Thursday, October 25, 2012

Case 5: Doctor, Why Are My Double Eyelids Unequal?

To prevent the loss of double eyelids (skin creases) or ones that are shallow, it is important to create good adhesion between the levator muscle and the orbicular muscle and skin (photos showing the procedure). However, several factors may prevent this from happening and these factors may be divided into surgeon and patient factors.
 
Surgeon factors:
  • Failure to clear adequate amount of tissue between the skin and the levator muscle.  This can interfer with correct adhesion between the structures.
  • Inadquate anchoring of tissue between the orbicularis/skin and the levator muscle. There should be adequate area of contact between these tissues or the skin creases can easily disappear with time.
 
Patient factors:
  • Excessive postoperative swelling. Prolonged swelling will affect the adhesion between theskin and the levator muscle.
  • Failure to take care of the lids. Excessive rubbing of the eyelids can loosen the adhesion.
This patient presented with asymmetrical double eyelids. The left double eyelid is well-formed but that of the right one is shallow. This is due to inadequate adhesion between the levator and the skin.
 
Shallow right double eyelid.
 
There are several ways of recreating the adhesion: either by incision or suture technique. With the incision technique, the skin crease need to be incised along its length and the tissues resutured, however, this can create significant post-operative swelling in lid that had had surgery before. I opted for the suture technique and the post-operative result appeared satisfactory at two weeks.
 
Steps in suture technique to deepen
the double eyelid.
 
Postoperative appearance.



 
 

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