Dermomusculo-Septal Fixation with Releasing Burden Factors for Natural Double Fold Formation in Asians with Sleepy Eyes
For creating natural double fold in Asians with sleepy eyes other than true ptosis, two things should be considered. First, removing all burden factors that interrupt eye opening such as orbital fat, lower-positioned transverse ligament and connective tissues around lateral horn of aponeurosis is essential. Second, there should be soft tissues – some thickness of muscle and levator insertion- between the crease and aponeurosis. We present successful clinical outcomes of refined dermomusculo-septal fixation technique followed by full release of burden factors.
Methods/Technique:
The medical records of 301 patients (298 women and 3 men) who had double-eyelid operation using dermomusculo-septal fixation technique from Nov, 2010 to Apr, 2013 were reviewed. Through an supratarsal incision, a pretarsal dermomuscular flap was made. Septal incision was made cephalad to the septoaponeurotic junction and burden factors were routinely released. Then the septal turnover flap was sutured to the pretarsal dermomuscular flap. The average follow-up period was 18.4 months.
Results/Complications:
In 301 patients, satisfactory results were recorded for 278 patients (92.4%). The technique produced more natural crease and less edema due to minimal tissue trauma. The complications were minor, with 9 patients (2.99%) of fading of the lid fold, 6 patients (1.99%) of asymmetry, and 4 patients (1.33%) of triple line, who required revision surgery.
Conclusion:
The technique we have adopted will not only prevent the immovable, deep crease with the use of pretarsal dermomuscular flap but also provide reliable and natural fold by septal turnover flap, which makes us easily adjust the tension of lower flap. In addition, once the septum is opened, burden factors can be also released simultaneously.