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Original Investigation |

Creating Natural Double Eyelids With Continuous Buried Suture and Mini-incision Technique Using Subcutaneous Absorbable Suture for Patients With Puffy Eyelids

Liqun Li, MD, PhD1; Binting Ni, MD1; Shengsheng Pan, MD1; Yuanshao Lin, MD, PhD1
[+] Author Affiliations
1First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, People’s Republic of China
JAMA Facial Plast Surg. 2014;16(3):188-192. doi:10.1001/jamafacial.2013.2512.
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Importance  Incision and buried suture are 2 primary techniques for creating double eyelids. The incision method is suitable for all kinds of eyelids, but operational trauma and prolonged recovery time limit its application. The nonincision approach can shape a natural and vivid crease with a relatively short recovery time. However, it is not suitable for patients with puffy eyelids, and in those patients the duration of the supratarsal crease is not long. We propose a method of combining the techniques of continuous buried suture and mini-incision.

Objective  To explore a new kind of double eyelid plasty, a corrective surgical procedure for patients with puffy eyelids.

Design, Setting, and Participants  Observational study of 221 patients with puffy single eyelids who underwent this new blepharoplasty from May 2007 to and March 2012.

Interventions  Combined continuous buried-suture and mini-incision surgery using subcutaneous absorbable suture to create natural double eyelids under local anesthesia. All procedures were performed by the same surgeon.

Main Outcomes and Measures  All patients were observed after surgery for a period ranging from 1 to 28 months (mean follow-up, 16 months). Data collection included operative time, postoperative recovery and complications.

Results  All double eyelids appeared natural after short operative time and rapid postoperative recovery, leaving an invisible scar and long-lasting supratarsal crease. No corneal damage or infection occurred.

Conclusions and Relevance  Combined continuous buried-suture and mini-incision surgery using subcutaneous absorbable suture to create natural double eyelids is a reliable, durable, and less-invasive technique for patients with puffy eyelids.

Level of Evidence  2.

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Figure 1.
Illustration of the 6 Puncture and Suture Points, Labeled a Through f, Used in the Procedure

A, Preoperative design: The double-eyelid margin is 6 to 8 mm at the natural level. Six puncture incisions are made with the tip of a No. 11 scalpel blade (approximately 1 mm long) for the creation of a pretarsal crease. B, A 6-0 nylon suture anchors the pretarsal fascia/levator aponeurosis (upper end of the tarsus) to the dermis. C, The 2 ends of the suture are tied, and the knot is buried under the mini-incision.

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Figure 2.
Illustration of the Suturing Technique

Subcutaneous tissue sutured on the edge of the mini-incision and the pretarsal tissue (upper end of the tarsus) with a 6-0 absorption line.

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Figure 3.
Preoperative, Intraoperative, and Postoperative Clinical Images of a 20-Year-Old Woman

A, Preoperative photograph shows single upper eyelids and puffy eyelids of a patient who underwent upper blepharoplasty of both eyes. B, Preoperative design of crease height and puncture incisions. C, With the patient under local anesthesia, the dermis was punctured at the designated points with a No. 11 blade. D, The orbital fat was released through the mini incisions. E, Appearance after suture fixation. F, Appearance immediately after the upper blepharoplasty treatment. G, Appearance of open eyes 2 months after the procedure. H, Appearance of closed eyes 2 month after surgery. Owing to the patient’s different eyelid conditions, there is slight asymmetry, but the patient was satisfied.

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