Revision of Asian upper eyelid crease







Table 6.1

Indications for surgery









Eyelid crease asymmetry
High placement of surgical eyelid crease
Hollowing of superior sulcus


Table 6.2

Preoperative evaluation













History of prior surgery to create eyelid crease
Amount of skin reserve above existing crease
Presence or absence of upper eyelid fat
Presence of co-existing ptosis
Shape and height of current and desired crease


Introduction


Revision of a high, asymmetric Asian upper eyelid crease is a challenging surgical problem. There are multiple etiologies including a high skin crease incision, excessive removal of orbital fat, damage to the levator, improper placement of crease formation sutures, and iatrogenic surgical trauma. Prior to undertaking surgical revision, the patient’s expectations should be kept low and the need for subsequent surgeries must be discussed. Alternative treatments, such as upper eyelid hyaluronic acid fillers, can be discussed if revision surgery is not an option.


The general principles of crease lowering are to excise an ellipse of skin and orbicularis to the desired level of the new crease and then inferior advancement of a preaponeurotic fat pedicle as a buffer to prevent multiple crease formation followed by placement of crease formation sutures.




Surgical Technique





Figures 6.1A–D


Skin marking

Figure 6.1A shows an asymmetrically high and hollow left superior sulcus compared to the right eyelid. In this case, the patient preferred the lower, more natural-appearing right upper eyelid crease and desired unilateral correction of the left side. The height of the right upper eyelid crease is noted to be several millimeters lower than the left eyelid ( Figure 6.1B ). The new crease height is then marked on the left upper eyelid with a fine tip marker ( Figure 6.1C ). The pinch technique can be used to identify redundant skin for removal and in this case corresponds to the site of the prior surgery ( Figure 6.1D ). As with any case of upper blepharoplasty, the inferior eyebrow to upper eyelid distance should be measured to ensure adequate anterior lamella for eyelid closure ( Chapter 3 ).



Figure 6.2


Skin incision

Local anesthetic consisting of 1% lidocaine/0.25% bupivacaine with 1 : 200,000 epinephrine is given in a total volume of less than 2 ml to minimize distortion of the skin marking. Careful skin incision with a #15 blade is performed within the marking.

May 16, 2019 | Posted by in Reconstructive surgery | Comments Off on Revision of Asian upper eyelid crease
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