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Erschienen in: Aesthetic Plastic Surgery 2/2019

27.11.2018 | Innovative Techniques

Levator Pull-Out Suture Technique for Immediate Postoperative Correction of Eyelid Asymmetry After Ptosis Surgery in Asians

Erschienen in: Aesthetic Plastic Surgery | Ausgabe 2/2019

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Abstract

Background

Postoperative eyelid asymmetry is the most common complaint of patients after undergoing blepharoplasty and ptosis correction surgery. Calibrating eyelid asymmetry during ptosis correction surgery is still difficult for surgeons despite the development of innovative procedures. Our levator pull-out suture technique for correcting postoperative eyelid asymmetry after ptosis surgery is introduced.

Methods

A total of 330 patients who underwent ptosis correction surgery with upper blepharoplasty from 2016 to 2017 were enrolled in our study. All surgeries were performed using the levator pull-out suture technique, and the postoperative eyelid asymmetry was corrected in the outpatient clinic at 2–3 days after the operation. Patient satisfaction was evaluated preoperatively and at 1 week and 2 months postoperatively using a questionnaire. Visual acuity, marginal reflex distance 1 (MRD1), and vertical palpebral fissure length asymmetry were measured preoperatively and compared to values taken postoperatively.

Results

Patient satisfaction regarding asymmetry increased from 2.7/5 (preoperatively) to 4.1/5 points (postoperatively). MRD1 and vertical palpebral fissure length increased from 1.1/1.2 and 6.8/6.8 mm (preoperatively), respectively, to 2.8/2.9 and 8.5/8.6 mm (postoperatively), respectively. The asymmetry of MRD1 and vertical palpebral fissure length before and after surgery were corrected from 0.45/1.81 to 0.01/0.19 mm (p < 0.01).

