These slides are from the spring symposium of the Korean Cleft Palate-Craniofacial Association (KCPCA). When we operate on older eyes, looking natural is everything. If the patient walks out with too sharp an expression, or with residual sagging that the surgery did not address, satisfaction drops.
Older skin is much more redundant than young skin, so we have to make an incision and excise some of it. I want to walk through the talk I gave in March 2017.
The title of the lecture.
Patient requests in this group are remarkably consistent: 1) fix the sagging, 2) clean up the chronic irritation at the lateral lid, 3) keep it looking natural, and 4) keep it minimal (cost matters too).
If the brow-to-eye distance is short, a brow lift may be required. If only the lateral skin is irritated, a subbrow incision alone may be enough.
This patient did not need a new double-fold. A subbrow excision alone gave a clean result. The core of the talk was that proper fixation is what keeps the result from looking deep or pinched. Buried-suture fixation with skin excision has been described, along with several other variations. The point I emphasized was that fixation should not go directly to the tarsal plate, but rather to the orbital septum or to the junction where the levator and septum meet, so the result looks more natural.
The schedule was as above.
Min-soo, my colleague, recorded the video for me.