The small incisions combined with interrupted buried suture blepharoplasty: flexible-rigid fixation

Abstract

Background: The traditional full incision blepharoplasty is the most commonly used in Asia. However, it has significant drawbacks like long recovery period, excessive surgical marks etc. We offer a new suture idea and combine it with interrupted suture buried blepharoplasty to improve these disadvantages.

Methods: In our procedure, the orbital septum is opened and separating the levator aponeurosis-the retro-orbital septum complex under this 3-5 millimeters small incision, a flexible-rigid fixation would be made: suture fixation was made to the tarsus-the complex-lower lip orbicularis oculi muscle. We interrupted bury the sutures in the uncut skin between the two small incisions.

Results: This paper included 333 patients divided into small incision groups using flexible-rigid fixation (n = 244, 73.3%) and full incision groups using rigid fixation (n = 89, 26.7%). Both at 6-month and at 5-year postoperative follow-up, the satisfaction of small incision group was statistically higher than the full incision group. The overall postoperative complication rate was statistically significantly less in the small incision. The permanence was not statistically different. For Assignment of Postoperative Effort Score (PES) results, at 6 months postoperatively, the mean score was 8.29 ± 1.32 in the small incision group, 7.86 ± 1.54 in the full incision group. At 5 years postoperatively, the mean score was 7.48 ± 1.45 in the small incision group, 7.51 ± 1.73 in the full incision group. None were statistically different.

Conclusion: The small incisions group achieves a higher level of patient satisfaction and more mild trauma in the surgical area, has a low complication rate, and a decent degree of durability.

Keywords: Small-incision combined with interrupted buried suture; blepharoplasty; duration after blepharoplasty; flexible-rigid fixation; shallow scars.

FIGURE 1

The path of the sagittal suture in interrupted buried suture blepharoplasty and anatomical structure.

FIGURE 2

(A) Preoperative pictures. (B) Preoperative molds. (C) Design drawing lines.

FIGURE 3

Suture fixation at point B: (A) Separation of the levator aponeurosis, (B) Hang the tarsus, (C) Continue to fix levator aponeurosis and orbital septum together, (D) Final fixation with the lower lip orbicularis oculi muscle.

FIGURE 4

Flexible-rigid fixation: The suture is attached to the tarsus or anterior tarsus fascia, then threaded through the levator aponeurosis and the retro-orbital septum complex, and finally anchored to the orbicularis oris muscle of the lower lip using a mattress suture. Needle feed order is 0–8 through the tissue levels in sequence.

FIGURE 5

Interrupted submerged suture between two incisions.

FIGURE 6

Interrupted buried suture technique under small incision: This figure shows the 6–0 nylon suture being inserted at one side of the small incision to engage the levator aponeurosis or tarsus. The suture then travels through the subcutis and exits at the opposite side of the incision.

FIGURE 7

Immediate post-operative eye opening (A) and closing (B).

FIGURE 8

The same patient who eye opening (A) and closing (B) at 3 months after surgery.

FIGURE 9

This chart illustrates the distribution of PES scores among post-operative blepharoplasty patients in each group, according to the PES scoring rules.

FIGURE 10

Box plots represent raw data from the Postoperative Effort Score (PES) at 6 months and 60 months, showing the median (centerline), interquartile range (box margins), adjacent values (whiskers), and outliers (dots).

FIGURE 11

A 24-year-old female patient who underwent minimally invasive small incision combined with interrupted buried blepharoplasty is shown before surgery (A), immediately after surgery with open (B) and closed (C) eyes, and four years post-surgery with open (D) and closed eyes (E).

FIGURE 12

A 26-year-old female patient with good eye condition who underwent the small incision blepharoplasty is shown before surgery (A), five years post-surgery (B).

FIGURE 13

A 31-year-old female patient with moderately bloated upper eyelids and mild ptosis who underwent the small incision blepharoplasty is shown before surgery (A), seven years post-surgery (B).

FIGURE 14

A 54-year-old woman with mild upper eyelid skin redundancy. (A) Pre-operative design (left eye with double eyelid formed by the action of a toothpick). (B) Eye opening six months after surgery. (C) Eye closing six months after surgery.