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Asian Upper Blepharoplasty with the Hinge Technique

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  • MY Way
  • Published:
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Abstract

Asian upper blepharoplasty is one of the most commonly requested procedures in Asian patients. Many incisional and suture methods have been described in the literature. While the suture method is advantageous for its simplicity and quick recovery, the incision method is more versatile and able to deliver predictable and reproducible results for Asian patients presenting with a diverse range of anatomy and requests. Accordingly, the incision method remains the preferred approach for many surgeons performing Asian upper blepharoplasty. In this paper, we detail our open incision hinge upper blepharoplasty technique to create dynamic upper eyelid creases in Asian patients. The surgical videos associated with this paper present our surgical technique in detail, highlighting technical refinements and surgical nuances to perform the surgery precisely and predictably. The conceptual core of our approach is the use of a vascularized orbital septum as a flap to create a fibrous extension from the levator aponeurosis to the dermis at the location of eyelid crease. This vascularized flap securely connects the posterior lamella with the anterior lamella to securely form the eyelid crease with eye opening. This most accurately recreates the anatomy that is present in attractive Asian patients with naturally occurring double eyelid and predictably creates a dynamic and crisp upper eyelid crease.

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References

  1. Lee JS, Park W, Shin M et al (1997) Simplified anatomic method of double-eyelid operation: septodermal fixation technique. Plast Reconstr Surg 100(1):170–178 (Discussion 179–181)

    Article  CAS  PubMed  Google Scholar 

  2. Nguyen MQ, Hsu PW, Dinh TA (2009) Asian blepharoplasty. Semin Plast Sur 23(3):185–197

    Article  Google Scholar 

  3. Scawn R, Joshi N, Kim YD (2010) Upper lid blepharoplasty in Asian eyes. Facial Plast Surg 26(2):86–92

    Article  CAS  PubMed  Google Scholar 

  4. Kim SK, Hwang K, Kin CK et al (2013) Double eyelid surgery using septoaponeurotic junctional thickening results in dynamic fold in Asians. Plast Reconstr Surg Glob Open 1(2):1–9

    Article  PubMed  PubMed Central  Google Scholar 

  5. McCurdy JA (2005) Upper blepharoplasty in the Asian patient: the “double eyelid” operation. Facial Plast Surg Clin N Am. 13:47–64

    Article  Google Scholar 

  6. Flowers RS (2002) Asian blepharoplasty. Aesthet Surg J 22:558–568

    Article  PubMed  Google Scholar 

  7. Flowers RS, Lueprapai M (2009) Blepharoplasty in the East Asian patient. In: Aston SJ, Steinbrech DS, Walden JL (eds) Aesthetic plastic surgery. New York: Saunders

  8. Jeong S, Bradley LN, Dortzbach RK et al (1999) The Asian upper eyelid. Arch Ophthalmol 117:907–991

    Article  CAS  PubMed  Google Scholar 

  9. Liu D, Hus WM (1986) Oriental eyelids. Opthalmic Plast Reconstr Surg. 2(2):59–64

    Article  CAS  Google Scholar 

  10. Drenser SC (1989) Oriental blepharoplasty: anatomic considerations. Plast Reconstr Surg 84(6):1003

    Article  Google Scholar 

  11. Chen WPD (2016) Asian blepharoplasty and the eyelid crease. 3rd edn textbook, with video resources. Edinburgh: Elsevier Sciences

  12. Seiff SR, Seiff BD (2007) Anatomy of the Asian eyelid. Facial Plst Surg Clin N Am 15:309–314

    Article  Google Scholar 

  13. Park DH, Choi WS, Yoon SH (2008) Anthropometry of Asian eyelids by age. Plast Reconstr Surg 121(4):1405–1413

    Article  CAS  PubMed  Google Scholar 

  14. Kruavit A (2009) Asian blepharoplasty: an 18-year experience in 6215 patients. Aesthet Surg J 29(4):272–283

    Article  PubMed  Google Scholar 

  15. Cho IC (2015) Revision upper blepharoplasty. Semin Plast Surg 29:201–208

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chen WP (2019) Techniques, principles and benchmarks in Asian blepharoplasty. Plast Reconstr Surg Glob Open 7(5):e2271

    Article  PubMed  PubMed Central  Google Scholar 

  17. McCurdy JA (2007) Considerations in Asian cosmetic surgery. Facial Plast Surg Clin N Am 15:287–397

    Article  Google Scholar 

  18. Guo SW, Yang MY, Zhou C (2019) Corrective strategies for a complex deformity caused by “European-style double eyelid” blepharoplasty in Asians. Aesthet Plast Surg 43(2):395–403

