Small-incision orbicularis-levator fixation technique: a modified double-eyelid blepharoplasty for treating trichiasis in young Asian patients

Single Mini-incisional Blepharoplasty with the Orbicularis-Orbital Septum Fixation Technique for the Creation of a Natural Double Eyelid

BACKGROUND

Mini-incisional double-eyelid blepharoplasty has increasingly gained popularity in oriental populations. Moreover, many related studies have made a detailed technical introduction to this topic. This study aims to introduce a simple single mini-incisional blepharoplasty procedure with orbicularis-orbital septum fixation technique to create a physiologically natural double eyelid with no visible scar and a short postoperative recovery time.

METHODS

A single mini-incisional blepharoplasty with orbicularis-orbital septum fixation technique is described in detail and is illustrated with pictures. Patients who underwent this procedure in our department from November 2020 to May 2023 were retrospectively reviewed RESULTS: This study included 159 patients who underwent a single mini-incisional blepharoplasty with the orbicularis-orbital septum fixation technique. Surgery duration ranged from 16 to 42 minutes (mean 27 minutes). The majority of the swelling was reduced in 5 days and completely disappeared in 2 weeks for most patients. The follow-up period ranged from 2 to 31 months. All the double eyelids were natural and dynamic, and the creases were stable with no visible scar. Asymmetries occurred in 1.2% (2 of 159), and crease disappeared in 0.6% (1 of 159) of patients; during the follow-up period, no other complications were reported. Of the 159 patients, 99.4% (158) were satisfied with the surgical outcomes CONCLUSIONS: The single mini-incisional blepharoplasty with the orbicularis-orbital septum fixation technique offers a simple, safe, and effective approach to creating double eyelids. It provides natural, stable, scarless, and rapid recovery results with a low risk of complication.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Small-Incisional Double Eyelid Blepharoplasty: A Retrospective Study of Our Minimally Invasive Technique with Three Mini Incisions

BACKGROUND

Small-incisional double eyelid surgery has been increasingly performed these years and achieved good aesthetic results, but the techniques vary greatly between literatures. The authors reviewed the cases of three-small-incisional double eyelid surgery performed in the past three years and introduced their surgical technique in detail.

METHODS

A total of 87 patients receiving bilateral three-small-incisional double eyelid surgery were included in this retrospective study. The pretarsal folds were designed meticulously, along which three evenly distributed 2 mm-long incisions were made. A minimal amount of orbicularis oculi muscle and pretarsal soft tissue were removed to expose the pretarsal fascia for further fixation. An appropriate amount of orbital septal fat was removed through the lateral incision if required. The superficial orbicularis oculi muscle and dermis on the lower margin of the incision were fixed onto the pretarsal fascia with some underlying tarsus on the upper margin of the tarsus. The skin was closed by one stitch for each incision.

RESULTS

The average follow-up was 9.9 ± 5.2 months (range: 6-27 months). All the patients were satisfied with the result. None of them experienced loss of the pretarsal fold, bilateral asymmetry, scar hyperplasia, or persistent swelling after surgery.

CONCLUSIONS

Our three-small-incisional technique with minor soft tissue debulking offers a simple, safe, and reproducible approach to double eyelids. It can create a stable and natural-looking pretarsal fold with a short recovery period.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction of Primary Multiple Upper Eyelid Folds by Three Mini-Incision Upper Blepharoplasty and Simultaneous Orbital Fat Pad Repositioning in East Asians

BACKGROUND

This study aims to assess the feasibility and efficacy of a three mini-incision upper blepharoplasty combined with simultaneous orbital fat pad repositioning for correcting primary multiple upper eyelid folds in East Asians.

METHODS

A retrospective analysis of 75 patients who underwent three mini-incision double-eyelid blepharoplasty in conjunction with orbital fat pad repositioning for the correction of multiple upper eyelid folds between January 2018 and January 2022 was conducted. During the surgery, the lateral extension of the central upper eyelid fat mass was anchored medially to the upper medial eyelid via three small skin incisions. Postoperative follow-up was carried out to evaluate the improvement in multiple upper eyelid folds, and patient satisfaction was measured.

RESULTS

The follow-up period ranged from 6 to 36 months, with an average of 12 months. Post-surgery, the multiple fold lines were completely resolved in 71 patients (95%), while relapse occurred in 4 patients (5%). The overall satisfaction rate was 88%.

