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

Plastic Surgery Department, Beijing Chao-yang Hospital, Capital Medical University, # 8 Baijiazhuang Road, Chao Yang District, Beijing, 100020, China.
Aesthetic Plastic Surgery (Impact Factor: 0.96). 06/2009; 33(3):421-5. DOI: 10.1007/s00266-009-9344-x
Source: PubMed


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: In double-eyelid surgery, the dynamic connection of the levator aponeurosis and skin or derma is reconstructed with the formed scar or the ligated suture. The nonincision method can shape a natural and vivid crease with a short recovery time. However, the duration of the supratarsal crease formed by the ligated suture in the nonincision method is not long. A transcutaneous, subcutaneous, and intratarsal suturing technique was adopted. Five stab incisions were made in the designed double-eyelid line. A needle pass was made with a 7-0 nylon suture from the tarsal plane deeply and the dermis superficially. After tightening the suture and burying the four ligations under the skin, the supratarsal crease was formed. Between October of 2003 and November of 2008, we used the transcutaneous, subcutaneous, and intratarsal suturing technique for 118 patients with a single-eyelid appearance. One hundred six of these patients underwent follow-up ranging from 3 to 36 months. Most of these patients [95 of 106 patients (89.6 percent)] were satisfied with the outcome; 11 patients (10.4 percent) expressed dissatisfaction. Of the latter, the unilateral double eyelid of three patients (2.8 percent) regressed; five patients (4.7 percent) expressed dissatisfaction with the shape and height of the formed double-eyelid line; and mild asymmetry of the formed eyelid appeared in three patients (2.8 percent). The authors found that the transcutaneous, subdermal, and intratarsal suturing technique was successful in producing a natural supratarsal crease shape that permitted easy control. The authors also observed that even though one single knot may be loose or tight, it does not influence the final result.
    Plastic and Reconstructive Surgery 12/2010; 126(6):2133-9. DOI:10.1097/PRS.0b013e3181f44a96 · 2.99 Impact Factor
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    ABSTRACT: BACKGROUND: The surgical procedure aimed at constructing the upper eyelid crease is the cosmetic operation most commonly requested by Asian patients. The incisional approach leaves a permanent crease, but the swelling period can last longer than 3 months, and a distinct scar usually is unavoidable. Many mini-incisional techniques with incisions of varying sizes and locations have been developed, but the removal of pretarsal tissue has not been sufficient because these procedures wipe out only small pockets of soft tissue immediately inferior to skin for placement of the suture. Thus, the formed double eyelid may not be durable. The technique the authors introduce is a modified mini-incisional technique that combines the benefits of both the incisional and the usual mini-incisional methods. METHODS: Three 3- to 4-mm mini-incisions were made on each upper eyelid. The orbicularis muscle was isolated carefully from the skin and then cut off as much as possible in three directions: down (toward the palpebral margin), left, and right. Finally, the three incisions were sutured, and a vivid fold was created. This technique was applied for 110 patients. The follow-up period ranged from 3 to 12 months. The patients were welcomed for further treatment if any problems occurred at any time. An extra 3 years of follow-up evaluation was applied for 24 patients (46 cases) to assess the long-term maintenance of the fold. RESULTS: This study enrolled 110 patients (212 cases). A natural-looking skin fold appeared after the edema period. The scar was not obvious. Disappearance of the fold was not found in any case during 3-12 months (mean, 9 months) of follow-up evaluation. Obvious shifting of the fold was found in four cases during the additional 3 years of follow-up evaluation, but disappearance of the fold was not found in any case. CONCLUSION: This modified technique was found to be successful in developing a natural-appearing, long-lasting suprapalpebral fold with an inconspicuous scar. It combines the best of both the open and usual mini-incisional techniques. Because a large amount of pretarsal soft tissue is removed, the double fold is less likely to fade away. 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 .
    Aesthetic Plastic Surgery 08/2012; 36(5). DOI:10.1007/s00266-012-9950-x · 0.96 Impact Factor
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