A Two-Way Continuous Buried-Suture Approach to the Creation of the Long-Lasting Double Eyelid: Surgical Technique and Long-Term Follow-Up in 51 Patients
ABSTRACT Although it is seldom reported in the Western literature, the buried-suture operation to create a double eyelid is very popular in Asia. However, the buried-suture methods are traditionally associated with a high recurrence rate. Corneal damage and exposed conjunctiva suture are also possible.
The two-way continuous buried-suture approach was applied in double-eyelid operations. With seven to nine stab skin wounds on the upper eyelids, a continuous single-armed suture is passed through the dermis as well as the superficial part of the tarsus. Then the needle is inserted in the opposite way. Both ends of the suture are tied within the far lateral incision. The operation takes no longer than 20 min. The scars of the stab incision were no longer visible after several months postoperation.
From August 2003 to January 2008, 51 patients underwent this technique. All patients have been satisfied with their appearance after their initial surgery except two patients who had minimal associated morbidity. No disappearance of the formed double eyelids or corneal damage occurred.
The two-way continuous buried-suture approach is a simple method for establishing a long-lasting double eyelid. The results are durable and the potential for corneal injury is reduced.
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ABSTRACT: BACKGROUND: In recent years, many mini-incisional techniques for double-eyelid plasty have been developed. However, the removal of pretarsal tissue has not been satisfactory because only small pockets of soft tissue just inferior to the skin have been removed to place the suture. The formed double eyelid may therefore not be durable. This report introduces a modified mini-incisional method that involves removing a long uncut strip of orbicularis through three mini-incisions. METHODS: A strip of orbicularis uncut from the inner canthus to the outer canthus was removed through three mini-incisions made on the upper eyelid, quite similar to that of a full incisional procedure. The left orbicularis then was pruned in three directions: left, right, and down (toward the palpebral margin). Finally, the incisions were sutured, and a vivid fold was created. RESULTS: From 2008 to 2012, the authors applied this technique to 90 patients (174 eyes). Although the trauma may have been more severe due to a large amount of orbicularis removed, including an uncut strip of orbicularis, bleeding during the operation was easy to control and usually very limited. The edema period for most patients ended within 3 weeks, mainly because of the skin bridge between each incision. The scars became unnoticeable after 3-6 months. Disappearance of the fold was not found in any case at either the 3- or 12-month (average, 9-month) follow-up evaluation or during the 4-year follow-up period. CONCLUSION: The described technique combines the advantages of both full incisional and the usual mini-incisional techniques in developing a long-lasting suprapalpebral fold with inconspicuous scars and a short recovery period. LEVEL OF EVIDENCE V: Opinions of respected authorities, based on clinical experience,descriptive studies, or reports of expert committees.Aesthetic Plastic Surgery 01/2013; 37(1). DOI:10.1007/s00266-012-0028-6 · 1.26 Impact Factor
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ABSTRACT: BACKGROUND: Double-eyelid blepharoplasty is performed using two alternative approaches: the incision method and the suture method. Buried suture double-eyelid blepharoplasty involves implantation of a foreign material, that is, the suture thread. Therefore, potential complications caused by foreign material should be considered. This article presents two modified techniques to decrease some suture-related complications of buried suture double-eyelid blepharoplasty. METHODS: A retrospective study was conducted on 349 consecutive patients who underwent buried suture double-eyelid blepharoplasty between June 2002 and December 2010 using two novel techniques modified by the author. One of the modified techniques used was the transconjunctival tarsal fixation technique without penetrating the tarsal plate. The conjunctival fixation site for the buried suture method was the anterior surface of the superior tarsal border. The other technique was buried suture double-eyelid blepharoplasty combined with resection of the pretarsal orbicularis oculi muscle through a small skin incision. RESULTS: No conjunctival complications, such as chronic inflammation of the tarsal plate or suture extrusion, were observed with the transconjunctival tarsal fixation technique without penetrating the tarsal plate. The loss rate of the double-eyelid fold after buried suture double-eyelid blepharoplasty combined with resection of the pretarsal orbicularis oculi muscle (9.6%) was lower than the loss rate after buried suture double-eyelid blepharoplasty alone (26%). This result highlights the benefits of resection of the pretarsal orbicularis oculi muscle, although the rate of blepharoptosis potentially increases. CONCLUSIONS: The transconjunctival tarsal fixation technique without penetrating the tarsal plate is simple and decreases the incidence of suture-related complications associated with buried suture double-eyelid blepharoplasty. Resection of the pretarsal orbicularis oculi muscle enhances the durability of the double-eyelid fold after buried suture double-eyelid blepharoplasty.Journal of Plastic Reconstructive & Aesthetic Surgery 12/2012; 66(4). DOI:10.1016/j.bjps.2012.11.019 · 1.47 Impact Factor
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ABSTRACT: Increasing numbers of Asian patients of varying ethnicity are expressing preferences and expectations for a specific aesthetic appearance following double eyelid surgery. Those of Northern Mongolian ethnicity (Northern Chinese, Japanese, or Korean heritage) generally prefer a narrow crease, whereas those of Southern Mongolian ethnicity (Indonesian, Filipino, or Malaysian) prefer a wider fold. Older techniques performed until the mid-1990s resulted in a deep fold, giving the patients a more "Western" appearance. In this article, the author describes a modified technique of placing the suture in the subdermal layer, which allows for variety in the width of the fold, enabling the surgeon to retain anatomical aspects that are typical of each patient's ethnicity. With this technique, an Asian patient may now choose the width of fold that he or she prefers, resulting in a more ethnically natural look.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 05/2013; 33(5). DOI:10.1177/1090820X13488389 · 2.03 Impact Factor