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

28F, uses lid crease tape and make-up to help crease formation. Pretarsal skin is pink from taping. Desires parallel crease (A).

I/O: tarsus 8.5 mm. Designed 7.5 mm parallel crease. Preaponeurotic fat appeared fibrotic and inferiorly located. Reduced with Wetfield bipolar cautery.

Mycocutaneous strip, which was very vascular, was excised. The crease may look broader on one side than the other during the immediate healing period due to hematoma.

(B) One week postoperative appearance.

35F Upper lid hooding with shielded NTC. Desired a more prominent crease. 5′5″.

I/O: tarsus 7.5mm. Designed same 7.5mm NTC + 2 mm skin. (Beware of tendency of right-handed

surgeon or right-eye dominant individual to mark the LUL crease’s lateral extent shorter than it should be. Always compare both sides.)

18F absent crease with mild ptosis, more over the left side. Desires standard height NTC. 5′3″.

I/O: tarsus 8 mm. Designed 7.5 mm NTC. Removed fraction of fat. Had to lyze some adhesion between the inferior skin edge and orbicularis to the

aponeurosis along the STB, in order to better place the 6/0 silk.

LUL: medial canthal dog-ear treated with direct excision of inferior dog-ear and supraplacement of suture knot.

21F absent crease, with medial canthal fold. Prefers parallel crease with average height.

I/O: tarsus 7 mm. Designed 7 mm parallel crease. Large amount of inferiorly migrated preaponeurotic

fat was reduced with bipolar cautery. Large roll of subcutaneous intraorbicularis fat along the STB was excised. Used multiple 6/0 interrupted sutures to enhance crease construction.

26F, RUL has no crease, LUL has a shallow low pseudo-crease line at 3mm from lashes. 5′4″. Desires NTC (A).

I/O: tarsus 7 mm. Designed 7 mm NTC + 2 mm skin. Partial excision of preaponeurotic fat OU.

(B) RUL formed crease well.

LUL medial half required additional reinforcement with 6/0 interrupted sutures.

19F, uses glue over pretarsal skin for crease formation. Heavily hooded lid with fat. 5′5″. Prefers NTC

(A).

I/O: tarsus 7.5 mm. Designed 7 mm NTC OU + 2mm skin. Used beveled approach to orbital septum.

RUL had abundant fat which required partial excision. Formed crease at 7mm.

LUL: also excised part of fat. The crease thus formed appeared shifted down to 6.5mm. This could be due to different amount of fat excision between the two sides, and the subsequent change in skin tension as fat has been reduced.

(B) One week postoperative appearance.

30F, absent crease OU. Prefers NTC with standard height. 5′7″.

I/O: tarsus 8mm. Used 7mm to draw NTC + 3mm skin. No fat was removed. The orbital septum was observed to be fused to the levator aponeurosis in a

very ill-defined manner. Had to delineate the superior tarsal border by using the cutting cautery to create a ‘mini-trough’ over and along the superior tarsal border, then attached multiple 6/0 fixation sutures. Worked well.

35M heavy eyelid with fat bulge. Hooding appears to cover 4mm of cornea, but lid margin is actually 2mm on to cornea. 5′5″. Prefers NTC (A).

I/O: tarsus 9.0mm. During the first procedure I used 7 mm to design NTC. Thick skin with amorphous orbicularis, orbital septum and very little preaponeurotic fat. Formed crease with 6/0 silk and 7/0 silk.

(B) RUL crease obliterated at 6 months and required enhancement.

I/O (revision): boggy lid tissue with amorphous infiltrated fat over the preaponeurotic space as well as within levator itself. These were left untouched. Excised M/C strip that included scarred tissues; created mini-trough along STB. Formed crease with 6/0 and 7/0 sutures. (C) One week postoperative appearance.