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Asian Blepharoplasty and the Eyelid Crease_Chen_2006

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Appendix 2 Modern Literature on Asian Eyelid Surgery (in English)

301

Modern Literature on Asian Eyelid Surgery (in English)

Author	WM Yoo, SH Park,	Hwang, Kim et al	Lam, Kim	SH Chen,
	DR Kwang			Mardini S,
				Chen HC et al
Year	2002	2003	2003	2004
Journal	Plast Reconstruct	Annals of Plast	Aesth Surg J	Plast
	Surg 109(6):2067–2071	Surg	23(3):170–176	Reconstruct
	Root Z-epicanthoplasty	50(2):156–159	Partial-incision	Surg 114(5):
	in Asian Eyelid		technique	1270–1277
				Corrective
				Asian
				Blepharoplasty
				after failed
				revisions
Country	Korea	Korea (Inha &	USA/Korea	Taiwan (Chang
		Yonsei U)		Gung U)
Conjunctival suturing
Skin incision			15–18 mm wide
			skin incision
Remove skin			No
Orbicularis			Through orbic
Orbital septum			Open
Preaponeurotic fat			Partial excision
Crease form			Levator/inf. skin
			edge
Suture
Days left in
Effectiveness
Comments	(See JI Park’s	Lateral	Clin photo	A general
	1996 PRS article on	septoaponeurotic	shows skin	discussion of
	Z-epicanthoplasty)	artery as source	incision	factors that
		of bleeding	spans 3/ of	lead to failures
			4
		during upper	width of ciliary	and its
		blepharoplasty	margin.	corrections
			Crease may
			appear deeper
			centrally.
			(See Yang’s
			2001 paper)

303

Index

Absent crease 4, 8, 24, 25, 143, 148, 154, 155, 163, 174, 192, 211–13, 244

Acceptability of Asian blepharoplasty 33 Adhesive tape 176, 177, 190

Advanced technique 79

Aesthetic surgery, challenge of 262, 283–4 Anatomy of eyelids 3–22

Asians vs. Caucasians 4–5 Asians without crease 4–6

Caucasians with crease 5, 6, 24, 27, 28, 244 double 1–2, 3, 4, 39, 54

and facial anatomy 19 lower eyelid 12

medial canthus 11–14, 16, 171 single 3, 4, 5, 7, 9, 10

upper tarsus 14

see also Crease conﬁguration Anesthetics 61–2

Arterial arcades 17, 266

Asymmetric crease 34, 200, 201, 203

Beveled approach 67–8, 255–64

Biﬁd creases 114, 141, 195, 199, 203, 232, 233 Blepharoplasty, Asian

acceptability of 33 challenges of 262, 283–4

clinical cases 135–92, 195–241 complications 111–18, 281 crease conﬁguration 23–31

crease enhancement 87, 88, 107–9, 136, 161 future of 283–4

in men 40

patient counselling 33–8 postoperative care 107–9

preferred surgical technique see Surgical technique revision and correction 119–33

suboptimal results 111–18 Boo-Chai, Khoo 265–722 Boo-Chai method 267–71

Buried orbicularis-aponeurosis suture 90–104

Canthus, medial see Medial canthus

Central fat pad see Preseptal fat pad

Cicatricial ectropion 118, 121 Clinical cases

absence of crease 143, 148, 154, 155, 163, 174, 192, 211–13, 244

asymmetric creases 200, 201, 233

biﬁd creases 114, 141, 195, 199, 203, 232, 233

crease enhancement 136, 142, 166, 169, 185, 186, 198, 202, 215

crease fading 34, 37, 147, 151, 219 crease reduction 234 dermatochalasis 6, 10

dynamic crease 151–3 elderly patients 140

excessive fat removal 139, 197, 202, 234 grafting 228

high crease 138, 198, 203, 216–17, 222, 230 incomplete crease 199, 208

lid deformity 209

lid hooding 137, 140, 166, 186, 216–17, 221, 236

males 235

multiple creases 187, 188, 202, 203, 228 obliterated crease 218, 223

patient compliance 135 patient-created crease 176, 177, 190

ptosis 169, 179, 206–7, 220, 226, 231, 237, 241

shielding 139, 141, 142, 147, 151, 154, 209 static creases 201, 231

supratarsal sulcus 140, 197 tattooing 206–7

triangular conﬁguration 165, 178, 235, 240

weight gain 212

Closure, wound see Surgical technique Collagen 5, 127

Congenital blepharophimosis syndrome 14 Conjunctival suture placement 41 Continuity and permanence 114–15, 117

