.001). Skin excision during blepharoplasty does not affect brow height. CONCLUSIONS: Brow position changes significantly following upper blepharoplasty according to the decrease in brow-pupil distance. The morphology of the brow showed no significant postoperative change. Different techniques and authors locations may result in different levels of postoperative brow descent. 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 .

Research progress of iatrogenic blepharoptosis repair after double eyelid surgery / 中国修复重建外科杂志

OBJECTIVE@#To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia.@*METHODS@#To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications.@*RESULTS@#Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion.@*CONCLUSION@#When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.

Review of complications in double eyelid surgery.

Double eyelid surgery is popular worldwide, especially in East Asia. Although double eyelid surgery seems simple, it comes with numerous complications. These complications can be divided into disordered complications and esthetic complications. Plastic surgeons pay more attention to the esthetic aspect. In our long-term clinical work, we have repeatedly observed that many patients with overactive facial muscles (frontalis muscle or corrugator supercilii muscle) often develop esthetic complications after surgery. These patients present with an appearance of a double eyelid fold that is either too high, too low, or absent. However, some plastic surgeons have not realized this, and most of them believe that esthetic complications are caused by improper techniques during surgery. Therefore, it is necessary for us to share our experience in this field with our peers.

Full-Incision Double-Eyelid Blepharoplasty with Selective Neurovascular Preservation Method.

BACKGROUNDS: Double-eyelid blepharoplasty remains popular in east Asia. To avoid rigid eyelids and sinking scar after double-eyelid blepharoplasty, a new surgical approach with selective neurovascular preservation (SNVP) method is proposed to crease more physiological and dynamic double-eyelid crease. METHODS: During the full-incision double-eyelid surgery, a strip of preseptal orbicularis oculi muscle was resected. The longitudinally spreading upper eyelid nerves and vessels were preserved carefully. Four to five anchoring points between these neurovascular branches were made to reach the pretarsal fascia. Skin- orbicularis oculi muscle-pretarsal fascia sutures were placed on the anchoring points. RESULTS: From May 2018 to April 2020, 385 patients received double-eyelid surgery with SNVP method. Eyelid edema resolved quickly within a week and generally disappeared in 4 weeks. In total, 259 (67.27%) patients scored very satisfied, and 109 (28.31%) patients scored satisfied on six-month follow-up. CONCLUSIONS: The SNVP approach can produce reliable and dynamic palpebral crease with inconspicuous scar. Vital neurovascular branches of upper eyelid could be saved, thus reducing postoperative complications and recovery period. 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 .

Asian Blepharoplasty: The Indian Perspective.

The upper eyelid crease is an indentation at the level where fibers from the levator aponeurosis insert into the skin. Typically, Asian eyes are described as creaseless and puffy and the aim of blepharoplasty is to achieve an eyelid crease, without losing the ethnicity of the individual. We aim to describe the most commonly performed technique as well as the peculiar points to be kept in mind from the Indian perspective.

Unsatisfactory Upper Blepharoplasty Revision Technique: Reconstruction of the Upper Orbital Septum and its Fusion Point.

