Soft-Set Serpentine Eyelid Crease Formation

Abstract

Achieving a truly natural and effective eyelid crease during blepharoplasty surgery in patients of both Asian and Native North/South American descent can be challenging. Typical techniques of open crease formation can create unnaturally firm attachments, whereas closed techniques have limited efficacy. We present a partially open technique that achieves a soft, natural eyelid crease by recreating the normal anatomic attachments without a deeper dissection between the levator aponeurosis and the anterior lamella. A retrospective review of all patients at a single oculoplastic surgery practice undergoing the serpentine “soft” upper eyelid crease formation maneuver was performed. Charts were reviewed for outcomes, complications, and subjective satisfaction with the procedure. The review included analysis of the preoperative and postoperative photos. The surgical technique involved using a 7-0 silk suture to surgically tether the tissues of the pretarsal levator aponeurosis to the pretarsal orbicularis in a continuous serpentine fashion. The retrospective review yielded 16 patients (32 eyelids) who underwent this style of eyelid crease formation at the time of blepharoplasty. All patients were pleased with the outcome at their final visit. There were no complications. There was 1 revision surgery at 1 year postop to optimize symmetry. Natural-appearing eyelid crease surgery requires efficacy without aggressiveness. We present a technique that allows for reproducible reformation of the upper eyelid crease using a running, overlapping, 7-0 silk suture.