Corrective measures to reverse crease 33, 41, 42, 115, 131–2

Cosmetic oculoplastic surgery 1–2

Index

304

Crease conﬁgurations 3–7, 23–31 asymmetric 34, 200, 201, 203 average 19

broad 19

Caucasian 5, 6, 24, 27, 28, 244 continuity 24, 198

dynamic see Dynamic crease and face shapes 19–21 height 112–13, 120–1

high crease 114, 117, 138, 198, 203, 216–17, 222, 230

low crease 121

multiple 24, 113, 126–7, 187, 188, 202, 203, 228

narrow 19

nasally tapered 24, 26, 27, 28, 29, 136, 145 obliterated 34, 122–4, 125, 218, 223 parallel 24, 25, 26, 65, 216–17 partial/incomplete 24, 25, 26, 199, 208 semilunar 24, 27, 28, 30, 34, 127–31, 233 shape 19, 116

static 87, 201, 231

triangular 165, 178, 235, 240 undesirable 112–15 unnatural 27, 30, 118, 131

Crease deformity 113, 209, 256 Crease, patient-created 176, 177, 190 Crease reversal 33, 41, 42, 115, 131–2

Debulking 83–6, 262

Dermatochalasis 6, 10 Dermis-fat graft 127

Double eyelid 1–2, 3, 4, 39, 54 cosmetic surgery 1–2

Double Z plasty 14

Dynamic crease 57, 87, 151–3

Effectiveness of crease reversal 132

Elderly patients 7, 35, 84, 85

Asians 9, 10, 79–81, 140

Caucasians 6

Eurasian 146

Electric coagulation 2

Epicanthal folds 11, 15, 40, 273–81

Epicanthus inversus 11, 12, 14

Epicanthus palpebralis 11, 13, 16

Epicanthus supraciliaris 11, 12

Epicanthus tarsalis 11, 12–13

Esotropia 15

Eurasian patients 13, 146

Excessive fat removal 139, 197, 202, 234 see also Preaponeurotic fat pads

Excision, skin see Surgical techniques External incision methods 51–9

levator aponeurosis to inferior subcutaneous plane approach 54–8

skin-levator-skin approach 52–4 Eyelid anatomy see Anatomy of eyelids

Face shapes 19–21 Facial anatomy 19 Facial paresis 196 Facial symmetry 19–21

Fading crease 34, 37, 147, 151, 219 Famined look 30, 112

Fat pads

four types of 7

preaponeurotic 6, 7, 10, 30, 33, 40, 51, 56, 67, 68, 69–73

preseptal 7–11, 71–2, 212 pretarsal 2, 7, 9–10 subcutaneous 147

Full-thickness suture 42, 43 with stab skin incisions 42, 44

Glide sign 249 Glide zone 247, 248

obliteration of 261 restoration 261, 262

Glue 183, 297 Grafts see Skin grafts

Historical aspects 1–2 Hollowed eye 30, 112

Hollow supratarsal sulcus 12, 30, 127

Hooding, lid 10, 137, 140, 166, 186, 216–17, 221, 236

‘Huh’ syndrome 27 Hyaluronidase 168

Hypertrophic scarring 27, 37, 91, 108, 130, 254, 261, 281

Implants 127, 284

Incisions 51–9, 66

Induration, tissue 37, 108, 109

Informed consent 37

Index

305

Inside fold see Nasally tapered crease		Paresis, facial 196
Intercanthal ﬁxation 108		Park Z-epicanthoplasty 273–81, 281
		complications 281
Keloids 108, 281		procedure 274–80
KTP-YAG (potassium-titanyl-phosphate) laser 284		Partial external incision with buried orbicularis-
		aponeurosis suture 90–104
Lagophthalmos	78, 84, 118, 255, 256, 260, 262	Patients
Laser surgery 284		compliance 135
Lateral canthus 18, 19, 20, 21, 27, 113, 129, 229		counselling 33–8
Laterally ﬂared crease 27, 130		elderly 7, 35, 84, 85
see also Nasally tapered crease		‘homemade’ creases 176, 177, 190
Lateral septoaponeurotic artery 19		postoperative care 107–9
Levator aponeurosis 3, 5–11, 19, 42, 43, 45, 87–90		postoperative complaints 3, 108–9
to inferior subcutaneous plane 54–8		preoperative meeting 33–8
Levator muscle 243–4, 259		weight gain in 212
Lid deformity 209		Pinch sign 250
Lid hooding see Hooding		Postoperative
Lidocaine 42, 61, 71, 265		care 107–9
Literature sources		complaints 8, 108–9
modern 288–301		edema 5, 36, 37, 73, 111, 114, 164, 205,
pre-1952 285–7		225
Lower biﬁd crease 113		Postsurgical creases 126–7
		Preaponeurotic fat pads 6, 7, 10, 30, 33, 40, 51, 56,
McCord’s anchoring/retention stitches 87		67, 68, 69–73
Marginal arterial arcade 266		see also Supratarsal sulcus
Medial canthoplasty 108		Preaponeurotic space 143
Medial canthus 11–14, 16, 171		restoration of 262
Asian children 11–14		Preaponeurotic tissues, debulking 83–6, 262
correction of folds 14		ratios 84
epicanthal fold types 13–14		Preoperative counseling 33–8
Mid-lamellar clearance 255–64		continuity and permanence 37–8
Mongolian eye 12		shape of crease 35–7
Müller’s muscle 243–4, 259		tarsal height 33–4
Multiple creases 187, 188, 202, 203, 228		Preseptal fat pad 7–11
		hypertrophy 212
Nasally tapered crease 24, 26, 27, 28, 29, 136, 145		optional excision 71–2
laterally ﬂared crease 27, 130		redundant 6
Needle see Twisted needle method		removal of 30, 35, 197, 261
		Pretarsal fat pads 2, 7, 9–10
Oculoplastic surgery, cosmetic 1–2		Pretarsal platform 7, 9, 10, 87–90
Orbicularis oculi muscle 5, 7, 11, 17		Proparacaine hydrochloride 61
Orbital fat pad see Preaponeurotic fat pads		Pseudo-crease 147, 206–7
Orbital septum 3, 6–9, 18, 19, 51, 56, 61, 66–8,		Ptosis 169, 179, 206–7, 220, 226, 231, 237,
69–81, 285–301		241
Outside fold see Parallel crease
		Rectangular debulking 83–6, 262
Palpebral ﬁssure 3, 20–1, 25		Reduction, crease 234
Parallel crease 24, 25, 26, 65, 216–17		Reversing crease see Corrective measures