BACKGROUND: The orbital septum prevents both superficial eyelid infection and the spread of bleeding into the orbit. The fusion point between the upper eyelid orbital septum and the levator aponeurosis or the tarsal plate plays an important role in determining the width of the natural double eyelid. We observed a number of unsatisfactory upper eyelid blepharoplasty outcomes resulting from improper handling of the orbital septum-such as excessive destruction of orbital septum tissue and failure to form a firm attachment point between the orbital septum and the levator aponeurosis or palpebrae plate-during primary surgery. OBJECTIVES: The three most common types of unsatisfactory upper blepharoplasty outcomes include abnormally high double eyelid creases, multiple creases, and disappearance of creases. In the repair operation, we try to determine the remaining orbital septum tissue for reconstruction and form a firm attachment between the orbital septum and the levator aponeurosis or tarsal plate. Follow-up after surgery was performed to observe whether our technique can ensure effective and favorable long-term natural-looking upper eyelid blepharoplasty outcome. METHODS: From January 2018 to January 2020, secondary blepharoplasty involving the above-mentioned unsatisfactory double eyelid results was performed in 83 patients, including 63 patients (141 eyes) with abnormally high skin creases, 6 patients (8 eyes) with multiple creases, and 14 patients (24 eyes) with double eyelid disappearance. The outcomes were assessed 6 months to 2 years after the surgery by reviewing the photographs to evaluate the esthetic outcomes including stability of double eyelid, double fold curve, symmetry, patient satisfaction, and the incidence of complications. RESULTS: After an average follow-up of 12 months, most patients achieved a better double eyelid appearance. The esthetic outcome was graded as good in 80 patients, poor due to recurrence of double eyelid disappearance in 2, and poor because of asymmetry of the double eyelid curve in length or width in 1 patient. All patients had acceptable scars. No cases of infection or ptosis were observed. CONCLUSION: Reconstructing the orbital septum and ensuring a firm fixation with the levator aponeurosis or tarsal plate is an effective method to repair unsatisfactory upper eyelid blepharoplasty. Moreover, it is very important to protect the orbital septum and proper treatment during the initial surgery. 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 .

Mini-incision Blepharoplasty with Pretarsal Fasciectomy for Double-Eyelid Surgery.

BACKGROUND: Double-eyelid surgery has been one of the most popular aesthetic surgeries in oriental populations. The objective of this study was to introduce a simple procedure for double-eyelid surgery. METHODS: The mini-incision blepharoplasty with pretarsal fasciectomy technique is described and illustrated. Blepharoplasty cases in our practice from June 2018 to December 2019 were retrospectively reviewed. Patients who underwent mini-incision blepharoplasty with pretarsal fasciectomy were followed up for at least 6 months. RESULTS: Of 280 blepharoplasty cases, 32 patients underwent mini-incision blepharoplasty with pretarsal fasciectomy on both upper eyelids. Nineteen patients experienced resolve of swelling within 5 days postoperatively. No loss of fold was observed during follow-up. The satisfaction rate was 93.8%. CONCLUSIONS: The mini-incision blepharoplasty with pretarsal fasciectomy is ideal for selected patients requesting double-eyelid surgery. It provides stable, natural, scarless result with minimum complication and rapid recovery. LEVEL OF EVIDENCE: IV.

Supraciliary Incision as a New Double-Eyelid Approach for Asian Patients: Clinical Experience of 528 Cases.

BACKGROUND: The double-eyelid operation is the most requested cosmetic surgery in Asians. The incision is usually located at the pretarsal skin 6 mm to 8 mm above palpebral margin. The purpose of this paper is to report a novel approach of double-eyelid operation through a supraciliary incision (SCI). METHODS: Three transverse curved lines were drawn on the upper lid skin. The location of line 1 (SCI) was 1.5 mm above the eyelash, line 2 according to the amount of redundant skin excised and line 3 at 3 mm to 4 mm above line 2. After the incisions were made between line 1 and line 2, the subcutaneous dissection is carried out over 5 mm the line 3. Then, the redundant skin and a strip orbicularis oculi muscle were removed to open the orbital septum and to explore underside levator aponeurosis. Along the line 3, the internal buried fixation sutures between dermal tissue and the fusion line of the orbital septum and levator aponeurosis were placed. Finally, the wounds were closed between line 2 and line 1. RESULTS: There were 528 patients who underwent the double-eyelid operation through the supraciliary approach. In long-term follow-up, 288 patients were evaluated at 6 months to 78 months postoperatively. Of those, 266 patients were satisfactory for the result (92.36%) with natural shape and invisible surgical scar. In another 22 patients (7.63%), a revised blepharoplasty was performed in 22 eyelids. CONCLUSION: The double-eyelid surgery using the SCI has several advantages including less visibility of the incision, the protected subdermal vascular network, the intact continuity of the upper eyelid skin, the combination of the SCI and internal dermal buried suture method. The approach can be considered an efficient technique for Asian patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Palpebral Marginal and Traditional Incision Techniques for Double-Eyelid Surgery.