    Article  Google Scholar 

  19. Chen SH, Mardini S, Chen HC et al (2004) Strategies for a successful corrective Asian blepharoplasty after previously failed revisions. Plast Reconstr Surg 114(5):1270–1277

    Article  PubMed  Google Scholar 

  20. Flowers RS (2015) Upper eyelid rejuventation. In: Plastic and reconstructive surgery: approaches and techniques

  21. McCord CD, Codner MA (2008) Classical surgical eyelid anatomy. In: Eyelid & periorbital surgery. St. Louis Quality Medical, pp 3–46

  22. Lee CK, Ahn ST, Kim N (2013) Asian upper lid blepharoplasty surgery. Clin Plastic Surg 40:167–178

    Article  Google Scholar 

  23. Paik JS, Lee JH, Uppal S et al (2020) Intricacies of upper blepharoplasty in Asian burden lids. Facial Plast Surg 36:563–574

    Article  CAS  PubMed  Google Scholar 

  24. Chang SH, Chen WP, Cho IC et al (2014) Comprehensive review of Asian cosmetic upper eyelid oculoplastic surgery: Asian blepharoplasty and the like. Arch Aesthetic Plast Surg 20(3):129–139

    Article  Google Scholar 

  25. Kim DW, Bhatki AM (2005) Upper blepharoplasty in the Asian eyelid. Facial Plast Surg Clin North Am 13(4):525–532

    Article  PubMed  Google Scholar 

  26. Chen WP (2016) Visual, physiological, and aesthetic factors and pitfalls in Asian blepharoplasty. Aesthet Surg J 36(3):275–283

    Article  PubMed  Google Scholar 

  27. Weng C, Noordhoff SM (1989) Complications of oriental blepharoplasty. Plast Reconstr Surg 83(4):622–628

    Article  CAS  PubMed  Google Scholar 

  28. Chen WP (2018) Primary double eyelid surgery—Trapezoidal debulking of upper eyelid tissues. Plast Reconstr Surg Glob Open 6(5):e1780

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wong CH, Hsieh MKH, Mendelson B (2020) Upper eyelid ptosis correction with levator advancement in Asian patients using the musculoaponeurotic junction of the levator as the key reference point. Plast Reconstr Surg 146(6):1268–1273

    Article  CAS  PubMed  Google Scholar 

  30. Wong CH, Hsieh MKH, Mendelson B (2021) A comprehensive approach to Asian upper eyelid ptosis correction: the levator musculo-aponeurotic junction formula. Aesthet Surg J. https://doi.org/10.1093/asj/sjab039

    Article  PubMed  Google Scholar 

  31. Mendelson B, Wong CH (2021) Upper blepharoplasty—nuances for success. Facial Plast Surg Clin N Am 29:179–193

    Article  Google Scholar 

  32. Hirohiko K, Raman M, Dinesh S (2009) Upper eyelid anatomy: an update. Ann Plast Surg 63(3):336–343

    Google Scholar 

  33. Woo CC, Yong OK, Young SK et al (2002) Refinement of double eyelidplasty in Asian patients: attachment of the septoaponeurotic union to the pretarsal dermis. Aesthet Surg J 22(2):154–161

    Article  Google Scholar 

  34. Huang JZ, Feng SY, Dong RJ et al (2020) Secondary upper blepharoplasty: converting static folds into dynamic folds. Aesthet Surg J. Epub Ahead of Print

  35. Li G, Ding W, Tan J, Zhang B et al (2018) A new method for double-eyelid blepharoplasty using orbital septum. Ann Plast Surg 81(6):633–636

    Article  CAS  PubMed  Google Scholar 

  36. Jin R, Shen Y, Yu W et al (2020) Tarsal-fixation with aponeurotic flap linkage in blepharoplasty: bridge technique. Aesthet Surg J 40(12):NP648–NP654

    Article  PubMed  Google Scholar 

  37. Chen WP (2020) Commentary on: tarsal-fixation with aponeurotic flap linkage in blepharoplasty: bridge technique. Aesthet Surg J 40(12):NP655–NP656

    Article  PubMed  Google Scholar 

  38. Hirohiko K, Igal L, Dinesh S et al (2009) Orbital septum attachment on the levator aponeurosis in Asians: in vivo and cadaver study. Ophthalmology 116(10):2031–2035

    Article  Google Scholar 

  39. Owsley JQ (1981) Functional upper eyelid anatomy as applied to aesthetic blepharoplasty. Aesthet Plast Surg. 5:115–121

    Article  Google Scholar 

  40. Chen WP (2007) The concept of a glide zone as it relates to upper lid crease, lid fold and applications in upper blepharoplasty. Plast Reconstr Surg 119(1):379–386

