Importance of managing retro-orbicularis oculi fat in double-fold eyelid surgery for patients with swollen upper-eyelid / 中华医学美学美容杂志

Objective:To explore the importance of managing retro-orbicularis oculi fat (ROOF) in double-fold eyelid operation for patients with swollen upper-eyelid.Methods:From January 2018 to December 2020, 76 cases of swollen upper-eyelid were treated with double-fold eyelid operation by PARK method. In operation, an oval shape ROOF was removed from the outside-to the inside, and then appropriate lateral intraorbital fat was also removed. If fleshy orbicularis oculi muscle and anterior tarsus fat affected appearance of double-fold eyelid, both of them might be removed properly.Results:All patients were followed up from seven days to two years, two cases presented with shallowed double-fold eyelid, 5 cases of lacrimal gland prolapse had good lacrimal gland reduction and no recurrence; 4 cases of ptosis had normal corneal exposure and natural appearance after correction; the swollen upper-eyelid was obviously improved in 74 cases, and restoration stage was short, the apperaence and radian of doule-fold eyelid were beautiful, local scar was slight, satisfactory operative effect was achieved.Conclusions:In double-fold eyelid operation by PARK method for patients with swollen upper-eyelid, an ideal effect would be achieved, if transconjunctival route and fleshy orbicularis oculi muscle are appropriately removed in turn according to the reasons to give rise to swollen upper-eyelid.

Double-Fold Operation with a Partial Incision and Continuous Buried Suture

BACKGROUND: The double fold operation is one of the most common aesthetic surgeries in Korea. There are many methods to make double fold using non-incision, incision and partial incision. Patients seeking double folds prefer natural appearance, less downtime, minimal scarring technique. The most favorable method is the minimal invasive but long-lasting fold formation technique. METHODS: From October 2003 to September 2016, this procedure was applied in 7,963 patients who worried about surgical scar or preferred non-incision method with puffy eyelids. Five stab incisions including two small incisions were taken in the upper eyelid. Through the small incision lines, the pretarsal muscle and the orbital fat were removed to facilitate tissue adhesion. The double fold line was made with the continuous buried suture. The suture was tied in the fifth stab incision site and the knot was placed deeply to prevent granuloma formation. RESULTS: This method was performed in all patients. The complications were asymmetry (52 cases), fold loosening (43 cases), granuloma (12 cases), conjunctival hemorrhage (5 cases), and scar (4 cases). Especially 74% of fold loosening cases were developed in mild ptotic patients. CONCLUSIONS: This method achieves good cosmetic result, shorter operation time, less morbidity, faster recovery in puffy eyelids than the other method.

Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery

PURPOSE: To evaluate height and symmetry of double folds following simultaneous levator palpebral muscle resection and double eyelid blepharoplasty for correction of blepharoptosis. METHODS: We retrospectively studied 400 eyes of 286 patients who underwent simultaneous surgeries for double eyelid construction and correction of blepharoptosis from January 2006 to December 2011. All the patients were divided into three groups based on levator palpebrae muscle function: group A consisted of 82 eyes whose Levator Function Test (LFT) was 5 cm or less, group B consisted of 115 eyes whose LFT was between 5 and 10 cm, group C consisted of 203 eyes whose LFT was over 10 cm. For each group, we evaluated the preoperative marginal reflex distance 1 (MRD1), surgical methods, the postoperative height and symmetry of the double folds, and additional operations for correcting blepharoptosis. RESULTS: Blepharoptosis surgery was performed in all groups by simultaneous levator resection and double eyelid blepharoplasty in all groups. Postoperative asymmetric double fold was the most common outcome observed in the poor levator function group A. Blepharoptosis under-correction was the most common cause of asymmetric double fold and its occurrence was statistically different between the three groups. The other causes were skin redundancy, brow elevation, double fold loosening, and blepharoptosis over-correction. CONCLUSIONS: The height of a double eyelid can be changed postoperatively by changing levator palpebrae muscle function. In cases of poor levator function, the levator palpebrae muscle is positioned slightly lower than the normal double fold. This condition may result in further relapse or recurrence in the poor levator function group. Also, levator function should be considered among the diverse factors that determine the height of the double fold.

Skin removal based on design of double-fold eyelid line and suprapalpebral fold marginal line in doublefold eyelid plasty / 中华医学美学美容杂志

Objective To explore a suitable method to estimate the quantity of removing skin in double-fold eyelid operation.Methods Upper eyelid skin gently pulled towards eyebrows was flattened with the eyelash being slightly curved,the double-fold eyelid line that was parallelled to blepharitis was marked at 6-7 mm far from blepharitis.Then opening eyelid and looking upwards,the suprapalpebral fold was formed,and several dots were marked on the fold margin. After slightly closing eyelid the suprapalpebral fold margin line was formed through connecting the dots.The skin between the two line was the quantity to remove in operation.If the two line overlaped,removing skin did not need.Results A total of 89 cases were enrolled in this study.The patients were followed up from three months to one year,and the results showed that 67 cases were satisfactory,22 cases were basically satisfatory,and no one was not satisfactory.Conclusions The designing method for removing skin according to double-fold eyelid line and suprapalpebral fold margin line is a good method to estimate the quantity of removing skin in double-fold eyelid operation.

