How double eyelids are formed
The upper and lower eyelids are medically known as the upper and lower eyelids. The upper eyelid is governed by the levator muscle, which is in front of the eyeball and is shaped like a curtain, and is also governed by the ophthalmic nerve. When the levator muscle contracts, it opens the upper eyelid, which contains a cartilage-like, rigid connective tissue called the lid plate that maintains the normal shape of the upper eyelid. The levator muscle is attached to the upper edge of the lid. If some of the fibers of the levator muscle extend upward and attach to the skin of the upper eyelid 3-5 mm from the lid margin, when the levator muscle contracts, the eyelid is lifted upward and the upper eyelid surface forms a distinct crease, a horizontal groove, that is narrow inside and wide outside, which is the reason for the double eyelid.
Indications
1. Healthy and mentally normal people with single eyelids who request surgery and have no contraindications.
2, monolids with bloated upper eyelids (commonly known as blister eyes).
3. Monolids with internal canthus.
4. mild upper eyelid entropion.
5, mild upper lid ptosis (combined with levator muscle shortening).
6, upper lid skin laxity and ptosis, affecting the visual field. Most often seen in the elderly.
7, one single and one double in both eyes, single lid side can be operated. or both eyes with different crease widths and lid fissures of different sizes.
8. Inner double or hidden double where the heavy lids are not obvious when the eyes are open.
Age of blepharoplasty: Because eyelids are so variable at an early age, sometimes single and sometimes double, the age of surgery should not be too early, and surgery should be considered around puberty.
Contraindications
1. people who are mentally abnormal or have psychological disorders, lack determination of their own condition, and are obsessed with pursuing unrealistic heavy-lid forms
2. patients with bleeding disorders and hypertension, as well as active and progressive diseases of the heart, lungs, liver, kidneys and other vital organs, uncontrolled diabetes mellitus and those suffering from infectious diseases
3, congenital amblyopia, inner or outer eye, and those with acute or chronic periocular infectious diseases that have not been controlled and have not healed on their own
4, those with facial paralysis with incomplete lid closure
5, those with various causes of ocular hyperopia, hyperconcave or eyelid recession
6. those whose families are firmly opposed to it
7. Those with ptosis.
Pre-operative preparation
1. If you have conjunctivitis, blepharitis, or severe trachoma, you must be cured before surgery. If there is inflammation around the eye, surgery should be postponed. Antimicrobial eye drops should be administered twice a day before surgery.
2. For patients with a history of bleeding tendency, platelets and blood clotting time should be checked.
3. Middle-aged and elderly patients should have their blood pressure measured and electrocardiogram done if necessary, and if there are mild abnormalities, symptomatic medication should be administered before surgery.
4.Avoid menstrual period to perform surgery.
5.Pre-pregnancy (third trimester) or late pregnancy (third trimester) surgery should be suspended.
6.Stop taking steroid hormones and aspirin and other anticoagulant drugs 7-10 days before surgery.
Common Double Eyelid Methods
There are dozens of surgical methods of blepharoplasty, but they can be summarized into three categories.
1. Incisional lid fixation method.
It is the oldest method of blepharoplasty because it regulates and changes the tissue structure at all levels of the upper eyelid and can address many of the complex problems that exist on the eyelid, such as lax upper lid skin, eyelash entropion, upper lid bloating, sagging orbital fat, septal laxity, and bulging outer superior orbital rim. The resulting heavy lid is firm and long-lasting, with deep creases and a three-dimensional appearance. The disadvantage is that the procedure is complex and requires familiarity with eyelid anatomy and a solid foundation in plastic surgery. After surgery, the incision line scars are visible for 3-6 months, but gradually fade as time passes.
2.Buried wire method
This method is suitable for young people with large lid fissures, thin eyelids, no bloating, no laxity of the eyelid skin, normal tension, and no canthal redundancy. The advantages are that it is simple to perform and easy to master. The ligature is fixed between the upper lid dermis and the anterior or superior lid margin of the levator aponeurosis, resulting in a natural-looking crease. There is no incision and the post-operative tissue reaction is minimal and does not interfere with work, making it easy to accept. If the beginner does not master the technique properly, the original method can be used or the incision method can be used to make up for the failure without sequelae.
The disadvantage is that the upper lid crease can easily become shallow and narrow. The upper lid crease can disappear if the case is not properly selected or if the technique is not well mastered. The knot can easily come loose, leading to failure, and the knot can be buried too shallowly, exposing or forming small cysts. Case selection is narrower than with the incision method. If the upper lid is mildly bloated and the patient is adamant about the buried wire procedure, a small incision can be made in the outer 1/3 of the upper lid crease to remove the orbital fat.
3. Suture method (also known as the penetrating suture method)
This is suitable for those with large lid fissures, thin eyelids, no bloating, and no laxity or mild laxity of the upper lid skin without medial canthus. The advantage is that it is simple to perform and easy for beginners to master. No incisions are made and there are no visible scars after surgery, making it easy for the patient to accept. The disadvantage is that because the entire eyelid tissue is ligated and lymphatic flow is impaired, postoperative reliance on tissue response to the sutures results in an oblique fibrous adhesion between the levator aponeurosis and the skin at the upper edge of the lid, but often the fibers formed are not uniform. Once the scar has relaxed, the crease becomes shallow or disappears. If the position of the ligature is too high, it restricts the mobility of the levator and Muller muscles, which can lead to ptosis, eye fatigue, and difficulty in opening the eyes. The surgery should not remove loose upper eyelid skin or orbital fat at the same time.
Precautions.
For a faster and better recovery after surgery, postoperative care should not be ignored. The main post-operative care for oculoplastic surgery is to use your eyes more, not to read or watch TV for a long time, but to do more eye opening and closing exercises to exercise your eyelids, and not to keep your eyes closed for fear of excessive eye use or wound pain. Doing more eye-opening and eye-closing exercises will help your eyelids to take shape and help the swelling to subside, which is important to speed up your recovery.