title: Orbicularis-levator-tarsus composite suture technique in double-eyelid operation.
abstract: OBJECTIVE
  Fold loss and suture extrusion are fairly common in double-eyelid surgeries. We hereby explore a new composite suture technique that aims to reduce such complications and to improve the long-term aesthetic outcome.
  
  
  METHODS
  Based on the conventional external incision procedure, the suture procedure in our technique involves three stitches that fixate the orbicularis oculi, the levator aponeurosis, and the tarsal plate. This modified upper-eyelid blepharoplasty was performed in 98 patients (91 female and seven male, 196 eyes) with either congenital absence of the upper-eyelid folds (n = 84) or loss of fold from previous procedures (n = 14). The patients were followed up for 6-30 months. The complications were documented, and the overall outcomes of upper-eyelid folds were evaluated by both surgeons and patients as excellent, good, fair, or poor.
  
  
  RESULTS
  Among 98 patients, 89 (91%) had excellent results and nine (9%) had good results; no patient had fair or poor results. Four patients had scar formation at postoperative week 2, all resolved without particular treatments at 6 months. The buried sutures could not be seen or felt through the skin. In addition, no suture extrusion was noted. There was no case of faded or disappeared folds during the follow-up. All patients were satisfied with the outcome.
  
  
  CONCLUSIONS
  The composite suture technique ensures a firmer fixation and improves the aesthetic outcomes. It is a highly applicable and reliable approach for upper-eyelid blepharoplasty.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, PR China; Plastic Surgery Department III, Face and Neck Center, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, PR China.
authors.forename: Lehao W
authors.initials: LW
authors.lastname: Wu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, PR China. Electronic address: yezirong@126.com.
authors.forename: Zirong
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, PR China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, PR China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, PR China.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D017060:Patient Satisfaction; D013536:Suture Techniques; D055815:Young Adult
keywords: Blepharoplasty; Composite suture technique; Fold loss; Tarsus-septum fixation