2-loop En Block Double Fold Operation through 3 Small Incision

Korean small eyes are characterized in thickness and pseudoptosis of the skin of the upper eyelid. They also have a large amount of subcutaneous and preaponeurotic fat. The hypertrophic orbicularis oculi muscles and the lower positioned transverse ligaments are included in their structural characteristics. These special features act as various burden factors in Korean double eyelid operation. Just burden factors restrict the movement of the upper eyelid and so Korean eyes looks like Ptosis (pseudoptosis). For creation of double fold eyelid, we performed continuous 2-loop single stitch buried suture to make an en bloc fixation with dermis, levator aponeurosis and Muller muscle through three small incisions. And then we tried to eliminate the burden factors through small sized lateral incision. After removal of the external sutures at postoperative 3 days, we obtained our intended double fold lines such as in-fold, in-ward fold and out fold successfully and only experienced minor complications such as edema, ecchymosis and loss of fold. And also the range of excursion in the upper eyelid improved without levator shortening or any other operation such as a sling. The objective of this article is to share our experience and to introduce our method of treating Korean pseudoptotic eyes by using 2-loop en bloc fixation through three small incisions with various reviews of literature.

The Effect of Nonincisional Double Fold Formation Using Three Small Incisions, Two-stitch Method

PURPOSE: The aim of this study was to analyze the effects of using the nonincisional, double fold formation method with three small incisions and two-stitches. METHODS: This study included 39 patients who underwent double eyelid operation by a nonincisional technique and who were followed up for more than 6 months. On the desired double eyelid line, three points 6 mm apart were marked and three stab incisions made. A small amount of subcutaneous tissue was removed through the incisions, and orbital fat was removed through the lateral wound site-if necessary. Using double-armed 7-0 nylon or prolene, two buried sutures of 6 mm width were made. Sixteen patients also underwent surgery for epiblepharon, and three patients with unilateral double eyelid due to trauma had a contralateral eyelid operation for asymmetry correction. Five patients also had epicanthoplasty. RESULTS: Two patients lost their folds completely and reoperations were performed. Two patients showed cysts due to suture material and so the suture knots were removed; the double fold remained afterwards, so no other procedures were needed. In one case, the suture was seen subcutaneously, so suture removal and reoperation were performed. CONCLUSIONS: To minimize double fold loss, which is a disadvantage of the nonincisional double fold formation technique, we removed a portion of pretarsal tissue, muscle, and/or orbital fat and made two wide slings. Also, we corrected asymmetry due to traumatic unilateral double eyelid and epicanthal fold. In conclusion, we expect that our method could extend the applicability of nonincisional double fold formation.

The Effect of Nonincisional Double Fold Formation Using Three Small Incisions, Two-stitch Method

PURPOSE: The aim of this study was to analyze the effects of using the nonincisional, double fold formation method with three small incisions and two-stitches. METHODS: This study included 39 patients who underwent double eyelid operation by a nonincisional technique and who were followed up for more than 6 months. On the desired double eyelid line, three points 6 mm apart were marked and three stab incisions made. A small amount of subcutaneous tissue was removed through the incisions, and orbital fat was removed through the lateral wound site-if necessary. Using double-armed 7-0 nylon or prolene, two buried sutures of 6 mm width were made. Sixteen patients also underwent surgery for epiblepharon, and three patients with unilateral double eyelid due to trauma had a contralateral eyelid operation for asymmetry correction. Five patients also had epicanthoplasty. RESULTS: Two patients lost their folds completely and reoperations were performed. Two patients showed cysts due to suture material and so the suture knots were removed; the double fold remained afterwards, so no other procedures were needed. In one case, the suture was seen subcutaneously, so suture removal and reoperation were performed. CONCLUSIONS: To minimize double fold loss, which is a disadvantage of the nonincisional double fold formation technique, we removed a portion of pretarsal tissue, muscle, and/or orbital fat and made two wide slings. Also, we corrected asymmetry due to traumatic unilateral double eyelid and epicanthal fold. In conclusion, we expect that our method could extend the applicability of nonincisional double fold formation.

