Various Clinical Application of the Bead Stitch Method

A double eyelid plasty is performed by an incision technique or a nonincision technique, the latter comprising a stitch method and a buried suture method. With this surgery, an appropriate design and operative technique must be selected into careful consideration of patient's desire and eyelid condition. Patients were classified into four groups according to age and upper eyelid condition and got double eyelid plasty, modified techniques based on the Shirakabe's bead stitch method by each group. From above mentioned techniques, authors obtained a relatively successful result, so authors would like to report the outcome of the modified surgery methods. In this study, bead stitch method was performed in 405 patients(402 females, 3 males, average 31.2 years) from January to December of 2001. The follow up period ranged from one month to four years. Preoperatively, considering the patient's age, skin laxity of the upper eyelid and quantity of periorbital fat, patients was divided into four groups. For the bead stitch method, the eyelid is everted by raising the eyelash, and No. 2 braided white silk suture 16 cm in length is thrust from the two third of upper tarsal rim on the conjunctival side to the anticipated point on the skin side by using No. 5 round needle. The other end of the suture is guided out at a 4 to 5 mm distance from that point in a similar manner, such a procedure is usually carried out six to seven times for each eye. Simultaneously, if necessary, defattimg, skin undermining and upper blepharoplasty was also performed. Most of our patients were satisfied except thirteen cases with minor complications(mild asymmetry: 7 cases, sunken eye: 3 cases and high fold: 3 cases). But, the post operative palpabral swelling is comparatively strong. In conclusion, Some of the positive aspects were the followings: Lowering the chance getting an infection from stitches, the prevention of loosening by the scars forming double eyelids, and the development of natural double eyelids coming from the even pressure on the upper eyelids by the glass beads. Moreover, the new method improves, by combining the bead stitch method with the blepharoplasty, the prior incision method, which was difficult to apply to eyelids with excessive skin, therefore being able to expect more successful results from all age groups.

Complication of Non-Incision Oriental Blepharoplasty: Is Disappearance of the Lid Crease a Fearful Complication ?

The Non-incision "double eyelid" operation reported by Mikamoto of Japan in 1896 has the advantage of shorter operating time, less morbidity and minimal scarring thus more natural final appearance. Incidence complications of this procedure such as disappearance of the fold, asymmetry, and inclusion cyst has been reported to be higher than the incision method and there has been reports of complication rates of up to 30%. The surgeon and the patient are most worried about the complete disappearance of the surgical palpebral fold. The complications of Non-Incision ""double eyelid"" operation was evaluated in 190 patients who were available for follow up of more than 1 year. Classification of the complications which required revision surgery was classified and evaluated. There were no major complications such as blindness, retrobulbar hematoma, and blepharoptosis. Total number of complications requiring reoperation: 24(100%). The most common reoperation procedure that we experienced was asymmetry which occurred in 10(42%) patients followed by lowering of the fold line and disappearance of the fold with 6(25%) cases each. All these patients were taken back to surgery and were corrected by Non-incision method with favorable results. Conclusively, 24 complications of Non-incision double eyelid procedure experienced in 190 patients. Disappearance of the palpebral fold was seen in 6 patients who were corrected by another Non-incision technique with excellent results. The complete disappearance of the fold was experienced in very few patients and correction of this complication was satisfactory. Thus, disappearance of the fold after Non-incision double eyelid procedure should not be termed by the patient or the surgeon with full under- standing of the procedure.

CORRECTION OF THE UNILATERAL DOUBLE EYELID BY NON-INCISION TECHNIQUES

Double eyelid operation is one of the most common cosmetic surgery in orientals. Among this, the non-incision technique has been usually performed in the patient with thin upper eyelid, lesser amounts of orbital fat, less redundant skin of upper eyelid, and so on. A non-incision technique make a more smooth and natural double eyelid. The merit comes from short operating time, short recovery time, less morbidity and inconspicuous scarring, Therefore, when we decide double eyelid operation on a patient who has a congenital unilateral double eyelid, we correct the aesthetic deformity in appearance caused by an unnatural asymetric upper lid which is not double eyelid using a non-incision technique. This study includes 255 patients to whom underwent double eyelid operation of unilateral double eyelid by non-incision techniques from 1990 to 1995, ranged in age 19 to 55years and follow-up period ranged from 2 months to 2 years. Two methods of non-incision technique were used in this study. One is single stitch method and the other is continuous buried suture method. The former was used in 176 patients(70.2% ) who are young with thin upper lid and the latter was used in 79 patients( 29.8% ) with redundant or puffy upper lid. Most of the patients were satisfied with smooth and symmetric appearance. We concluded that non-incision technique can be a good surgery method of correcting unilateral double eyelid. And we had good results using the continuous buried suture method in the case of puffy upper eyelid.

Various clinical applications of the continuous buried suture method: non-incision double eyelid operation

The double eyelid operation is one of the most common cosmetic surgery performed in orientals, and there are numerous studies about surgical procedures of that. In the case of appropriate candidates, the non-incision technique makes excellent cosmetic results, with the advantages of shorter operating time, less morbidity, less pain, no scarring and easy revision of shape. But, usually the non-incision technique is recommended in the cases with thin upper eyelid, small amount of orbital fat, less redundant skin of upper eyelid and in whom a wide fold is not desired so on. Therefore, the disadvantages of this method are that it cannot be applied to all patients. The postoperative complications are disappearance or faded fold, formation of cyst or lumps, asymmetry etc. and the incidence of these complications is slightly higher than those of the incisional method. In this study, the double eyelid operation using the continuous buried suture method was performed in 210 patients for formation of double eyelid from Jan. 1993 to Dec. 1995. In conclusion very good results can be obtained by the continuous buried suture method even in the cases of puffy upper eyelid. This method can make a double eyelid shape in the fashion the patient wants and can be a new indication for correction of unilateral double eyelid. This method is safe, satisfactory and take shorter postoperative recovery time and it can reduce the incidence of postoperative complications.