Upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture

To describe the upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture in order to evaluate the efficacy of the technique.

Methods:

This is a retrospective study in which the medical records of 5,882 patients who underwent this technique between January 1999 and July 2015 were evaluated. The frequency and main causes of clinical complications and surgical reoperation were analyzed.

Results:

The incidence of complications found was 12.7% (n=750), being 0.8% (n=47) due to persistent chemosis, 3% (n=176) due to poor lower eyelid positioning, 4.17% (n=245) due to mild eyelid retraction and 4.8% (n=282) because of mild to moderate chemosis.

Conclusion:

The technique appears to be effective as it is simple and practical, and capable of resulting in positive functional and aesthetic outcomes with low rates of complications.

Keywords:
Blepharoplasty/adverse effects; Canthopexy; Ligaments/pathology; Eyelid diseases; Aging

Authorship

Jandira Maria Mourão Coscarelli

Clínica de Olhos Ennio Coscarelli, Belo Horizonte, MG, Brazil.Clínica de Olhos Ennio CoscarelliBrazilBelo Horizonte, MG, BrazilClínica de Olhos Ennio Coscarelli, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-4144-4375

Sandra Coscarelli

Clínica de Olhos Ennio Coscarelli, Belo Horizonte, MG, Brazil.Clínica de Olhos Ennio CoscarelliBrazilBelo Horizonte, MG, BrazilClínica de Olhos Ennio Coscarelli, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-7123-2357

Tatianne Fernandes Duarte

Hospital de Olhos Hilton Rocha, Belo Horizonte, MG, Brazil.Hospital de Olhos Hilton RochaBrazilBelo Horizonte, MG, BrazilHospital de Olhos Hilton Rocha, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0001-9645-6560

Juliana Senna Figueiredo Barbi Corresponding author: Juliana Senna Figueiredo Barbi, Rua Groelândia, 135 – Sion. Zip code: 30320-060 – Belo Horizonte, MG, Brazil. E-mail: drajulianabarbi@gmail.com

Hospital de Olhos Hilton Rocha, Belo Horizonte, MG, Brazil.Hospital de Olhos Hilton RochaBrazilBelo Horizonte, MG, BrazilHospital de Olhos Hilton Rocha, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0001-6888-0495

Kimberly Marie Jones

Kennedy and Promove University, Belo Horizonte, MG, Brazil.Kennedy and Promove UniversityBrazilBelo Horizonte, MG, BrazilKennedy and Promove University, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-8630-1255

Corresponding author: Juliana Senna Figueiredo Barbi, Rua Groelândia, 135 – Sion. Zip code: 30320-060 – Belo Horizonte, MG, Brazil. E-mail: drajulianabarbi@gmail.com

Conflict of interest: no conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Clínica de Olhos Ennio Coscarelli, Belo Horizonte, MG, Brazil.Clínica de Olhos Ennio CoscarelliBrazilBelo Horizonte, MG, BrazilClínica de Olhos Ennio Coscarelli, Belo Horizonte, MG, Brazil.

Hospital de Olhos Hilton Rocha, Belo Horizonte, MG, Brazil.Hospital de Olhos Hilton RochaBrazilBelo Horizonte, MG, BrazilHospital de Olhos Hilton Rocha, Belo Horizonte, MG, Brazil.

Kennedy and Promove University, Belo Horizonte, MG, Brazil.Kennedy and Promove UniversityBrazilBelo Horizonte, MG, BrazilKennedy and Promove University, Belo Horizonte, MG, Brazil.

