Orbicularis–levator–tarsus composite suture technique in double-eyelid operation

Wu, Lehao; Ye, Zirong; Xu, Yi; Yu, Jingjing; Wu, Yiping

doi:10.1016/j.bjps.2015.04.009

Cited by 25 publications

(10 citation statements)

References 20 publications

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“…Besides levator aponeurosis, the septum and tarsal plate were included in the fixation in our technique aiming to further consolidate the adhesions. A similar fixation concept with orbicularis oculi-levator aponeurosis-tarsal plate as a composite entity was reported previously 20 to generate a more solid bond than fixation without the tarsal plate. The tarsus is a thick compact structure composed of dense fibrous connective tissue.…”

Section: Discussionmentioning

confidence: 61%

A Composite Tissue Flap for Double-Eyelid Blepharoplasty in Asian Patients: A Retrospective Study

Zhou

et al. 2021

Journal of Craniofacial Surgery

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Double-eyelid blepharoplasty, the procedure to create supratarsal crease, has been one of the most popular cosmetic operations in Asia for many years. This study aimed to assess the effectiveness and safety of a surgical procedure using a composite tissue flap for double-eyelid blepharoplasty. A surgical technique was introduced and patients having blepharoplasty with this technique from January 2017 to August 2019 were retrospectively studied. In this technique, a composite tissue flap consisted of the posterior septum and levator aponeurosis was formed and fixed with orbicularis oculi muscle and tarsus. The cosmetic outcomes, patient satisfaction, and complications from the documented medical records were analyzed. Eighty female and 1 male patients had blepharoplasty with the proposed technique and were followed up from 6 months to 42 months. Six patients were found to have mild blepharoptosis. As for cosmetic outcomes, 71patients were graded as good, 7 patients were graded as fair, and only 1 patient was graded as poor. Those patients who were not graded as good had visible scarring, shallow eyelid crease, or asymmetry. The overall patient satisfaction was as high as 95.1%. Mild hematoma formation occurred in 3 patients and no infection or blepharoptosis was observed. One patient complained of asymmetry and 2 patients complained of unilateral crease fading as the complications. The technique is effective to develop durable and natural-looking double eyelids with minimal complications. It could also be an option for mild ptotic patients who ask for double-eyelid blepharoplasty.

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Section: Discussionmentioning

confidence: 61%

A Composite Tissue Flap for Double-Eyelid Blepharoplasty in Asian Patients: A Retrospective Study

Zhou

et al. 2021

Journal of Craniofacial Surgery

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“…Even though it is suggested to fix the mini-flaps at the base, this somewhat complicated procedure is not suitable for surgeons who lack experience and may cause iatrogenic ptosis. In 2015, Wu et al [ 24 ] performed composite fixation of pretarsal orbicularis oculi muscle, levator aponeurosis fascia, and tarsal plate in 98 cases of double-eyelid surgery. Choi and Eo [ 25 ] also identified the outer fascia of orbicularis oculi muscle as an anchoring point for levator aponeurosis fascia.…”

Section: Discussionmentioning

confidence: 99%

Re-positioning pretarsal tissue layers for double-eyelid surgery: 6-year experience

et al. 2022

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Double-eyelid surgery is a very common practice in East Asian patients. The differential distribution of pretarsal tissue layers is considered to be the anatomical mechanism of natural Asiatic single eyelid, it is possible to form double-eyelid crease by re-positioning the pretarsal structure layers. The author presents a new double-eyelid surgery based on re-positioning of the pretarsal structure layers without tissue removal. Over a 6-year period, 1440 patients underwent new double-eyelid surgeries. With the pretarsal orbicularis oculi muscle incised, the pre-pretarsal levator aponeurosis fascia fibroadipose was first dissected to form a fibroadipose flap, and then repositioned with the eyelid lower lip orbicularis oculi muscle flap. The new composite structure was anchored at 3 points on the pretarsal levator aponeurosis fascia; the skin was sutured to form a smooth crease. Postoperative outcome and follow-up data were analyzed. Patients were followed up for an average of 2 years. esthetic outcomes were satisfactory for 97.91% of patients, who enjoyed new double upper eyelids with smooth creases and invisible incision lines. Outcomes were unsatisfactory for 2.08% of patients (double-eyelid regression, 0.76%; asymmetric creases, 1.32%). All patients who were not satisfied with their esthetic outcomes underwent second correction surgery. This new Pan-flap technique focuses on the correct dissection and repositioning of differentially thickened pre-pretarsal levator aponeurosis fascia fibroadipose tissue in East Asian patients. This new technique can generate broader and tighter attachment between pretarsal orbicularis oculi muscle and levator aponeurosis fascia, and form smooth double-eyelid crease without pretarsal soft tissue removal.

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“…This technique provides for a solidly fixed, tightly stretched pretarsal skin when the eyes are open with significantly reduced chances of relapse. In 2015, Lehao et al 27 reported an orbicularis-levator-tarsus composite suture technique in double-eyelid operation in 98 patients with either congenital absence of the upper-eyelid folds or loss of fold from previous procedures. After all the patients were followed up for 6 to 30 months, the author suggests that this composite suture technique is a highly applicable and reliable approach for upper-eyelid blepharoplasty.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Shen²,

Zhang³

2021

Journal of Craniofacial Surgery

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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.

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Orbicularis–levator–tarsus composite suture technique in double-eyelid operation

Cited by 25 publications

References 20 publications

A Composite Tissue Flap for Double-Eyelid Blepharoplasty in Asian Patients: A Retrospective Study

A Composite Tissue Flap for Double-Eyelid Blepharoplasty in Asian Patients: A Retrospective Study

Re-positioning pretarsal tissue layers for double-eyelid surgery: 6-year experience

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

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