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

(A) A 35-year-old man had seen another surgeon for placement of a lid crease. He later wanted the crease removed or lightened. (B) The creases and the underlying scar tissues on both lids were removed. A persistent crease remained over the lateral half of the

right upper lid; the left lid appeared satisfactory. A second procedure was carried out 6 months later to release the subdermal aponeurotic attachment. This resulted in minimal improvement.

(C, D) A year later, I performed a recession of the right upper lid coupled with placement of autolo-

gous temporalis fascia. Although the crease faded on downgaze, it could be seen on forward and upgaze.

46M 2yrss/p removal of upper lid hooding. Has rudimentary crease, low-set and dark incisional line with spreading; 3mm cornea covered (ptosis). Medial incision line measures only 3mm from lashes. (A&B) Preoperative appearance.

I/O: designed a single 5mm parallel incisional line as there was no skin redundancy. Lyzed along upper

edge of incision until large amount of preseptal and preaponeurotic (postseptal) fat was seen. Debulked scar along the superior tarsal border such that a new crease could form along there.

27M, 6 yrs s/p lid crease procedure, has high crease and pretarsal fullness. NTC. Right crease height is 9 mm, left is 11–12 mm. Patient feels irritation of the eyelid when blinking (A).

I/O: tarsus 6mm. Past history of ptosis and repair? In this revisional attempt for the LUL, 8.5 mm was chosen to mark an NTC and included 2.5mm as the amount of skin and scar to be excised. Lyzed along

the upper incisional edge to reach the preaponeurotic space. Found and removed two buried stitches. Then excised myocutaneous strip of skin and scar. Reconstructed a shallower NTC.

(B) Appearance at two months postoperative. Patient reported a greater degree of comfort when he blinks.

30F with obliterated crease. Had surgery 6 yrs ago with incisional approach; uses tape for OU daily. Has rudimentary crease RUL, LUL has pigmented incisional spots along medial end of eyelid.

I/O: tarsus 8 mm. Designed 7.5 mm NTC with 1mm skin, such that the lower incision line was below her previous scar, and included 1mm of scarred skin only.

RUL; beveled approach along the upper edge to reach the preaponeurotic fat within the remnants of the preaponeurotic space. Although I initially reduced the abundant fat partially with bipolar cautery, the

crease did not form well owing to its location along the STB. I reopened the wound and excised the preaponeurotic fat that was along the STB, leaving the upper half mostly intact. It was only then that the crease formed well. Three buried nylon stitches were removed.

LUL also included scar excision. Again excised preaponeurotic fat. The central crease fixation suture did not perform well and was removed; more of the inferior edge tissues were cleared and excised; the 6/0 suture then fixed well, with better crease formation.

37M, 12yrs s/p upper blepharoplasty, with first revision done same year to enhance crease. RUL had been revised by me and was satisfactory. Now desires revision of LUL. LUL has segmentation of medial onethird of crease, with peaking there. Crease measured 8.5mm and chronic edema had caused an extra fold of skin to appear, as if hanging over the lateral portion of the crease.

I/O: scar at 8.5 mm. I used 7 mm to design an NTC, encompassing his scar in the 1.5 mm of skinscar tissues. Used superior beveled approach for this revision to reach the preaponeurotic space. Removed three buried nylon stitches. His voluntary upgaze then showed good crease formation.

21M left eye with congenital ptosis and had levator resection 2 years ago. Six months s/p suture technique O.U. to form crease. RUL medial end has tapered crease, absent crease over LUL. Left upper lid’s incision line is only 2–3mm from lid margin. Feels as if LUL has resistance and discomfort (A).

I/O: tarsus 8 mm. Designed incision at 7 mm + 1mm skin. Removed buried 4/0 Mersilene stitch cen-

trally above STB. Used beveled approach to reach preaponeurotic space. Little fat remains. Excised M/C strip. Used cutting cautery to clear a small trough along anterior tarsal surface just inferior to STB. Used crease fixation sutures from skin to tarsus/aponeurosis and skin.

(B) Appearance two months postoperatively.