Objectives: In the author’s practice, 85-90% of upper blepharoplasties consist of skin excision and pretarsal microcoagulation.
If skin was excised only, the aesthetic result would depend on the presence of a well-defined and not too mobile pretarsal skin crease, the uppermost insertion of the levator aponeurosis on the skin. High, pretarsal coagulation of the orbicularis oculi muscle just above the lower incision induces local fibrosis, including transmuscular levator extensions.
Introduction: When the coagulated zone is included in the continuous skin suture, it is likely that the levator extensions and the skin will remain well-connected and less prone to dehiscence or descent respectively later in life. Spot coagulation with the tip of closed eyelid forceps and a 4 Mhz radiofrequency current, or with the CO2 laser pen out of focus, is a simple means to achieve the intended fibrosis. It comes at the expense of a little more swelling and potential delay of healing compared to excision alone.
Materials / method: Minimal reduction of a little, medial protrusion of fat, or a more general reduction in young people with good skin quality and obvious fat excess, can occasionally be performed through small openings in the orbicularis oculi muscle.
Uncontrolled and therefore sometimes excessive removal of fat may lead to hollow upper eyelids, which look artificial or old in their own way.
Results: When upper eyelid fat needs to be explored and at least partially repositioned in the orbit, when there is tendency towards eyelid ptosis or when the contralateral upper eyelid in a patient with unilateral ptosis needs surgery, the author prefers “open sky” exposure and surgical suturing of the levator aponeurosis anterosuperiorly to the tarsus (10-15% of upper blepharoplasty cases.
Open sky exposure allows unequivocal identification of all relevant anatomical structures and precise correction of skin excess, fat position and quantity and levator extensions.
Conclusion: Unlike classic teachings about levator fixation with a single, central stitch, using three to six polyglycaprone sutures can maintain or restore a natural looking curve of the eyelid border. The medial and lateral levator horns very rarely need to be released in aesthetic blepharoplasty patients. Suturing the severed skin end to the deep suture line helps to create a beautiful and stable pretarsal crease.
Disclosures
Did you receive any funding to support your research for this TOPIC?
No
Were you provided with any honoraria, payment or other compensation for your work on this study?
No
Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No
Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No
This work was not supported by any direct or non direct funding. It is under the author's own responsability