Ординатура / Офтальмология / Английские материалы / Asian Blepharoplasty and the Eyelid Crease_Chen_2006

18M, 5′7″. Rudimentary crease OD (right eye), has distinct NTC, LUL.

I/O: tarsus 7.5mm. The rudimentary crease of RUL measured 7mm. Designed NTC at 7mm + 2mm skin. Reduced fat; excised orbicularis overlying along the

STB. Medially there was a small web – this was excised and deep placed 6/0 suture through skin as well as orbicularis to form crease without a medial canthal web.

43F, 5′4″. Wanted parallel crease. Had more skin over RUL and OD fissure smaller size. LUL has a higher pseudocrease.

I/O: used hyaluronidase with 2% xylocaine. Tarsus measured 8 mm. Designed 8 mm parallel crease. Over RUL removed 5 mm segment of skin. Fat untouched. Upon closure of wound, crease now measured at 6 mm. Therefore, redrew LUL crease to be at

6.5mm, and this side remained unchanged after the procedure.

Conclusion: Hyaluronidase can expand tissue plane and spread out the skin such that 8mm marking in reality covered 6mm of skin. The second eye, LUL done 30 minutes later showed no variation in crease position with closure of wound.

24F born without crease, but ‘developed’ mild NTC OD, and hooded and low-set NTC OS. For crease enhancement.

I/O: 7.5mm tarsus.

RUL designed 7.5mm crease + 2mm redundancy; excised inferior orbicularis strip and fatty infiltrate.

Beware of fixating crease along a dehisced edge of the levator aponeurosis as it will probably lead to a higher than expected crease. Should stay along superior tarsal border.

LUL same finding as RUL.

57F, slight ptosis RUL, covers 2 mm cornea. Heavy edematous RUL, moderately heavy LUL. Small fissures OU. Heavy brows.

I/O: I was not able to evert tarsal plate to measure it. Designed 7mm parallel crease. Found large amount of amorphous fibro-mosaic fat inferiorly to pre-

aponeurotic fat (which itself was inferiorly placed). Excised fat. Reinforced the usual crease fixation sutures of 6/0 silk with one double-armed 6/0 Vicryl suture, applied from pretarsal skin to aponeurosis to pretarsal skin.

23F absent crease, smaller fissure OD, 5′0″, prefers parallel crease. Had mild medial canthal fold (A).

I/O: tarsus floppy and measured 6 mm only. Designed 6mm parallel crease.

RUL had large sheet of amorphous preaponeurotic fat, down to below the superior tarsal border. This was dissected off of the underlying shiny healthy aponeurosis, and excised. Excised larger than usual amount of myocutaneous strip, which appeared boggy from fatty infiltration of the orbicularis muscle.

Treatment of Medial Canthal Fold

Small redundant of ‘dog-ear’ over the medial end of the crease wound is based along the lower border. It

was overlapped onto the upper skin edge and excised appropriately. The two edges are then anchored with 6/0 silk. The bite along the upper skin edge is exaggerated in terms of the amount of skin taken as well as the depth of the orbicularis that is secured. The knot is pulled and tied onto the upper side of the wound. It will then heal imperceptibly, as the edges are perfectly aligned and without tension.

LUL: also excised larger strip of mycocutaneous tissues. Medial dog-ear similarly treated.

(B) One week postoperative appearance.

22F, intermittent creasing over RUL, LUL never creases and has smaller fissure. Prefers parallel crease with lateral flare. Levator function OD 9 mm, OS 12– 13mm. 5′3″ (A).

I/O: tarsus 8 mm. Designed minimally tapering parallel crease, plus 2mm redundancy. Excised mod-

erate amount of preaponeurotic fat that migrated over the STB, although it was not apparent clinically on preoperative examination. Excised M/C strip.

(B) One week postoperative appearance.

34F with mild lid retraction. Upper lid margin at superior corneal limbus. Had rudimentary multiple partial lines OU. Wanted NTC. 5′3″.

I/O: tarsus 9mm. Used 7mm and designed NTC, + 2 mm skin. RUL has 3+ fat over lateral 2/3 of lid,

LUL 2+ fat lateral 2/3 of lid. The inferior orbicularis was very vascular over the lateral end of the incision.

27F, high brows, moderate fat OU, large eyes with OS being larger. 5′7″. Desires NTC.

I/O: designed 6.5mm NTC OU. Found amorphous fat and preaponeurotic fat close to STB; they were

reduced. Also excised a strip of fibroadipose tissue along the anterior aspect of the STB. Formed crease with 6/0 and 7/0 silk.

28F absent crease, desires low-set NTC. 5′3″. Had severe brow overaction with some head-tilt backward position (A).

I/O: tarsus 8 mm. Designed 7.5 mm + 2 mm skin redundancy. Had prominent preaponeurotic fat

requiring excision OU. Had abundant soft, mosaic tissue redundancy along the STB which was excised.

(B) One week postoperative appearance.

23F wears lid crease tape constantly for her RUL, and occasionally for LUL. Has hooded shielded skin over lateral RUL, and incomplete non-joining crease lines over lateral pretarsal area of LUL. Prefers NTC (A).

I/O: tarsus 7.5mm. Designed 7mm NTC.

RUL: reduced significant preaponeurotic fat; excised a band of fibroadipose tissue along the STB.

LUL: rechecked drawn crease to ensure it is 7mm. Same procedure as RUL.

(B) One week postoperative appearance.