The durability of buried-suture double eyelid surgery | How many years does it last? The traits of those prone to losing it, and countermeasures
1. Introduction: the merits and challenges of the buried-suture method
"The buried-suture method comes off easily, so in the end the incision method is the only option"— quite a few people think so.
In fact,research reports are revising the conventional understanding.There are reports that the double-eyelid disappearance rate of 19.3% with the conventional buried-suture method has dropped to 8.6% with the new technique.
The buried-suture method, which forms a double eyelid, has many advantages — because it does not excise skin, it is minimally invasive, the surgery time is short, there is little postoperative swelling, and the downtime is short — and it is a very popular surgery in Asia [1-4]. However, it has long had the challenge thatthe double-eyelid line tends to disappear (revert), and it tended to be thought that the incision method was needed to obtain long-term durability [3, 5, 6].
So why do some people's last long while others come off quickly?Let us unravel that answer from medical research.
2. The improvement of durability through suture technique: the continuous buried-suture method vs. the ligated (interrupted) buried-suture method
The important factor that governs the durability of the buried-suture method lies in the "suturing method."
Conventional thinking was that "the buried-suture method comes off easily," but with the improvement of suturing methods, a change is being seen in the situation.
- Ligated (interrupted) buried-suture method (interrupted method): It is the conventional technique, a method of independently fixing the threads from three small incisions [7]. Because this method has few fixation points, the disappearance rate of the double-eyelid line tends to be high [8, 9]. One study reported that the double-eyelid disappearance rate due to reversion was 19.3% [10, 11].
- Continuous buried-suture method (continuous method): It is a method of using a single thread to continuously suture the dermis and tarsal plate at multiple points and fold it back through the subcutaneous layer [12]. Because the skin and tarsal plate are fixed at, for example, six points, a stronger and more permanent adhesion is formed, andthere are reports that the double-eyelid disappearance rate has dropped to 8.6%[9-11]. Also, because there is only one knot, on the outer side, complications such as knot exposure are also said to be fewer [13, 14].
Thus, with the improvement of suturing methods, a decrease in the failure rate has been reported.
3. The usefulness of the two-way continuous buried-suture method
"Even so, that means 8.6% still come off."You may have such a question.
And so what was developed is the further-advanced "two-way continuous buried-suture method." Let us explain this technique in detail.
A "two-way continuous suture" technique has also been reported, in which 7 to 9 minute incision holes (about 1 mm) are made, and a single thread is used to continuously suture the dermis and the superficial layer of the tarsal plate in a wave pattern, then folded back and sutured in the reverse direction [15-17]. With this technique, the following effects can be expected.
- Improvement of durability: With stronger fixation force, there is a possibility of maintaining a natural double-eyelid line over the long term [16, 18, 19].
- Reduction of corneal injury risk: By keeping the thread only in the superficial layer without penetrating the full thickness of the tarsal plate, and by using a single thread (single-arm) rather than a double-ended needle (double-arm), it may be possible to reduce the risk of damage to the cornea [20-22].
However, there are also phenomena that cannot be explained by improvements in technique alone.Why, with the same technique, does it come off quickly in some patients? One of those factors lies in the structure of the eyelid explained next.
4. The effect brought by removal of upper-eyelid fat (ROOF / orbital fat)
The factor reported to lower the reoperation rate
In addition to the suturing method,removal of eyelid fat (ROOF and orbital fat)has been reported, in a 4.5-year follow-up study, to contribute to the durability of the double eyelid [23-25].
"Why does removing fat improve how long it lasts?"Let us explain that mechanism.
When the eyelid is thick and has a lot of fat, the volume of that tissue is said to become a physical barrier and a factor that hinders the reliable adhesion between tissues by the thread [26-28].
How great is the difference in the actual research data?Here we introduce the reported results:
- Decrease in the reoperation rate: There are reports that, whereas the reoperation rate of the group that did not undergo fat removal was33.5%, in the group that underwent fat removal from a minute incision hole at the same time as the buried suture it dropped to17.0%[24, 29, 30] (120 subjects, average follow-up period 4.5 years, statistically significant difference at p<0.05).
- Promotion of tissue settling: By removing the fat, the anatomical gap decreases, and strong scar (adhesion) formation may be promoted [31]. Also, by removing the vascular-rich orbital fat, postoperative swelling subsides faster, which may also lead to early tissue stabilization [32].
- Note: Excessive excision of fat carries the risk of emphasizing future eyelid hollowing or ptosis, so it is important to discern the patient's anatomical state and remove only the protruding fat conservatively [33, 34].
Thus, with fat removal, a decrease in the reoperation rate has been reported.
5. Conclusion
"So in the end, which method should I choose?"To this question that many people have, we answer based on medical grounds.
It has been reported that double-eyelid formation by the buried-suture method, rather than merely fixing the thread, can be expected to improve durability by combining"strengthening the fixation force through continuous suturing"and"eliminating the adhesion-hindering factors through appropriate fat removal"[9, 18, 35].
With the new techniques, a change is being seen in the conventional understanding that "the buried-suture method comes off easily."Choosing the technique to match the anatomical conditions is an important factor in making a beautiful, natural double eyelid last a long time.
Why not thoroughly consult a specialist about the option best suited to the state of your eyelids?
If you find yourself thinking, "What about my case?"
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