title: Two modified techniques to decrease complications of buried suture double-eyelid blepharoplasty.
abstract: BACKGROUND
  Double-eyelid blepharoplasty is performed using two alternative approaches: the incision method and the suture method. Buried suture double-eyelid blepharoplasty involves implantation of a foreign material, that is, the suture thread. Therefore, potential complications caused by foreign material should be considered. This article presents two modified techniques to decrease some suture-related complications of buried suture double-eyelid blepharoplasty.
  
  
  METHODS
  A retrospective study was conducted on 349 consecutive patients who underwent buried suture double-eyelid blepharoplasty between June 2002 and December 2010 using two novel techniques modified by the author. One of the modified techniques used was the transconjunctival tarsal fixation technique without penetrating the tarsal plate. The conjunctival fixation site for the buried suture method was the anterior surface of the superior tarsal border. The other technique was buried suture double-eyelid blepharoplasty combined with resection of the pretarsal orbicularis oculi muscle through a small skin incision.
  
  
  RESULTS
  No conjunctival complications, such as chronic inflammation of the tarsal plate or suture extrusion, were observed with the transconjunctival tarsal fixation technique without penetrating the tarsal plate. The loss rate of the double-eyelid fold after buried suture double-eyelid blepharoplasty combined with resection of the pretarsal orbicularis oculi muscle (9.6%) was lower than the loss rate after buried suture double-eyelid blepharoplasty alone (26%). This result highlights the benefits of resection of the pretarsal orbicularis oculi muscle, although the rate of blepharoptosis potentially increases.
  
  
  CONCLUSIONS
  The transconjunctival tarsal fixation technique without penetrating the tarsal plate is simple and decreases the incidence of suture-related complications associated with buried suture double-eyelid blepharoplasty. Resection of the pretarsal orbicularis oculi muscle enhances the durability of the double-eyelid fold after buried suture double-eyelid blepharoplasty.
authors.affiliation: Anesis Biyogeka Clinic, Okazaki, Japan. anesis@biyoclinic.com
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Mizuno
mesh_terms: D000293:Adolescent; D000328:Adult; D019882:Blepharoplasty / Q000009:adverse effects* / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013536:Suture Techniques