Index

306

Revision and correction 119–33	semilunar crease 24, 27, 28, 30, 34, 127–31, 233
case histories 195–241	undesirable crease 112–15
crease asymmetry 119, 120	‘Superﬁcial’ crease see Dynamic crease
effectiveness of 132	Superior tarsal border 3, 7, 39–42
hollow supratarsal sulcus 127	see also Levator aponeurosis to inferior
inequality in crease height 119–20	subcutaneous plane
late obliteration 121–4, 125	Supratarsal sulcus 30, 56, 140, 197
low crease 121	correction of 69, 71, 112
multiple creases 126	Surgery, aesthetic see Aesthetic surgery
postsurgical creases competing with original	Surgical techniques
creases 126	advanced 79
postsurgical multiple creases 126, 127	anesthetics 61–2
semilunar crease 126–31	beveled approach 67–8, 255–64
	crease enhancement 87
Scarring see Hypertrophic scarring	crease formation 87–90
Semilunar crease see Crease conﬁguration	incisions 51–9, 66
Septum, orbital 3, 6–9, 18, 19, 51, 56, 61, 66–8,	myocutaneous ﬂap excision 73
69–81, 285–301	nasally tapered crease and marking 64
Seventh nerve palsy 196	orbicularis muscle excision 75–6
Shielding 139, 141, 142, 147, 151, 154, 209	parallel crease and marking 65
Silicone oil 127	preaponeurotic fat pads 71–2
Single eyelid 3, 4, 5, 7, 9, 10, 20	revisions 119–33
Skin blanching 62	wound closure 77–9, 87–105
Skin excision 51, 61, 64, 80, 83–5	Suture ligation method 39–50
Skin grafts 121, 127, 130, 228, 256–8	buried orbicularis-aponeurosis 90–104
Skin-levator-skin method 52–3	full-thickness 42, 43, 44
Skin-orbicularis-orbital septum ﬂap 67, 69,	full thickness with stab skin incisions 42, 44
89	transconjunctival intramuscular 42, 45
Skin redundancy 9, 83, 175, 187, 221, 257	transcutaneous intradermal and intratarsal 48, 49
Skin-tarsus-skin method 2, 51, 52, 58, 87	transcutaneous intramuscular 42, 46
S/L/S see Skin-levator-skin method	twisted needle and compression method 42, 47,
Static crease 87, 201, 231	49
STB see Superior tarsal border	Suturing
S/T/S see Skin-tarsus-skin method	levator aponeurosis, to inferior subcutaneous
Subcutaneous fat pads 147	plane 54–8
Suboptimal results 111–18	materials 58, 111, 265, 283
crease asymmetry 200, 201, 233	skin-levator-skin 52–3
crease obliteration 218, 223	translid 1, 293
effectiveness of revisions 119–33	Symmetry, facial see Facial symmetry
fading crease 34, 37, 147, 151, 219
high crease 114, 117, 138, 198, 203, 216–17,	Tarsal eversion 63
222, 230	Tarsus, and crease placement 120, 127
hollow supratarsal sulcus 12, 30, 127	Tattoos 206–7
low crease 121	Tetracaine hydrochloride 62
multiple creases 187, 188, 202, 203, 228	Transconjunctival intramuscular method 42, 45
reversal of crease 33, 41, 42, 115, 131–2	Transcutaneous intradermal method 48, 49
revision techniques see Revision and correction	Transcutaneous intramuscular method 42, 46

Index

307

Transorbicularis vector 84 Trapezoidal debulking 83–6, 262 Triangular debulking 84

Twisted needle method 42, 47, 49, 292

Upgaze skin traction sign 250 Upper tarsus 14

Vascular supply 14–19

Weight gain 212

Western culture, inﬂuence of 3 Wound closure 77–9, 87–105

Y-V-plasty 14

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