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I. Phan, T. N. Hwang, L. Pereira, T. J. McCulley; A Double-Layered Closure for Eyelid Crease Manipulation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2289.
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The creation, repositioning or preservation of the upper eyelid crease is an important aesthetic element in many eyelid procedures. We report a novel approach to eyelid crease formation utilizing a layered closure with tarsal fixation. This allows for precise placement of the crease and also avoids cumbersome externalized sutures.
In this retrospective institutional study, 34 eyelids in 19 patients (7 M, 12 F; age range 1 to 88 years) were identified from the electronic medical record database that consecutively underwent eyelid crease formation with the double-layered closure at the University of California at San Francisco between June 2006 and October 2007. Patients that had eyelid crease manipulation by other techniques were excluded. The desired position and contour of the eyelid crease was determined pre-operatively, based primarily upon patient preference. Blepharoplasty and adjunctive procedures were performed in a standard fashion. The layered closure consists of buried 6.0 Vicryl sutures passed through the orbicularis oculi both superiorly and inferiorly with pre-tarsal/tarsal fixation. Five to six such sutures were placed, creating a barrier to pre-aponeurotic fat descent. Overlying skin was closed with a running 6.0 fast-absorbing gut suture.
This surgical technique was performed on seven patients that underwent frontalis sling (three for congenital ptosis, three for neurogenic ptosis, and one for chronic progressive external ophthalmoplegia), seven patients who underwent external levator advancement (one for congenital ptosis, six for involutional ptosis), and five patients who underwent isolated blepharoplasty. All eyelids had well-formed creases that remained in the desired position at follow-up (range 3 to 6 months).
The double layer closure with deep fixation allows for precise positioning and contouring of the upper eyelid crease. It avoids externalized fixation sutures, can be used to create any crease contour or position, and can be utilized in conjunction with any number of procedures from straight-forward Asian blepharoplasty to more challenging cases such as congenital blepharoptosis.
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