Conclusion

Our innovative surgical method of using the levator pull-out suture technique is relatively simple and allows for finer suture adjustments postoperatively to effectively correct eyelid asymmetry, with satisfactory results.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
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Literatur
1.
Zurück zum Zitat Golan S, Goldberg RA (2017) Time course analysis of upper blepharoplasty complications. Dermatol Surg 43:307–309CrossRefPubMed Golan S, Goldberg RA (2017) Time course analysis of upper blepharoplasty complications. Dermatol Surg 43:307–309CrossRefPubMed
2.
Zurück zum Zitat Czyz CN, Lam VB, Foster JA (2011) Management of complications of upper eyelid blepharoplasty (Master techniques in blepharoplasty and periorbital rejuvenation). Springer, New York Czyz CN, Lam VB, Foster JA (2011) Management of complications of upper eyelid blepharoplasty (Master techniques in blepharoplasty and periorbital rejuvenation). Springer, New York
4.
Zurück zum Zitat Chang S, Lehrman C, Itani K, Rohrich RJ (2012) A systematic review of comparison of upper eyelid involutional ptosis repair techniques: efficacy and complication rates. Plast Reconstr Surg 129:149–157CrossRefPubMed Chang S, Lehrman C, Itani K, Rohrich RJ (2012) A systematic review of comparison of upper eyelid involutional ptosis repair techniques: efficacy and complication rates. Plast Reconstr Surg 129:149–157CrossRefPubMed
5.
Zurück zum Zitat Pool SM, van der Lei B (2015) Asymmetry in upper blepharoplasty: a retrospective evaluation study of 365 bilateral upper blepharoplasties conducted between January 2004 and December 2013. J Plast Reconstr Aesthet Surg 68:464–468CrossRefPubMed Pool SM, van der Lei B (2015) Asymmetry in upper blepharoplasty: a retrospective evaluation study of 365 bilateral upper blepharoplasties conducted between January 2004 and December 2013. J Plast Reconstr Aesthet Surg 68:464–468CrossRefPubMed
6.
Zurück zum Zitat Yi MY, Choi HS, Jang JW, Kim SJ, Jang SY (2017) Asymmetry of preoperative incision design markings for upper blepharoplasty. J Craniofac Surg 28:e419–e422CrossRefPubMed Yi MY, Choi HS, Jang JW, Kim SJ, Jang SY (2017) Asymmetry of preoperative incision design markings for upper blepharoplasty. J Craniofac Surg 28:e419–e422CrossRefPubMed
7.
Zurück zum Zitat Park KS, Park DD (2017) Objective outcome measurement after upper blepharoplasty: an analysis of different operative techniques. Aesthet Plast Surg 41:64–72CrossRef Park KS, Park DD (2017) Objective outcome measurement after upper blepharoplasty: an analysis of different operative techniques. Aesthet Plast Surg 41:64–72CrossRef
8.
Zurück zum Zitat Saonanon P (2014) Update on Asian eyelid anatomy and clinical relevance. Curr Opin Ophtalmol 25:436–442CrossRef Saonanon P (2014) Update on Asian eyelid anatomy and clinical relevance. Curr Opin Ophtalmol 25:436–442CrossRef
9.
Zurück zum Zitat Wang TT, Wessels L, Hussain G, Merten S (2017) Discriminative thresholds in facial asymmetry: a review of the literature. Aesthet Surg J 37:375–385CrossRefPubMed Wang TT, Wessels L, Hussain G, Merten S (2017) Discriminative thresholds in facial asymmetry: a review of the literature. Aesthet Surg J 37:375–385CrossRefPubMed
10.
Zurück zum Zitat Park DH, Kim CW, Shim JS (2008) Strategies for simultaneous double eyelid blepharoplasty in Asian patients with congenital blepharoptosis. Aesthet Plast Surg 32:66–71CrossRef Park DH, Kim CW, Shim JS (2008) Strategies for simultaneous double eyelid blepharoplasty in Asian patients with congenital blepharoptosis. Aesthet Plast Surg 32:66–71CrossRef
11.
Zurück zum Zitat Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA (2007) Muller’s muscle-conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position. Arch Facial Plast Surg 9:413–417CrossRefPubMed Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA (2007) Muller’s muscle-conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position. Arch Facial Plast Surg 9:413–417CrossRefPubMed
12.
Zurück zum Zitat Mühlbauer W, Holm C (1998) Eyebrow asymmetry: ways of correction. Aesth Plast Surg 22:366–371CrossRef Mühlbauer W, Holm C (1998) Eyebrow asymmetry: ways of correction. Aesth Plast Surg 22:366–371CrossRef
13.
Zurück zum Zitat Kakizaki H, Malhotra R, Selva D (2009) Upper eyelid anatomy: an update. Ann Plast Surg 63:336–343CrossRefPubMed Kakizaki H, Malhotra R, Selva D (2009) Upper eyelid anatomy: an update. Ann Plast Surg 63:336–343CrossRefPubMed
14.
Zurück zum Zitat Chen B, Song H, Gao Q, Xu M, Wang J, Wang F, Chen S, Wu J, Li H (2017) Measuring satisfaction with appearance: validation of the FACE-Q scales for double-eyelid blepharoplasty with minor incision in young Asians- retrospective study of 200 cases. J Plast Reconstr Aesthet Surg 70:1129–1135CrossRefPubMed Chen B, Song H, Gao Q, Xu M, Wang J, Wang F, Chen S, Wu J, Li H (2017) Measuring satisfaction with appearance: validation of the FACE-Q scales for double-eyelid blepharoplasty with minor incision in young Asians- retrospective study of 200 cases. J Plast Reconstr Aesthet Surg 70:1129–1135CrossRefPubMed
15.
Zurück zum Zitat Lee JH, Nam SM, Kim YB (2015) Blepharoptosis correction: levator aponeurosis-Muller muscle complex advancement with three partial incisions. Plast Reconstr Surg 135:388–395CrossRefPubMed Lee JH, Nam SM, Kim YB (2015) Blepharoptosis correction: levator aponeurosis-Muller muscle complex advancement with three partial incisions. Plast Reconstr Surg 135:388–395CrossRefPubMed
16.
Zurück zum Zitat Oster G, Sullivan SD, Dalal MR, Kazemi MR, Rojeski M, Wysham CH, Sung J, Johnstone B, Cali AM, Wei LJ, Traylor L, Anhalt H, Hull M, Van Vleet J, Meneghini LF (2016) Achieve control: a pragmatic clinical trial of insulin glargine 300 U/mL versus other basal insulins in insulin-naive patients with type 2 diabetes. Postgrad Med 128:731–739CrossRefPubMed Oster G, Sullivan SD, Dalal MR, Kazemi MR, Rojeski M, Wysham CH, Sung J, Johnstone B, Cali AM, Wei LJ, Traylor L, Anhalt H, Hull M, Van Vleet J, Meneghini LF (2016) Achieve control: a pragmatic clinical trial of insulin glargine 300 U/mL versus other basal insulins in insulin-naive patients with type 2 diabetes. Postgrad Med 128:731–739CrossRefPubMed
17.
Zurück zum Zitat Gravante G, Caruso R, Araco A, Cervelli V (2008) Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis. Aesth Plast Surg 32:243–251CrossRef Gravante G, Caruso R, Araco A, Cervelli V (2008) Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis. Aesth Plast Surg 32:243–251CrossRef
Metadaten
Titel
Levator Pull-Out Suture Technique for Immediate Postoperative Correction of Eyelid Asymmetry After Ptosis Surgery in Asians
Publikationsdatum
27.11.2018
Erschienen in
Aesthetic Plastic Surgery / Ausgabe 2/2019
Print ISSN: 0364-216X
Elektronische ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-018-1276-x

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