I know that some surgeons attach the levator muscle to tarsal plate(static), and some attach levator to skin(dynamic). some asian patients complain that in static crease, that the scar is indented when the eyes are closed (doesn't fade, always there), giving unfavorable cosmetic result. In dynamic, scar shows when eyes are closed but is invisible in half a year Is it possible that the patient can ask the surgeon what kind of crease (static/dynamic) that he/she wants and are they interchangeable?
The Type of Scar from Upper Blepharoplasty?
Doctor Answers 4
Asian Upper Eyelid
The Asian upper eyelid Blepharoplasty is a very fascinating procedure. In some Asian patients the muscle that opens the upper eyelid(like a garage door opener) does not insert into the skin, creating a fold. On top of this some may have excess fat in the area.
I have never heard static versus dynamic. I would propose it is simpler than that. Once the amount of crease is agreed upon, the excess skin is excised. Then muscle, and fat may be trimmed. Most people will simple close the upper eyelid incision by tacking the skin down to the deeper tissues-levator/ tarsal plate area.
There are several factors that could lead to a depressed scar;
1 The patients innate scarring and healing
2. Taking too much muscle out over the tarsal plate- or maybe too narrow of a strip
3 Sutures being too tight as a result of swelling or technique.
Upper Eyelid Blepharoplasty Scar: Different scar for different races
Upper eyelid blepharoplasty is a straight forward operation when skin only is removed. Typically this is combined with a browlift in the female patient and the scar is designed to be invisible. In the asian patient, the purpose of an upper eyelid blepharoplasty is to define an upper eyelid crease and this can be preformed in numerous ways, but in general involves attaching the upper eyelid skin to the levator aponeurosis. This is designed to create a crease on eyelid repose and elevation.
I hope this helps.
I usually attach the ski to the levator muscle and not the tarsal plate for the reasons you mention. It should give a natural result.
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Your understanding of upper eyelid surgery is not correct.
A properly executed Asian or Western upper eyelid surgery benefits from a precisely structured upper eyelid platform and upper eyelid crease. This is done by a technique called anchor blepharoplasty. The crease is created by making a scar adhesion between the levator aponeurosis and the upper eyelid crease. This support the upper eyelid platform skin and the upper eyelid eyelashes. The levator itself does insert over the tarsus. However, in many individual with upper eyelid ptosis this insertion is thinned or frankly disinserted. In these cases, the tendon needs to be properly reattached to the tarsus but this is independent of the formation of the crease.
A so-called dynamic crease lacks the advantage of controlling crease placement and risks that the double fold will fail after surgery. The reason some surgeons avoid making the hard crease of the anchor blepharoplasty is that technically, it is one of the most difficult and demanding procedures of oculofacial plastic surgery. Very few surgeons possess the precise technical and artistic skills needed to execute this surgery. So occasionally one runs into nonsense out there explaining why the anchor blepharoplasty was not performed.
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