Partial Incision Double Fold Operation Using Debulking Method

Double fold operation is one of the most common cosmetic operations performed on young adults in Korean. These days, as many women are working outside home, growing number of women who want to have a natural-looking double eyelid choose the method with not only a short recovery time and less discomfort but also definite long lasting double fold. Double fold operation can be classified as incision technique and non incision technique. Although there are various non-incision techniques yielding good result, these techniques still have some problems, such as loosening of double fold with time, cyst formation, conjunctivitis and so on. Incision techniques also have problems such as long recovery time, irreversibility and visible scar. Our technique uses two or three 4-5mm of partial incision and removes the subcutaneous fat, pretarsal muscle, and small part of orbital septum through small incisions. And then we suture the wound skin to skin through levator aponeurosis and upper part of tarsal plate. These procedures prevent the possible problem of loosening of the folds of non-incision method by creating scar- adhesion between wider portion of the dermis and the tarsal plate and allows the application on puffy eyelid without any difficulty and is expectable of short recovery time. A retrospective review of data for 154 patients who underwent the partial-incision blepharoplasty using debulking method from November 2000 through april 2003 is presented. Most results were successful except 3 cases. Two patients complained of weak fold and one patient complained of short fold line. Satisfactory results in most patients prompt us to report this method, and we hope this debulking method complement the existing incision and non-incision method.

Eyelid Shape of the Chosun Dynasty: Analysis of 101 Portraits

The aim of this study is to elucidate the morphology and preference of the eyelid shape of the Chosun dynasty. One hundred and one portraits of Chosun dynasty were analyzed. Portraits of early(1392-1550), mid(1551-1700), and late (1701-1910) Chosun dynasty were 26, 17 and 58 respectively. The most of the portraits were men of noble birth(86). Others were the portraits of the Kings(4) and Monks(4), Women(4) and patriots(4).The double fold were observed in 20%, among them 65% were outfold. Epicanthal fold were present in 16% Thirty-one% had hooding of the upper eyelid. Sixty nine% had Wrinkles of the lower eyelids. Sixty three had baggy lower eyelid and lower lid ectropion were observed in 6% and 1% respectively. According to the Korean aphorism of the portrait drawing of Chosun dynasty "If one hair is different, the portrait is another man's", the portraits were drawn like a photograph. In this aspect our attempt to light up the eyelid shape of several hundreds years ago when photographs were not available have validity.

Double Fold found in Portraits of Korean Women: Analysis of 2001, 1990, 1982 Grand Art Exhibitions of Korea

The author attempted to analyze the upper eyelids of 30 faces of Korean women's portraits which were awarded at 1st, 9th and 20th Grand art exhibiton of Korea held in 2001, 1990, and 1982. In 1982, 36% of eyelid were double fold. The incidence increased to 47% in 1990. In 2001, 97% of eyelids were double fold. Among them, 67% were infold, and 33% were outfold. Only 14% of eyelids had epicanthal fold. Fourteen % were high fold, remainders were low or medium height. We may consider that the ideal eyelid nowadays in Korea is a double fold with low or medium height, with infold, without epicanthal fold.

Double Fold Operation of Incisional Method: Skin-Tar-Sal Plate-Muscle-Skin Fixation

The purpose of this article is to introduce author's method of double fold operation by using skin-tarsal plate-muscle-skin fixation. Three thousand patients were operated during last ten years. The incision line is 7 to 10mm above the ciliary margin while the skin is pulled upward. Excess skin and orbicularis oculi muscle is removed. Orbital septum is opened on its lateral part and orbital fat is removed. 1) Skin of the lower flap, 2) tarsal plate and/or levator aponeurosis, 3) orbicularis oculi muscle of the upper flap, and 4) skin of the upper flap are sutured with removable suture material. The fixations are performed at three points of each eyelids(midpupillary line, medial and lateral margin of the tarsal plate). Additional nine stitches of skin-levator-skin fixation are put on each eyelid. Sutures were removed on third to 6th postoperative-day. Most of the patient were satisfied with the result. Only 30 patient complained loss of fold. However, 150 patients had conjunctival bleb and 15 patient suffered from dellen. This method is unique method which can avoid triple fold by fixating the orbicularis muscle of the upper flap.

Double Eyelid Operation with Three Tiny Incisions

There are numerous noninvasive buried suture methods available to make a double eyelid, such as, fixation with skin and pretarsal tissue, fixation with skin and conjunctiva through the tarsal plate and the sling technique, which goes between the levator and Muller muscle and subdermal tissue. But these methods have some shortcomings and many operators are concerned for preventing the double fold to lower and to fade away in puffy eyelid. Because, in puffy eyelid, the excessive orbital fat may migrate to the area of fixation and it jeopardizes the effect of suturing. So, We tried to change the thick and puffy eyelid to the slim eyelid by selectively removing soft tissue(pretarsal fat, muscle, orbital fat) through the three tiny incisions. Ninety-five patients underwent operation for creation of a double fold between January of 1996 and February of 1999. All were female. The patients' age ranged from 16 to 31 years, with the mean of 22 years. Most of our patients were satisfied except 5 cases with minor complication(mild asymmetry: 4 cases, foreign body granulation: 1 case). Our method is very similar to various nonincisional methods, however, we removed a portion of pretarsal tissue, muscle, and/or orbital fat around three small incision sites to facilitate tissue adhesion. A continued modification in nonincisional method and improvement in results for double eyelid operation can be expected.