BACKGROUND: The palpebral marginal incision technique is a novel method for double-eyelid surgery. However, studies comparing palpebral marginal and traditional incisions are scarce. We aimed to compare the two techniques with respect to post-operative patient satisfaction and complications. METHODS: This retrospective analysis included 422 patients who underwent double-eyelid surgery with either the palpebral marginal incision or traditional incision at the Medical Cosmetology Department of Tianjin Eye Hospital from February 2015 to September 2018. Patients were divided into the palpebral marginal (n = 280, 66.4%) and traditional incision (n = 142, 33.6%) groups. Patient satisfaction at 3 and 6 months post-operatively and incidence of complications were compared between the groups. The average post-operative follow-up duration was 6.75 months. RESULTS: The palpebral marginal incision group was younger than the traditional incision. There were no significant differences in sexes between the groups. Compared with the traditional incision group, the palpebral marginal incision group had greater patient satisfaction at 3 months post-operatively. Patient satisfaction at 6 months post-operatively and total incidence of complications were similar between the groups. Incidence of hypertrophic scar formation was lower in the palpebral marginal incision group. Other complications showed no significant between-group differences. CONCLUSIONS: The palpebral marginal incision technique has similar surgical outcomes to the traditional incision technique. Our findings confirm that the advantages of the palpebral marginal incision technique include almost indiscernible surgical scarring and faster post-operative recovery, which may result in increasing popularity among young people. Therefore, we suggest that the palpebral marginal incision technique is reliable and worthy of recommendation. 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.

Aesthetic Analysis of Alteration of Eyebrow Position After Double Eyelidplasty.

BACKGROUND: There is an anecdotal belief among some surgeons performing Asian eyelid surgery that double eyelid surgery itself decreases eyebrow position. However, the exact amount of descent and the specific changes in the proportion of facial aesthetics are unknown. PURPOSE: The goal of this study is to determine whether there indeed is a change in brow position after double eyelidplasty and to quantify the proportional differences associated with the change. The three-point double eyelids surgery method was used so that the change in the brow position is solely attributed to the surgery itself and not to the excision of redundant skin. METHODS: From January 2016 to December 2017, double eyelid surgery using the three-point technique was performed on 204 patients who did not require skin excision. Their pre- and postoperative photographs were standardized and analyzed. The ratio of the length between the upper edge of the eyebrow and the edge of the lower eyelid (A) and the length between the edge of the lower eyelid and the nasal base (B) as well as the subsequent change in the midfacial proportion was measured and analyzed. RESULTS: There was a statistically significant brow descent after double eyelidplasty. The average preoperative A/B was 0.71 and the average postoperative A/B was 0.67 (P < 0.001). Although the eyebrow distance did not change in 32.5% of patients, the remaining cohort showed average brow descent of 5.6%. And in this cohort that showed descent, linear regression showed that there was a correlation between the ratio of pre- and postoperative eyebrow distance CONCLUSION: Double eyelid surgery can lower the eyebrow in patients with foldless eyelids. This is in accordance with clinical observation in Asian blepharoplasty. In addition, there are associated changes in the proportion of midfacial aesthetics after the surgery. Such knowledge can be helpful in preoperative consulting with patients as well as in predicting postoperative results. 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.

The Epidemiology and Clinical Features of Blepharoptosis in Taiwanese Population.

