Cosmetic Double Eyelid Surgery: Single 5 mm-Partial Incision Method

Ryu, Hyun Suck; Kum, In Sup; Minn, Kyung Won

Abstract

In Asian double eyelid surgery, there have been two approaches to form a suprapalpebral fold: the buried suture (nonincision) method and the full external incision method. Usually excessive fat tissue in upper eyelid has been removed by using a full external incision method, or 2 to 3 partial incisions with buried suture method. The full external incision method is more invasive than the buried suture method, which is not suitable for patients with excessive orbital fat. From March 1999 to January 2002, we have introduced the single 5 mm-partial incision method to 216 patients. This method is applied to patients who have excessive amount of orbital fat or those who do not have excessive orbital fat but which must be removed for better result. These patients have bulging supra-crease areas when we form suprapalpebral folds with a curved wire loop preoperatively. Excessive orbital fat was removed through a single 5 mm incision in the middle of designed eyelid crease and tarso-dermal suture was performed. At another 2 to 3 points, through skin stab punctures by using 18 gauge needle, full-thickness eyelid tarso-dermal sutures were done. Pretarsal and preseptal orbicularis muscles were preserved. If muscles were removed, that could result in thinning of the overlying skin and could make suprapalpebral fold unnatural. This method has several advantages. First, we could perform the operations safely in patients who have excessive fat tissue, without a full external incision. Second,fat tissue can be removed almost totally by a single 5 mm-partial incision. Third, we can minimize the scar formation, and the possibility of complications, and make healing process and operation time shorter compared to the full incision technique. However a very delicate technique is required in this method. In patients who have a thick orbital septum, a superiorly located fat pad, and a bleeding tendency, exposure of fat tissue could be difficult and injury of levator muscle aponeurosis is possible. The complications of this method are the possibility of disappearing of the crease with the lapse of time(3 percents), and suture granuloma formation(less than 1 percent). In conclusion, patients who have excessive fat tissue in upper eyelid don't have to proceed a full incision, and can have more excellent results with this single 5 mm-partial incision method.