Figures

Figures (3)

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Figura 1
Surgical technique. (A) Lower blepharoplasty skin removal. The skin is detached up to the lower portion of the pretarsal orbicularis muscle. (B) Resection of the myocutaneous flap. Excessive skin and preseptal orbicularis muscle are completely resected using the radiofrequency device in the blend mode. (C) Incision in the orbital septum at the upper-lateral orbital rim to expose the white region, which corresponds to the lateral canthal tendon. (D) A prolene 5-0 suture needle transfixes the tendon, passing under it. (E) The needle is inserted outward through the lower border of the pretarsal orbicularis muscle at the same height of the eyelid lateral canthus. (F) The pre septal muscle is identified and fixed by moving the needle in the opposite direction (towards the upper eyelid). (G) Before entering the tunnel (below the lateral canthal tendon), the needle is introduced between the pretarsal orbicularis muscle and inferior tarsus and rotated 180° prior to being reinserted into the tunnel (under lateral canthal tendon) and being removed via the entrance site. (H) The suture is fixed in the periosteum of the upper-lateral orbital rim. (I) Three knots are tied. Notice that the knot is buried just to the periosteum, underneath the orbicularis muscle that is isolated at the time of suture, to avoid trapping its fibers with the suture. (J) The needle is again introduced in the tunnel, but this time in a more lateral position compared to the first knot. (K) The needle penetrates the submuscular space to the topography of the upper border of the superficial musculo-aponeurotic system, shown by the tweezer in the figure. (L) Plicature of pre septal orbicularis muscle in a lateral position. (M) Pre septal orbicularis muscle elevation shown by the skin traction. (N) The needle is again introduced in the tunnel, in a more lateral position compared to the first knot, without fixing the periosteum. (O) Another knot is tied, lying internal do the septum. (P) The final aspect without a skin suture showing, and featuring the correct positioning of skin and muscles without any traction.

Thumbnail

Figure 2
Complication rates in absolute numbers and percentages within the study sample.

Thumbnail

Figure 3
Preoperative (upper line) and 6-month postoperative (lower line) photos of a 55-year-old, female patient submitted to upper and lower blepharoplasty with a canthopexy technique in primary position of gaze and right and left oblique views.

Figura 1 Surgical technique. (A) Lower blepharoplasty skin removal. The skin is detached up to the lower portion of the pretarsal orbicularis muscle. (B) Resection of the myocutaneous flap. Excessive skin and preseptal orbicularis muscle are completely resected using the radiofrequency device in the blend mode. (C) Incision in the orbital septum at the upper-lateral orbital rim to expose the white region, which corresponds to the lateral canthal tendon. (D) A prolene 5-0 suture needle transfixes the tendon, passing under it. (E) The needle is inserted outward through the lower border of the pretarsal orbicularis muscle at the same height of the eyelid lateral canthus. (F) The pre septal muscle is identified and fixed by moving the needle in the opposite direction (towards the upper eyelid). (G) Before entering the tunnel (below the lateral canthal tendon), the needle is introduced between the pretarsal orbicularis muscle and inferior tarsus and rotated 180° prior to being reinserted into the tunnel (under lateral canthal tendon) and being removed via the entrance site. (H) The suture is fixed in the periosteum of the upper-lateral orbital rim. (I) Three knots are tied. Notice that the knot is buried just to the periosteum, underneath the orbicularis muscle that is isolated at the time of suture, to avoid trapping its fibers with the suture. (J) The needle is again introduced in the tunnel, but this time in a more lateral position compared to the first knot. (K) The needle penetrates the submuscular space to the topography of the upper border of the superficial musculo-aponeurotic system, shown by the tweezer in the figure. (L) Plicature of pre septal orbicularis muscle in a lateral position. (M) Pre septal orbicularis muscle elevation shown by the skin traction. (N) The needle is again introduced in the tunnel, in a more lateral position compared to the first knot, without fixing the periosteum. (O) Another knot is tied, lying internal do the septum. (P) The final aspect without a skin suture showing, and featuring the correct positioning of skin and muscles without any traction.

Figure 2 Complication rates in absolute numbers and percentages within the study sample.

Figure 3 Preoperative (upper line) and 6-month postoperative (lower line) photos of a 55-year-old, female patient submitted to upper and lower blepharoplasty with a canthopexy technique in primary position of gaze and right and left oblique views.

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Upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture

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[1] Corresponding author: Juliana Senna Figueiredo Barbi, Rua Groelândia, 135 – Sion. Zip code: 30320-060 – Belo Horizonte, MG, Brazil. E-mail: drajulianabarbi@gmail.com