BACKGROUND: Blepharoptosis describes a condition of low-lying upper eyelid that may affect individuals of all ages under various etiologies. It may be of congenital or acquired form by the timing of onset or be divided into myogenic, neurogenic, aponeurotic, or mechanical types according to the mechanism. Our goal was to report the characteristics of age-specific blepharoptosis and to analyze the association between levator function (LF) and ptosis severity of each ptosis subtype. MATERIALS AND METHODS: The retrospective, single-center, cross-sectional study consisted of patients diagnosed with blepharoptosis in the plastic surgery practice at a medical center between September 2009 and May 2017. We reported patients' age at presentation, sex, laterality of ptosis, etiology, classification, and evaluation of ptosis including levator function and ptosis severity. RESULTS: During a nine-year span of study, a total of 1975 eyelids of 1164 Taiwanese patients aged between 2 and 88 years were enrolled in the research (mean = 57.73 ± 13.41 years). The female-to-male ratio was 2.72 (95% confidence interval [CI]: p < 0.0001). Acquired blepharoptosis and bilateral blepharoptosis were more frequently observed (55.85%, p < 0.0001 and 69.67%, p < 0.0001, respectively). In age-specific relative incidence of blepharoptosis, myogenic ptosis was the majority in patients younger than 40 years. Early onset of aponeurotic ptosis was observed in young contact lenses wearers. Aponeurotic blepharoptosis was the predominant type of ptosis in the senior population older than 40 years (p < 0.0001). Among the subtypes, mechanical ptosis had the most preserved LF (p < 0.0001). LF and MRD1 had statistically positive correlations in all subtypes of blepharoptosis, in which neurogenic ptosis demonstrated the severest levator dysfunction for each millimeter in MRD1 reduction. CONCLUSIONS: Of the 1164 Taiwanese patients, blepharoptosis had a higher propensity for female gender and the age between the second to fourth decades. Bilateral involvement of blepharoptosis with acquired type was frequently diagnosed. Myogenic ptosis had a preponderance in age younger than 40 years, while aponeurotic ptosis usually affects senile population. Many mild degree myogenic ptosis was simultaneously recognized in young-aged adults seeking aesthetic double eyelid surgery. Early onset of acquired aponeurotic ptosis was also observed in contact lens wearers given the trend of decorative contact lens use. Levator dysfunction was implicated in the pathology of not only myogenic ptosis but aponeurotic, mechanical, and neurogenic ptosis. Moreover, levator function of neurogenic ptosis was most severely impacted in each MRD1 reduction among all subtypes of blepharoptosis. 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 .

Application of 4+ 1 photography in determining the end point of double eyelid surgery / 中华整形外科杂志

Objective@#To explore the practicability and reproducibility of judgment method and assessment indexes for the end point of double eyelid surgery using 4+ 1 photography in supine position.@*Methods@#From 2017 October to 2018 October, 158 patients were included and randomly divided into 2 groups. Photos were taken by 4 + 1 photography in supine position of 79 patients, while other 79 patients in control group were evaluated by traditional observation. By 4+ 1 photography in supine position, the surgeon stood at the head side of the patient, taking photos with eyes movement: looking straight forward, looking up, looking downward and eye-closed. It was to observe the upper eyelid creases, upper and lower tissues of double eyelid creases, and upper and lower eyelid margo palpebrae. In addition, the surgeon looked from patient′s feet to observe the indexes such as upper margo palpebrae, to make a decision whether the surgery could finish. In control group, the surgeon observed the upper eyelid creases, upper and lower tissues of double eyelid creases and upper and lower eyelid margo palpebrae. The patient has to sit if necessary.@*Results@#All 158 patients were performed double eyelid surgery successfully. Average times of valuating end point was 1.20 by 4+ 1 Photography in supine position, and 1.53 in control group. The operation time of 4+ 1 photography group is (151.65±21.58) s, and control group were (241.53±33.53) s. The satisfaction level was increased to 89.87% in 4+ 1 photography group, compared to 78.48% in control group.@*Conclusions@#The 4+ 1 Photography method is simple and easy to practice. The observation indexes are accurate and comprehensive. It is useful in determining the end point of double eyelid plasty in supine position.

[Effectiveness of retro-orbicularis oculi fat resection in Park double eyelid surgery to correct swollen upper eyelid].

Objective: To investigate the effectiveness of retro-orbicularis oculi fat resection in Park double eyelid surgery to correct the swollen upper eyelid. Methods: Between September 2015 and July 2016, partial resection of the retro-orbicularis oculi fat was performed on 32 cases with bilateral swollen upper eyelids in Park double eyelid surgery. There were 10 males and 22 females with an average age of 25 years (range, 19-32 years). The patients had normal function of the levator muscle, and had no history of double eyelid surgery. Results: All the incisions healed by first intention. There was no obvious congestion, swelling, levator muscle dysfunction. All patients were followed up 2-14 months, with an average of 10 months. The double eyelid fold was naturally smooth, without depressed scar; blepharochalasis was obviously improved, and the function of upper eyelid levator muscle was normal. All patients were satisfied with the aesthetic effect. Conclusion: Park double eyelid surgery and partial resection of retro-orbicularis oculi fat can effectively improve the aesthetic effect in patients with swollen upper eyelid, and can achieve the perfect function and appearance.

