Don't Worry its Just a Small Black Head - An Unwanted Side-effect of Suture Technique for Double Eyelid

This 46 year-old woman underwent double eyelid procedure in a beauty saloon 2 year ago. The procedure was performed by a so-called "beauty surgeon" employed by the saloon. Although, she got her double eyelids but she was unhappy with the excess skin hanging over her skin creases (double eyelids) which the beauty surgeon was unable to do anything. Recently, she had been bothered by constant irritation in the left upper eyelid and a black spot. She returned to the beauty saloon but was told by the owner that it was just a small black head and there was nothing to worry about. When the patient asked to see the beauty surgeon, the saloon owner says she had no idea where she was as she only employed those surgeons on one-off basis.

Poor double eyelid formation because the excess upper

eyelid skin was not addressed.

A black spot causing recurrent irritation in the left

upper eyelid.

When I examined her the black head appears to be the end of the suture used to form the double eyelids. The "black head" was cut and removed it in entirety. 

The suture was pulled and cut.

The whole suture removed and appeared to be 6/0 nylon.

Although suture technique is useful in young patients,  in older people with excess upper eyelid skin (dermatochalasiss), it does not work well. The treatment of choice for this lady would be to combine double eyelid surgery with removal of the excess skin and this could be achieved with incision technique.

The suture technique used in this patient is the two-way continuous buried-suture approach as shown in the diagram above. Picture A 7 to 9 incisions for the creation of a pretarsal crease are made with the tip of a No. 11 scalpel blade, approximately 1 mm long, and are placed approximately 5–7 mm apart in a gentle curving arc. The line begins 5 mm lateral to the medial canthus and ends 10 mm lateral to the lateral canthus. Picture B The first pass of the suture is from lateral to medial, capturing dermis between alternating incisions and superifical tarsal plate between dermal bites. Picture C The suture is then reversed and passed from medial to lateral, capturing dermis and tarsus in the opposite intervening segments.