CONCLUSIONS

The three mini-incision double-eyelid blepharoplasty combined with simultaneous orbital fat repositioning is an effective method for correcting primary multiple upper eyelid folds. This technique presents a novel alternative for patients with primary multiple eyelid folds, particularly those who are hesitant to undergo a full-incision double-eyelid procedure.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Comparison of 3 Different Double Eyelid Surgeries

OBJECTIVE

Double blepharoplasty or double eyelid surgery is a common plastic surgery in Asians. Our study aimed to evaluate the advantages and disadvantages of the minimally invasive 3-point subcutaneous tunnel double eyelid surgical technique relative to other commonly used approaches.

METHOD

The study compared 852 single eyelid patients electing 1 of 3 double eyelid surgical options; minimally invasive 3-point subcutaneous tunnel, minimally invasive 3-point embedding, or incision double eyelid surgery. Evaluation criteria included postoperative swelling, hyperemia, pain, scarring, single eyelid recurrence, and patient satisfaction after 2 years.

RESULTS

All surgical methods effectively achieved double eyelids. Directly after the procedure, the minimally invasive 3-point embedding method produced the mildest degree of swelling and congestion, followed by the 3-point subcutaneous tunnel method and then the incision method (F = 523.908, P = 0.000). The incision method also resulted in more serious postoperative pain, whereas the other 2 methods were equivalent (F = 83.117, P = 0.000). Patients in the incision group had the most severe scars compared with the other 2 groups with milder scarring (F = 882.102, P = 0.000). The minimally invasive 3-point embedding method group had the highest single eyelid recurrence rate (5.88%), whereas the recurrence rates for the other 2 methods were less than 1%. Patients satisfaction after 2 years was highest in the minimally invasive 3-point subcutaneous tunneling method, followed by the 3-point embedding method and lastly the incision method (F = 25.931, P = 0.00).

CONCLUSIONS

Minimally invasive 3-point subcutaneous tunnel double eyelid surgery has advantages over other techniques, and its clinical application is worth promoting for suitable patients.

Mini-incision Blepharoplasty with Pretarsal Fasciectomy for Double-Eyelid Surgery

BACKGROUND

Double-eyelid surgery has been one of the most popular aesthetic surgeries in oriental populations. The objective of this study was to introduce a simple procedure for double-eyelid surgery.

METHODS

The mini-incision blepharoplasty with pretarsal fasciectomy technique is described and illustrated. Blepharoplasty cases in our practice from June 2018 to December 2019 were retrospectively reviewed. Patients who underwent mini-incision blepharoplasty with pretarsal fasciectomy were followed up for at least 6 months.

RESULTS

Of 280 blepharoplasty cases, 32 patients underwent mini-incision blepharoplasty with pretarsal fasciectomy on both upper eyelids. Nineteen patients experienced resolve of swelling within 5 days postoperatively. No loss of fold was observed during follow-up. The satisfaction rate was 93.8%.

CONCLUSIONS

The mini-incision blepharoplasty with pretarsal fasciectomy is ideal for selected patients requesting double-eyelid surgery. It provides stable, natural, scarless result with minimum complication and rapid recovery.

LEVEL OF EVIDENCE

IV.

A Reverse Orbicularis-Tarsus Fixation Technique in Double-Eyelid Blepharoplasty: A Novel Fixation Technique Different From Park's Technique

BACKGROUND

Although Park's "orbicularis-levator fixation technique" has been widely used as a mature double-eyelid surgery in China recently. Shortcomings related to this method cannot be ignored. Thus, a reverse orbicularis-tarsus fixation technique in double-eyelid blepharoplasty has now been devised. The method is to create a physiological double-eyelid fold based on the formation mechanism of double-eyelid creases.

METHODS

A retrospective study of 112 Chinese patients who underwent double-eyelid surgery between October 2017 and September 2019 was undertaken through a review of medical records. All these patients underwent a reverse tarsus and orbicularis oculi muscle fixation technique, with postoperative follow-up ranging from 6 months to 2 years. Postoperative outcomes were reviewed, evaluated, and analyzed.

RESULTS

Altogether, 112 patients who underwent the double-eyelid surgery were reviewed. Among them, the results were judged as excellent in 104 cases (92.9%), good in 4 cases (3.6%), fair in 3 cases (2.7%), and poor in 1 case (0.8%). Clinical effectiveness was satisfactory in most of the patients (104/112, 92.9%). Only 5 patients (4.5%) expressed subjective dissatisfaction with postoperative outcomes; of these, 3 patients complained of eyelids asymmetry (2.7%). Two patients complained of eyelids scar formation (1.7%); Whereas surgical revision was required in only 1 patient (0.8%).

CONCLUSIONS

The reverse orbicularis-tarsus fixation technique for upper eyelid blepharoplasty is safe and effective, with better biomechanics and a satisfying aesthetic outcome. Therefore, this provides an alternative option in Chinese double-eyelid surgery.Level of Evidence: Level IV, case studies.