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
187
Case 44 (Fig. 14-44 A, B)
23F, uses nail file to manipulate eyelid skin to form crease. Multiple rudimentary crease lines. Prefers parallel crease on her highest crease line.
I/O: tarsus 7mm. Designed 7.5mm parallel crease + 2.5 mm skin redundancy. Little fat. Excised M/C strip. Formed crease.
A
B
Asian Blepharoplasty and the Eyelid Crease
188
Case 45 (Fig. 14-45 A, B)
34F, Chinese/Hawaiian, 5′4″. RUL has hooded NTC. |
had very little preaponeurotic fat and appeared bound |
LUL has sulcus above multiple rudimentary creases. |
down; these were released and repositioned sup- |
Very tanned skin (A). |
eriorly. Good crease formation. |
I/O: tarsus 6.5–7mm. |
(B) Postoperative appearance (patient wearing |
RUL included 2 mm skin, LUL + 3 mm skin. Has |
colored contact lenses). |
very thin skin, very vascular orbicularis. Both sides |
|
A
B
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
189
Case 46 (Fig. 14-46)
30F, has no crease RUL, LUL has occasional crease. Prefers above average parallel crease OU.
I/O: tarsus 8.5mm. Designed 7.5mm (7 + 0.5) parallel crease line with 2mm skin.
RUL: preaponeurotic fat very soft, repositioned superiorly. Orbicularis was vascular. Excised M/C strip.
LUL: preaponeurotic fat plastered down over lateral half of aponeurosis; vascular and therefore left alone.
Asian Blepharoplasty and the Eyelid Crease
190
Case 47 (Fig. 14-47 A, B)
22F, 5′7″. She had a single lid up until 16 years old. Now has incomplete or partial creases. Used tape daily (A).
I/O: tarsus 7.5 mm. Designed 8 mm parallel crease as the lid was edematous from xylocaine. Included 2 mm skin in myocutaneous strip. Orbicularis was very spongy and vascular. Used superiorly beveled
approach through septum. The preaponeurotic fat appeared bound down over the lateral half. This was released and repositioned superiorly. Excised M/C strip and inferior orbicularis edge of right side. Formed crease.
(B) One week postoperative appearance.
A
B
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
191
Case 48 (Fig. 14-48)
22M absent crease OU. Left fissure appears larger than right. Desired low-set parallel crease.
I/O: tarsus 8.5 mm. Used 7 mm design for parallel crease. Very vascular over orbicularis. Little pre-
aponeurotic fat. Excised M/C flap but did not vigorously debulk preaponeurotic platform. Used eight 6/0 silk sutures for crease construction, plus 7/0 silk running stitch.
Asian Blepharoplasty and the Eyelid Crease
192
Case 49 (Fig. 14-49 A, B)
31M with absent crease. Heavy lids, large face. 5′10″ |
lar, with fibromosaic preaponeurotic fat plastered |
(A). |
down. Excised around 3.5 mm M/C strip. Crease |
I/O: tarsus 8.5mm. Designed 7mm parallel crease. |
formed well. |
Skin very thin and stretched; orbicularis was vascu- |
(B) One week postoperative appearance. |
A
B
Chapter 14 Primary Cases of Asian Blepharoplasty – Before and After
193
Case 50 (Fig. 14-50 A, B)
31F, absent crease, 5′2″. Prefers average height NTC. |
into superior sulcus. Excised M/C strip. Formed |
I/O: tarsus 7.5mm. Designed 7.5mm NTC + 2mm |
crease. |
skin. Observed inferiorly migrated preaponeurotic |
(B) One week postoperative appearance. |
fat that was bound down. Released and repositioned |
|
A
B
Suboptimal Results and |
Chapter 15 |
Revision Operations |
William P.D. Chen
This chapter shows a variety of cases illustrating suboptimal results of blepharoplasty surgery, and some methods of correction. The contrast between Asian eye-
lids and those of Caucasians, and the diversity even among Asians themselves, are what makes Asian eyelid surgery a very interesting and challenging art.
Case 1 (Fig. 15-1 A, B)
This patient underwent a lid crease procedure. Notice that the crease does not merge into the fold medially. The medial aspect of the crease overrides the
supracanthal fold, resulting in an upper bifid crease.
(B) Higher magnification of RUL.
A
B
195
Asian Blepharoplasty and the Eyelid Crease
196
Case 2 (Fig. 15-2 A, B)
A 50-year-old woman with a left seventh nerve palsy who underwent a lid crease procedure. Note the poor
closure of her left upper lid owing to facial paresis and probable mid-lamellar contracture.
A
B
Chapter 15 Suboptimal Results and Revision Operations
197
Case 3 (Fig. 15-3)
A 35-year-old woman who has had excessive fat removal high over her supratarsal sulcus. Note the
inadequate formation of the lid crease and the hollow sulcus.