In the Oriental population, the central lid width is 5-8mm and the blepharoplasty line should be located at the upper edge of the lid. Many Chinese are not suited to the overly wide and pronounced eyelid shape of Westerners, who are more suited to a moderate and natural eyelid. A wide eyelid line can give a frightening appearance and affect the aesthetics! The method of adjusting an overly wide blepharoplasty line is closely related to the procedure chosen for the first blepharoplasty.
1. First-time blepharoplasty is a non-incision method (buried wire blepharoplasty)
With buried blepharoplasty, the scar caused by the surgery is small and the anatomical configuration is not altered much, so it is easier to correct an overly wide blepharoplasty line. If the eyelid line is found to be too wide within a short period of time after the buried wire reconstruction, the sutures can be removed directly and the eyelid line redesigned.
2. First blepharoplasty is incisional
The most important thing is to avoid designing an overly wide blepharoplasty line during the first blepharoplasty. When first surgery is performed with an incision blepharoplasty, the skin, lid plate, prelid tissue, and levator aponeurosis are more heavily adhered at the blepharoplasty line, making repair much more difficult than with the first non-incision blepharoplasty. To correct a wide blepharoplasty, the incision scar is removed by incision, the adhesions are released, and the soft connective tissue such as orbicularis oculi, orbital fat, and suborbital fat is transferred to prevent re-adhesions.
There are three conditions that require different treatment when repairing an incisional blepharoplasty
In cases where both the upper lid skin and orbital fat remain
In cases where the skin between the original blepharoplasty line and the newly designed blepharoplasty line needs to be removed and re-sutured to form a narrower blepharoplasty line to correct an overly wide blepharoplasty fold, it is important to transfer the surrounding soft tissues to prevent re-adhesion, and this is where orbital septal fat is the best choice, as it is extremely mobile and very suitable for filling and preventing adhesions.
Surgical Approach
(1) Excision of the scar at the original blepharoplasty line.
(2) transfer, filling, and fixation of the orbital septum
(3) Treatment of the orbital septum and suturing of the surrounding tissues and filling of the connective tissue.
(4) Skin suturing.
(2) Less skin on the upper lid and residual orbital septum fat
Surgical method
(1) Cut the newly designed line below the original blepharoplasty line, separate it to the orbital septum and pull out the orbital fat, and lay the orbital septum in front of the lid to prevent re-adhesion.
(2) Suture the upper margin of the lid and the dermis to form a new eyelid line at the newly designed eyelid line.
(3) Skin suturing.
(3) Skin suture.
When too much fat is removed from the orbital septum in the first surgery, the skin and levator aponeurosis have formed adhesions. Therefore, all of these adhesions are removed and the levator aponeurosis is reattached to the lid to reduce the height of the eyelid, thus creating a new eyelid line. To prevent adhesions, the central connective tissue, which includes the fat under the orbicularis oculi, can be used when there is a lack of fat. If the central connective tissue is also lacking, either free fat or free dermal grafting may be used.