Lower eyelid malposition is the most common complication after lower eyelid blepharoplasty.1 Traditional reconstructive techniques involve relatively simple maneuvers, such as a full-thickness skin graft2 or myocutaneous switch flaps, or more complicated surgeries, such as middle and posterior lamella lengthening or midface lifting.3Y8 Although the previously mentioned techniques were effective for correcting lower eyelid malposition, they had potential disadvantages, including additional trauma, additional scar, and long recovery period. This article discusses the authors’ minimal invasive approach for the treatment of lower eyelid malposition after cosmetic blepharoplasty by Aptos thread. PARTICIPANTS AND METHODS Between June 2005 and June 2010, 15 patients (24 eyes), 10 women and 5 men, ranging in age from 35 to 55 years (mean, 44 years), presented with varied amounts of inferior corneal exposure and ocular symptoms, including epiphora, ocular irritation, and conjunctivitis. Two of them had ectropion, the others had lower eyelid retraction. Five patients initially underwent lower eyelid transcutaneous blepharoplasty in our hospital; the others underwent lower eyelid transcutaneous blepharoplasty elsewhere. The interval between blepharoplasty and presentation ranged from 3 weeks to 6 months (mean, 3 months). Their symptoms developed immediately after the blepharoplasty. On clinical examination, the lower eyelid can be raised superiorly over the cornea with ease. These revealed that all cases of lower eyelid retraction stemmed from overzealous excision of skin and orbicularis. The preoperative lower eyelid position was 2.1 to 2.9 mm (mean, 2.6 mm) below the inferior limbus. Photographs were taken at the pretreatment visits and at the 12-months’ posttreatment visits and stored in secure, participantcoded files. The needleless thread used was made of 2Y0 polypropylene (manufactured by Shang Hai Jin Huan Medical Instrument Ltd, Fig. 1). It had converging prominences and could be introduced subcutaneously through a trocar needle. Such a thread introduced subcutaneously is fixed in soft tissues because of the barbs converging toward the middle thereof, carrying subcutaneous fat, pulling it together, and distributing it evenly. The needle, which is a flexible epidural trocar measuring 0.9
100 mm, was manufactured by Shang Hai Jin Huan Medical Instrument Ltd (Fig. 2). Suture placement markings were drawn on the patient’s skin before thread placement as a guide to ensure symmetrical as well as optimal placement. Entry point was approximately 5 mm above and 15 mm away from the lateral canthus. The exit point was approximately 5 mm above and 8 mm away from the inner canthus. The lowest point was approximately 7 mm inferior to the lower eyelid margin (Fig. 3). The thread was deep within the tissue like a bow string, which when stretched provided the effect of uplifting the lower eyelid.