Many Asians upper eyelids do not have a discernible crease due to the absence of connecting fibers between the levator aponeurosis and the underside of the dermis of the skin. Other eyelid anatomic findings include an excess of preaponeurotic fat and a lower fusion point of the orbital septum and the levator aponeurosis. These unique Asian eyelid features have led to a wide range of double eyelid surgery procedures to create a visible separation of the upper eyelids into two halves. Such procedures can be fundamentally divided into incisional and minimal incisional double eyelid techniques.
In the Surgical Pearls section of the May/June 2018 issue of the JAMA Facial Plastic Surgery journal, an article was published entitled ‘Asian Upper Blepharoplasty’. In this paper the author describes his Asian blepharoplasty technique which uses an excisional open technique with a beveled approach and trapezoidal debulking of preaponeurotic tissues. The objective is to remove as much redundant tissue as possible that presents an obstruction to the creation of a visible skin crease. The described technique does not use any buried sutures to create the crease.
The details of the technique include: 1) the creation of the eyelid crease line along the height of the tarsal plate (lower incision line), 2) an upper incision line 2 to 3mms above the lower, 3) skin excision between #1 and #2, 4) a beveled incision through the orbicularis oculi to the orbital septum from the superior incision line, 5) opening of orbital septum and excision of some preaponeurotic fat, 6) excision of lower hanging skin and muscle segment(trapezoidal debulking), 7) thinning of inferior edge orbiculares muscle fibers and fat, 8) release any constraining tissue between the preseptal skin-muscle flap and the levator, 9) a 6-0 suture is used between the upper skin edge to the levator and then through the lower skin edge and 10) skin closure with 7-0 suture.
This double eyelid surgery technique is an interesting and effective modification that relies on discrete tissue removal/debulking and uses no deep buried sutures for its result. This is a thoughtful anatomic approach that clears away obstructing tissues and allows the dermal skin edges to adhere down to the elevator and tarsal plate.
Dr. Barry Eppley
Indianapolis, Indiana