Eyelids which are puffy as a result of underlying fat tissue do not do well with the suture technique. The treatment of choice is the incision method as shown in the steps below.
This patient has a puffy upper lid (left). To create the
double eyelid (right), incision method was performed.
Before the operation, the desired height was agreed upon by
indenting the upper eyelid with a wire to simulate different
heights of the double eyelid. The desired height
was then makred on the eyelid.
A small amount of skin was first removed, marked a.
Then the orbicularis was removed (marked b), followed by
the orbital septum (marked c) to expose the underlying
fatty tissue (marked d).
Underneath the fat was the levator aponeurosis (arrowed),
an important anatomy crucial for the success of incision method
and must be exposed along its length. To expose the levator muscle,
the overlying fat was excised.
The exposed levator aponeurosis (arrowed) was sutured to
the orbicularis muscle along the inferior cut edge.
The skin was then closed using interrupted sutures.
The incision method causes more swelling than the suture method.
However, most swelling should settle by two weeks.