The Evolution of Looks and Expectations of Asian Eyelid and Eye Appearance.

Since Mikamo developed the double blepharoplasty technique at the end of the 19th century, there has been significant developments in the idealized periorbital appearance of the Asian patient. Currently there are four potential vectors of change possible (upper, lower, medial, and lateral). South Korea is the only country that most often utilizes the change in all four vectors. There is additionally a stark contrast between Asia-based and Western-based approach to the Asian eyes. In Asia, outside of South Korea, many surgeries employ a combined vertical upward vector and a medial directional change, particularly for the young eyes. In Western-based approaches, Asian blepharoplasty remains at this time primarily an open incision, upward vector change.

Curative effect analysis of three methods of epicanthus combined with small incision for double eyelid surgery / 局解手术学杂志

Objective To explore an effective and hidden incision scar method for epicanthus correction. Methods 80 patients of bi-lateral single eyelid with epicanthus were divided into group A,group B and group C. Twenty-five patients with 50 eyes of group A received“Z” plasty correction of epicanthus,25 cases with 50 eyes of group B received the traditional“Y-V” plasty correction of epicanthus,30 cases with 60 eyes of group C treated with modified “Y-V” plasty correction of epicanthus. The curative effective was observed. Results Three groups were followed up for 6~24 months, the appearances of 25 patients in group A were significantly improved,of whom 2 cases had uni-lateral recurrence,8 cases with obvious postoperative scar. The eyelid shapes of patients in group B were natural after surgery,12 cases with obvious scar. all patients in group C were found no postoperative hypertrophic scars. Conclusion The three surgical treatment were effec-tive for epicanthus,but the design approaches of“Z” plasty correction and“Y-V” plasty correction are more complex,and postoperative scar is obvious,meanwhile the modified “Y-V” plasty correction is simple with incision hidden good shape scar formation.

Oriental upper blepharoplasty.

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.

Cosmetic Double Eyelid Surgery: Single 5 mm-Partial Incision Method

In Asian double eyelid surgery, there have been two approaches to form a suprapalpebral fold: the buried suture (nonincision) method and the full external incision method. Usually excessive fat tissue in upper eyelid has been removed by using a full external incision method, or 2 to 3 partial incisions with buried suture method. The full external incision method is more invasive than the buried suture method, which is not suitable for patients with excessive orbital fat. From March 1999 to January 2002, we have introduced the single 5 mm-partial incision method to 216 patients. This method is applied to patients who have excessive amount of orbital fat or those who do not have excessive orbital fat but which must be removed for better result. These patients have bulging supra-crease areas when we form suprapalpebral folds with a curved wire loop preoperatively. Excessive orbital fat was removed through a single 5 mm incision in the middle of designed eyelid crease and tarso-dermal suture was performed. At another 2 to 3 points, through skin stab punctures by using 18 gauge needle, full-thickness eyelid tarso-dermal sutures were done. Pretarsal and preseptal orbicularis muscles were preserved. If muscles were removed, that could result in thinning of the overlying skin and could make suprapalpebral fold unnatural. This method has several advantages. First, we could perform the operations safely in patients who have excessive fat tissue, without a full external incision. Second,fat tissue can be removed almost totally by a single 5 mm-partial incision. Third, we can minimize the scar formation, and the possibility of complications, and make healing process and operation time shorter compared to the full incision technique. However a very delicate technique is required in this method. In patients who have a thick orbital septum, a superiorly located fat pad, and a bleeding tendency, exposure of fat tissue could be difficult and injury of levator muscle aponeurosis is possible. The complications of this method are the possibility of disappearing of the crease with the lapse of time(3 percents), and suture granuloma formation(less than 1 percent). In conclusion, patients who have excessive fat tissue in upper eyelid don't have to proceed a full incision, and can have more excellent results with this single 5 mm-partial incision method.