■ Buried stitch method for upper eyelid surgery
One or two sets of horizontal mattress suture with 7-0 nylon are placed in a between the dermis and tarsus to create a new or higher double fold (supratarsal fold) line.
Although created line may not be permanent; about 20 to 50 % of cases will eventually lose the line. The procedure can provide predictable result and is easy to revise the line in case of dissatisfaction. The buried stitch method for double fold has been the most popular procedure in my practice.
Another application of stitch method has been introduced in my practice for last 2 years. This is the stitch method to correct blepharo-ptosis.
7-0 nylon suture is placed between the upper margin of tarsus and conjunctiva of the upper sulcus in a triangular fashion. The ligation of the suture plicate the conjunctiva and Muller muscle longitudinally, increasing the elevation of upper eyelid. Although long term result is still unclarified, 2 years follow-up of some of my cases has revealed the lasting of ptosis correction.
The presentation will demonstrate the detail of surgical technique and clinical results.
■ Augmentation of the midface in the lower blepharoplasty
It is considered that the goal of the lower eyelid rejuvenation is to create a mild concave in the preseptal portion of the lower eyelid, smooth eyelid ? cheek junction, and round projection of upper midface.
The negative vector is not uncommon in Japanese due to deficit of projection in the midface. Although the midface lift with lower blepharoplasty shift the tissue from the below to the above and produce the fullness of the upper midface, the volume increased was insufficient in many of cases.
The augmentation of the midface is essential for satisfaction in cases with thin facial soft tissue. Injection of fat or hyaluronic acid can be a choice when the patient requests the non-incisional treatment. In case where the lower blepharoplasty is performed, the silicone block implant which can provide long lasting result is useful.
I have used fat graft for the patients who do not like the use of artificial materials. A major concern of the use of fat graft is a donor site scar. The use of incision inside the umbilicus enables me to harvest two pieces of fat graft without leaving visible scar. Thorough the transcutaneous of transconjunctival approach, the midface is dissected around the infraorbital nerve and the fat graft is placed and secured in the midface pocket.