This chapter illustrates various conditions that required revision (correction of suboptimal results), all with prior surgery that may have included buried sutures methods and/or incisional methods. The contrast between Asian eyelids and those of Caucasians, and the diversity even among Asians themselves, are what makes Asian eyelid surgery such an interesting and challenging art.
Young woman who had a high crease set. (A) Note the aspect ratio between the pretarsal (lower) segment and the preseptal (upper) segment is almost 1 : 1. There is some acquired ptosis and limitation on upgaze , as well as lagophthalmos.
(B) Two weeks after a revision attempt utilizing the author’s beveled approach and resetting of crease height. The ptosis is released and the crease height will continue to settle down over the next few months. The aspect ratio has improved between pretarsal segment and preseptal region. (The patient returned to her overseas residence shortly after.)
Female university student who presented after lid crease placement. ( A ) She showed a high crease over the left upper lid and a segmented crease over the medial extent of the right upper lid and scar over the lateral half of the crease. I recommended enhancement and revision of the right upper crease, and repositioning to a lower level for the left upper crease. She elected to have only the right lid revised. A tarsal height-based Asian blepharoplasty was performed on the right upper lid, cicatrix was released from the lateral half ( B ).
( C ) One week postoperative appearance.
( A ) 30 y.o. female with multiple creases over RUL (with one dominant and several less distinct creases over the medial half) and multiple indistinct high creases over LUL. ( B ) Note the enhanced supratarsal sulcus on the LUL, probably due to excessive fat removal. ( C ) Correction of the LUL consisted of crease enhancement with excision of the small strip of skin encompassing the multiple creases. No attempts were made to correct the supratarsal hollow because (a) this is a difficult procedure to perform, and placement of synthetic fillers frequently leads to complications; and (b) the conversion of several faint lines to a main crease often creates enough inward folding, especially on upgaze, to make the hollow less noticeable.
( A ) 30 y.o. female who had two lid crease procedures in Asia. She complained that the crease tapered excessively towards the lateral canthi and of fullness in that area when she smiled. ( B ) Asian blepharoplasty was performed laterally. Intraoperatively, scar tissues were excised until the underlying aponeurosis was clearly seen.
( C ) Appearance immediately after the procedure.
( D ) Appearance 1 month postoperatively. Some residual pretarsal edema can still be seen.
( A, B ) 25 y.o. female had undergone placement of a reddish tattoo line in an attempt to form a pseudo-crease over the RUL. She had minimal ptosis of the same lid.
( C ) The tattooed crease line, which measured less than 1 mm wide, was excised. ( D ) A new crease was formed based on the author’s technique.
( E ) Closure of the wound over the RUL.