Asian upper eyelid blepharoplasty
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This is Richard Allen at the University of Iowa.
This video demonstrates an upper eyelid blepharoplasty in a patient of Asian descent.
In general the eyelid creases should be kept at a low position and excision of skin should be conservative. I do dissect in a suborbicularis plane to remove a flap of skin and orbicularis muscle. However, I rarely if ever open the orbital septum in patients who are Asian. I believe that this results in raising the eyelid crease, which is not desirable. In addition, if I would do a ptosis repair I would likely do an MMCR first followed by the blepharoplasty later. Again, dissection is carried out between the orbicularis muscle and the orbital septum.
The most important issue in Asian patients is the formation and height of the eyelid crease. I will in general keep the lid crease low and form a lid crease with the surgery by dissecting the confluence of the levator aponeurosis and the orbital septum from the anterior surface of the tarsus. This will then be incorporated into the closure of the skin. Basically what this allows is the establishment of a moderately strong crease, but due to the low placement of the skin incision, the crease will not rise significantly. Again, discussion should be had with the patient prior to surgery regarding the formation and placement of the lid crease.
So again, dissection is carried out between the underside of the levator aponeurosis and the Mullers muscle. This is performed bilaterally. A thermal cautery is very useful in performing this dissection.
This is a similar dissection as is performed for a levator recession in thyroid eye disease. A small amount of the confluence of the orbital septum and the levator aponeurosis is resected.
The skin is closed by incorporating the confluence of the levator aponeurosis and septum into the closure. Two things will be obtained from this maneuver: one, it will establish a lid crease; and two, it will evert the lashes to prevent lash ptosis or sliding of the anterior lamella over the posterior lamella. I prefer 6-0 Prolene suture for closure in an interrupted fashion.
This performed along the length of the incision to incorporate the confluence of the levator aponeurosis and orbital septum.
At the end of the surgery, the patient is instructed to keep ice over the eyes and elevate the head of the bed for two days. I will prescribe a tapering dose of prednisone in younger patients. Erythromycin ophthalmic ointment is used three times a day and the patient will return in one week for suture removal.