    Article  CAS  PubMed  Google Scholar 

  41. Fernandez LR (1960) Double eyelid operation in the Oriental in Hawaii. Plast Reconstr Surg 25:257–264

    Article  CAS  Google Scholar 

  42. Sheen JH (1974) Supratarsal fixation in upper blepharoplasty. Plast Reconstr Surg 54(4):424–431

    Article  CAS  PubMed  Google Scholar 

  43. Sheen JH (1977) A change in the technique of supratarsal fixation in upper blepharoplasty. Plast Reconstr Surg 59(6):831–834

    Article  CAS  PubMed  Google Scholar 

  44. Bang YH (1991) The double eyelid operation without supratarsal fixation. Plast Reconstr Surg 88(1):12–17

    Article  CAS  PubMed  Google Scholar 

  45. Park JI (1999) Orbicularis-levator fixation in double eyelid operation. Arch Facial Plast Surg 1:90–95

    Article  CAS  PubMed  Google Scholar 

  46. Flowers RS (1993) Upper blepharoplasty by eyelid invagination: anchor Blepharoplasty. Clin Plast Surg 20:193–207

    Article  CAS  PubMed  Google Scholar 

  47. McCord CD, Codner MA, Nahai F, McCord CD, Codner MA (2008) Upper lid blepharoplasty. In: Eyelid & periorbital surgery. St. Louis Quality Medical, pp 193–222

  48. McCord CD (1979) Techniques in blepharoplasty. Opthalmic Surg 10(3):40–55

    Google Scholar 

  49. Rohrich RJ, Coberly DM, Fagien S, Stuzin JM (2004) Current concepts in aesthetic upper blepharoplasty. Plast Reconstr Surg 113(3):32e–42e

    Article  PubMed  Google Scholar 

  50. McKinney P, Camirand A, Carraway JH, Fagien S (2004) Secondary upper eyelid blepharoplasty. Aesthet Surg J 24(1):51–59

    Article  PubMed  Google Scholar 

  51. Flowers RS, Flowers SS (1993) Precision planning in blepharoplasty: the importance of preoperative mapping. Clin Plast Surg 20:303

    Article  CAS  PubMed  Google Scholar 

  52. Baker TJ, Gordon HL, Moseinko P (1977) Upper lid blepharoplasty. Plast Recontr Surg 60(5):692–698

    Article  CAS  Google Scholar 

  53. Mendelson B, Luo D (2015) Secondary upper lid blepharoplasty: a clinical series using the tarsal fixation technique. Plast Reconstr Surg 135(3):508e–516e

    Article  CAS  PubMed  Google Scholar 

  54. Lee WY, Sung K, Lee SJ et al (2020) The Hinge effect of the posterior septum and levator muscle fixation technique in Asian double-eyelid operation. Eur J of Plast Surg. 44(3):315–318

    Article  Google Scholar 

  55. Suo L et al (2020) A four step technique for creating individual double eyelid crease shapes: a free style design. Plast Reconstr Surg 146(4):756–765

    Article  CAS  PubMed  Google Scholar 

  56. Mao et al (2020) Dual plane epicanthoplasty in Chinese blepharoplasty. J Cosmet Dermatol 1–8

  57. Liu Y, Lei M, Wang Y (2012) Lazy A epicanthoplasty in Asian blepharoplasty. Aesthet Plast Surg 36:254–260

    Article  Google Scholar 

  58. Li FC, Ma LH (2008) Double eyelid blepharoplasty incorporating epicanthoplasty using V-Y advancement procedure. JPRAS 61:901–905

    CAS  PubMed  Google Scholar 

  59. Jia et al (2018) Blepharoplasty incorporating epicanthoplasty using scar hiding procedure. Clint Pract 15(2): 533–554

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Authors and Affiliations

  1. W Aesthetic Plastic Surgery, Mount Elizabeth Novena Specialist Center, 38 Irrawaddy Road, Singapore, 329563, Singapore

    Chin-Ho Wong

  2. Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore

    Michael Ku Hung Hsieh

  3. Department of Plastic Surgery, Medical College, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan City, Taiwan

    Fu-Chan Wei

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  1. Chin-Ho Wong
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  2. Michael Ku Hung Hsieh
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  3. Fu-Chan Wei
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Correspondence to Chin-Ho Wong.

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Wong, CH., Hsieh, M.K.H. & Wei, FC. Asian Upper Blepharoplasty with the Hinge Technique. Aesth Plast Surg 46, 1423–1431 (2022). https://doi.org/10.1007/s00266-021-02703-8

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