Modified Blepharoplasty Simulating The Anatomic Microstructure Of The Upper Eyelid

Background of study: The double eyelid operation has come into use in the Orientals for more than a hundred years. Due to the exchange and development of the eastern and western cultures, the change of aesthetic standards and some other factors, there is an increasing need for this kind of cosmetology . The problem of how double eyelid takes form has attracted wide attention in the world beacause of the great need for the operation and its unknown mechanism. Controversy exists over whether levator aponeurosis fiber is located in the skin of the upper eylid(especially Mongoloid) and whether the presence of this fiber is essential for the formation of palpebral fold. A fiber link between the upper eyelid skin and levator aponeurosis has not been confirmed by previous experimental studies. In this study, we report our findings of this fiber link in adults with double eyelid using electron microscopy. Based on the anatomic microstructure of the oriental upper eyelid, we designed a new method of modified blepharoplasty, which reconstructs the link between the levator aponeurosis with skin of upper eyelid.Materials and Methods:The tissue of upper eyelid from mormal female adults was investigated and divided into three groups: the group of double eyelid formed primarily, the group of double eyelid formed gradually and non-double eyelie group. They amount to 90 sides of upper eyellids, which were made into spedimen pieces for examination by scanning electron microscope and optic microxcope. Based on this anatomic research, we designed a new method of modified blepharoplasty, which imitates the anatomical microstructure of the natural double eyelid. In this modified blepharoplasty, the levator aponeurosis was attached to the skin of the upper eyelid to get dynamics structure of double-eyelids, and the tissue volume of the orbicular muscle was trimmed. The effects of this method were clinically analyzed in 2068 patients with blepharoplasty.Results: In the upper eyelid of the double eyelid, the bunched fibers of levator aponeurosis penetrate through oricularis muscle to fuse with the skin in palpebral sulcus. This structure was not observed in the group with non-double eyelid. The muscle bundles were arrayed loosely in double eyelid, and dense in non-double eyelids. A new method of modified blepharoplasty was built, which imitates the anatomical microstructure of the natural double eyelid. The double eyelids reconstructed in 2068 patients by this modified method, were exactly like the natural double eyelids .Conclusions: The fiber-linked structure between eyelid skin and levator aponeurosis is essential dynamics structure for the formation of the double eyelid. The modified blepharoplasty, which imitates the anatomical microstructure of upper eyelid, can achieve approaching physiological effects of the natural double eyelids.