Refinements in Upper Blepharoplasty: The Five-Step Technique

Refinements in Upper Blepharoplasty: The Five-Step Technique: No abstract available




The article entitled “Refinements in Upper Blepharoplasty: The Five-Step Technique” by Dr. Rohrich et al.1 and the related articles published2 , 3 early are very inspiring and appealing. The authors divided the aging upper blepharoplasty into five steps and introduced the orbital rejuvenation treatment thoroughly, including the techniques of lateral canthopexy and volume restoration with fractionated fat. The comprehensive techniques improved the situation of blepharochalasis, decreased the laxity of the lateral canthus, alleviated the periorbital depression at the same time, and achieved excellent results. However, regarding the anatomical and cultural differences between Caucasian and Asian patients, we would like to share our experiences and introduce our techniques.



In the video, the authors did not show how to mark the incision before the operation. In the article, the authors described the principles of designing the incision, but they did not explain how to evaluate the size of skin to excise. Because removal of the skin has a direct effect on the outcome of surgery, we think the ignored content is very important. Excising too much skin may lead to lagophthalmos and otherwise to poor results. In our opinion, the shape of the upper lid crease is one of the most important criteria for assessing the size of the incision. Our assessment technique for the infraeyebrow blepharoplasty may be useful: we draw the upper incision just below the eyebrow and excise the skin; tighten the skin upward before suturing, until the shape of the upper eyelid is satisfactory; and finally, excise the skin beyond the upper incision. Attention should be paid to the effect of gravity.



In the case of elderly patients, overly long lateral incisions lead to permanent scars and otherwise to poor results. Because Asians are more prone to scarring and have lower acceptability of scars, we prefer infraeyebrow blepharoplasty. Compared with the upper eyelid blepharoplasty, it has several benefits, as follows: (1) the scar is inconspicuous, especially for eyebrow tattoo patients (because Asian hair is more sparse, eyebrow tattooing is a choice for many Asian women); (2) it will not affect the upper lid crease, so it can avoid an unnatural postoperative appearance for the patient, especially in elderly patients; (3) in upper eyelid blepharoplasty, surgeons pull the thicker skin below the eyebrow down to the upper eyelid, whereas in the infraeyebrow blepharoplasty, they pull the thinner skin up to the eyebrow, so the latter approach can effectively avoid postoperative swelling; (4) through infraeyebrow incision, a surgeon can separate part of the orbicularis oculi muscle and excise orbital septum fat; (5) the patient has rapid recovery, with light swelling; and (6) the eyebrow blepharoplasty can be repeated, because scar tissue after surgery has little effect. The disadvantages include the following: (1) surgeons cannot achieve upper eyelid folds; (2) removal of too much skin will lead to postoperative wrinkle, and thus the skin should be removed with caution; and (3) it will cause the eyebrows to move down slightly. Because the distance between the eyebrow and the margin in Caucasians is shorter, the effect of this operation for Caucasians needs further verification.



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DISCLOSURE

The authors received no funding support for the research of this communication and declare no potential conflicts of interest with the respect to the research, authorship, or publication.



Shiwei Guo, M.D.



Mingyong Yang, M.D.



Minimally Invasive Plastic Surgery Center



Plastic Surgery Hospital



Chinese Academy of Medical Sciences and Peking Union Medical College



Beijing, People’s Republic of China



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REFERENCES

1. Rohrich RJ, Villanueva NL, Afrooz PN. Refinements in upper blepharoplasty: The five-step technique. Plast Reconstr Surg. 2018;141:1144–1146.

Cited Here...

2. Rohrich RJ, Coberly DM, Fagien S, Stuzin JM. Current concepts in aesthetic upper blepharoplasty. Plast Reconstr Surg. 2004;113:32e–42e.

Cited Here...

3. Fagien S. Advanced rejuvenative upper blepharoplasty: Enhancing aesthetics of the upper periorbita. Plast Reconstr Surg. 2002;110:278–291; discussion 292.

Cited Here...

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