Is it true that blepharoplasty doesn't work?"
Would I benefit from a blepharoplasty?"
I've heard that the incision on the outer corner of the eye can cause a regression."

I feel that many of the questions about eye incisions are negative, such as

In this issue, we will look at the mystery behind the many negative questions about eye incisions.

There are three conditions that must be met in order to perform an eye lid incision that will be effective.

Let us explain each of them.

Condition 1) There must be an outer hidden ocular conjunctiva (white eye).

The basic premise is that an incision in the outer corner of the eye cannot extend beyond the hidden whites of the eyes. There is a pocket structure in the corner of the eye called the arcuate area, and the depth of that pocket varies from person to person. You can tell how deep the pocket is during a medical examination, but it is difficult to confirm the depth of the pocket yourself. If the depth of the pocket is less than 1 mm, there is no indication for surgery due to lack of prolongation effect; if the pocket is about 3 mm deep, a firm change can be made.

Condition 2) The corners of the eyes must not be hidden.

Even if the outer corner of the eye is widened, the effect cannot be felt if the outer corner of the eye is hidden in the first place. If the inner corner of the eye is hidden by a single eyelid or a double fold, double-lid surgery should be performed first. If there is excess skin covering the outer corner of the eye, it is better to perform an incision under the eyebrow to pull up the skin so that the outer corner of the eye can be seen first.

Condition 3) Sufficient vertical eye opening.

When the eyes are closed, the effect of eye corner extension is not apparent. The effect of eye corner extension is clear when there is sufficient vertical eye opening. It is well known that when a glamorous line is used in conjunction with an incision at the corner of the eye to extend the lower eyelid in a downward direction, the surgeries have a synergistic effect on each other. In cases where the eye opening is weak, a combination of blepharoplasty and blepharoplasty can also be effective.

If any of the items in conditions 1-3) are not met, then the results of an incision in the outer corner of the eye will be poor. The depth of the pocket in the corner of the eye cannot be changed, but conditions 2) and 3) can be resolved surgically.

Unfortunately, it is not possible to eliminate retrogression.

However, the degree of retroversion is more or less related to the carefulness of the surgical technique.

The extended corner of the eye will be sutured to the skin and conjunctiva. Too much tension on the suture or an ill-fitting wound can cause retraction. Stitches that are not perfectly aligned with the wound will cause contracture and shrinkage due to a secondary healing process. The skin and conjunctiva should be stitched with proper tension to achieve primary healing with minimal contracture. Retroversion is largely due to the skill of the surgeon rather than patient factors.

Other surgeries that make the eyes appear larger include blepharoplasty, glamorous lines, and craniotomy. The effect of these surgeries can be seen when viewed from the front. On the other hand, the outer corner of the eye is located at an angle when viewed from the front, so the direction of extension of an incision at the outer corner of the eye is obliquely backward. This is another factor that makes the effect of eye corner incision extension less noticeable. However, in real life, we cannot always see the face from the front, so if you look at it from a slightly oblique angle, you should be able to feel the change.

Case Studies

Finally, here is a case study of a monitored patient with an incision in the outer corner of the eye.

The depth of the pocket in the corner of this patient's eye was just over 2 mm. The corner of the eye was not hidden even before surgery, and eye opening is not a problem. Thus, if appropriate surgery is performed on a person who meets conditions 1-3), it is possible to produce changes that can be perceived as an extension effect from the front.

An incision at the corner of the eye is a classic surgery, but it can be effective if the indications are carefully identified.

If the pockets are shallow, you should be honest about it, and if they do not meet conditions 2-3), you should also suggest ways to improve them.

Some cosmetic surgeons may perform surgeries on people who are not expected to be effective in order to increase sales. Because such cases are not infrequent, it is thought that the story that "eye lid incisions are ineffective" is prevalent.

Deputy Director: Hiroki Kuroda

Series of Frequently Asked Questions in #Counseling