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Section: Complications

Revision Upper Crease Surgery
Photographed Start to Finish

Young female nine months following unsatisfactory
unsatisfactory double eyelid surgery

Note absense of defined crease with multiple skin folds

Such an appearance is often associated with (1) inadequate deep fixation, (2) damage to the levator muscle complex, and (3) excessive fat removal. In this case, all three factors were contributory.

1. Skin incision is placed just below the existing scar

2. Dissection through the orbicularis muscle reveals complete disinsertion of a damaged levator muscle complex

3. The remaining orbital fat is identified and retrieved from inside the socket

4. The levator aponeurosis (tendon) is dissected free from scar tissue and advanced back into the eyelid

5. The aponeurosis repair is now complete with the tendon fully attached at a normal functional position

6. The orbital fat has been mobilized and sutured into the eyelid to prevent reformation of previous internal scarring, enhance missing volume, and eliminate infolding of the overlying skin

7. The original skin scar has been excised and underlying adhesions removed. Slight additional skin has been removed.

8. First three deep fixation sutures between skin and repositioned levator aponeurosis have been placed to form a new crease

9. All five deep fixation sutures are now in position, and the skin edges have been closed with a continuous suture

10. Immediately After
(Note: Maturation of the new crease to its lower final level takes several months.)

More Examples of Asian Eyelid Revision

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Frank Meronk, Jr., M.D.
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