Tuesday, June 3, 2014

Double Eyelids and Fat: Case 1

The anatomy of the Chinese eyelids (also that of the Korean and Japanese) is different from that of the other races in that the orbital fat descends more inferiorly due to lower insertion of the orbital septum. This is the main reason why the Chinese has absent or lower double eyelids (skin creases) and a fuller eyelid. An understanding of this anatomical difference is essential for surgeon who perform double eyelid surgery (Asian blepharoplasty). The following cases illustrate the importance of this this anatomical difference.

This 34 year-old woman underwent double eyelid surgery 5 months earlier. She was unhappy because of the presence of extra lines radiating from the central double eyelid. This was caused by incomplete removal of the fat so that the skin and the levator (the muscle that moves the eyelid ) can not form good adhesions.

Extra lines radiating laterally from the main double eyelid.

To remove the excess line, the residual fat and the levator muscle was resutured to the skin and the overlying muscle called orbicularis oculi.

Steps taken to erase the extra lines. a and b. Marking was done to remove some 
of the skin. The lower marking corresponded to her double eyelid (skin crease).
 c. and d. The skin and ocularis muscles were removed from the marked area. 
e. The orbital spetum was open and the fat isolated and excised. 
f. and g. after the fat excision, the extra line disappeared. 
h. The levator was then sutured to the overlying muscle and skin. 

Appearance of the eyelid at 3 months.

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