Ординатура / Офтальмология / Английские материалы / Asian Blepharoplasty and the Eyelid Crease_Chen_2006
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Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
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Case 18 (Fig. 14-18 A–F)
Steps showing a typical Asian blepharoplasty. (A) On the right upper lid the lower line of the lid crease incision is placed according to the measured central height of the tarsus. (B) The upper and lower incision is made with a no. 15 blade. (C) The orbital septum is opened transversely over the upper edge of the inci-
sion. Preaponeurotic fat pads are trimmed appropriately. (D) After fat removal. (E) A very small amount of the pretarsal and preseptal orbicularis muscles is trimmed (left upper lid). (F) The lid crease wound is closed using five to six interrupted 6/0 nylon sutures followed by a continuous 7/0 nylon suture.
A
B
Asian Blepharoplasty and the Eyelid Crease
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Case 18 (Fig. 14-18 A–F)—cont’d
C
D
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
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Case 18 (Fig. 14-18 A–F)—cont’d
E
F
Asian Blepharoplasty and the Eyelid Crease
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Case 19 (Fig. 14-19 A, B)
(A) A 55-year-old woman with a rudimentary crease on the right upper lid. (B) During surgical exploration the right upper lid showed a lower point of fusion of
the orbital septum, all the way down to the pretarsal region. Fat pads were noted in the preseptal and pretarsal regions.
A
B
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
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Case 20 (Fig. 14-20 A–F)
(A) A 30-year-old patient; preoperative views. (B) Postoperatively following Asian blepharoplasty.
(C, D) Left upper lid before-and-after views. (E, F) Right upper lid before-and-after views.
A
B
Asian Blepharoplasty and the Eyelid Crease
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Case 20 (Fig. 14-20 A–F)—cont’d
C
D
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
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Case 20 (Fig. 14-20 A–F)—cont’d
E
F
Asian Blepharoplasty and the Eyelid Crease
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Case 21 (Fig. 14-21 A–C)
(A) A patient with absence of a crease over the right upper lid. (B) Two months after Asian blepharoplasty; minimal edema is still present. (The patient is fix-
ing his gaze on the camera’s flash unit on top rather than at the lens aperture.) (C) Appearance 4 months postoperatively.
A
B
C
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
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Case 22 (Fig. 14-22 A, B)
26F with heavy fat pads laterally, slightly triangular, and a small fissure. Wants a low-set NTC.
I/O (intraoperatively): tarsus 6.5mm. Had a heavy bed of fat overlying along the superior tarsal border. Required a U-shaped ‘square well’ debulking of the fat overlying the STB (superior tarsel border); excised lateral preaponeurotic fat, and reduced sub-brow fat.
For a right-handed surgeon the tendency is to excise the myocutaneous strip of the right upper eyelid starting from the lateral end; this has a tendency to be shallow laterally as you proceed medially, therefore more tissue is left behind laterally and there is a higher likelihood of partial obliteration (regression) of the crease there.
A
B
Asian Blepharoplasty and the Eyelid Crease
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Case 23 (Fig. 14-23 A–C)
20F, single lid, with lateral two-thirds hooding. The patient desired a parallel crease (A).
I/O: tarsus 8mm. As she was 5′2″ tall I used 7mm in designing a parallel crease. Most of the preaponeurotic fat was excised. (B) Ten months later the RUL (right upper lid) crease had not formed well, the LUL (left upper lid) was perfect and parallel.
(C) Postoperatively following crease enhancement on right upper lid.
During the touch-up enhancement I designed a 7mm parallel line +1.5mm, which included the old scar. Excised M/C strip of scarred skin. Levator appeared thin for her age, although she was without ptosis and had excellent levator function. Some fatty tissue over the medial extent of the parallel crease was excised to help the infolding. Multiple 6/0 interrupted sutures were applied for crease construction.
A
B
C