![]() These correspond to levels 4, 3, 5, and 8.įernandez 2 discussed his two methods of crease construction, with one yielding a superficial crease and the other a deeper crease. Black dot: skin-tarsus-skin attachment green dot: skin-levator-skin attachment red circle: levator-to-orbicularis/tarsus attachment and blue suture loop: nonincisional buried sutures methods. Showing the four main categories of eyelid crease construction. Buried suture methods 1 using nondissolvable full-loop sutures to anchor high above the superior tarsal border, looping around levator-Mueller muscle complex and then slanting infero-anteriorly to the orbicularis oculi in front, with suture knot buried beneath skin surface (blue arrows represent trans-lid suture buried knot lies subcutaneous along upper tarsal border).Levator to orbicularis (variant methods of Park 4) as a dark red circle, with one arm of orange hyphenated exit suture taking inferior orbicularis oculi (represented as passage 1) and the other arm of skin on upper wound edge (passage 2) or of levator->tarsus 3 attachment (second variant of Putterman, 3 not drawn here).Skin->levator aponeurosis->skin attachment (variant of Fernandez 2 for superficial crease‚ shown as a green dot exit sutures tied on skin side).Skin-tarsus-skin attachment (of Putterman 3 shown as a black dot, exit suture tied on inferior skin surface). ![]() The published methods by which the upper lid crease is constructed include the following, as shown in Figure 1: Of the two parameters of crease height and depth, Chen 5, 6 discussed the importance of accurate placement of crease height in primary cases, while there has not been any substantial paper alluding to the depth level of a crease in any detail beyond Fernandez’s 2 original paper in 1960. 1–5 The author published a paper 6 in 2020 pertaining to scoring of abnormal crease height and crease depth findings in revisional cases. The history of both approaches is well covered in these references. Current approaches tend to favor the use of an external incision as it facilitates direct access to the eyelid skin, orbicularis oculi, tarsus, preaponeurotic fat, and the levator aponeurosis nevertheless, the original suture methods 1 first used in the early 20th century are still popular in Asia. INTRODUCTIONĭouble eyelid surgery aims to add a lid crease to an upper lid that is without one. ![]() Meaning: One can control the depth of a crease through thoughtful consideration of these factors. What are the factors that influence depth of crease construction?įindings: A graduated scale of “eight levels of depth” allows a better understanding of the interplay between tissues engaged, sutures selected, and pitfalls to avoid in upper lid crease construction (Asian double-eyelid surgery). Question: The depth of a constructed upper lid crease is an important factor in evaluating its aesthetic appeal.
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