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Minimally Invasive Techniques

There are issues unique to Asian skin and scarring. Asian skin tends to have more pigmentation and higher incidence of hypertrophic/keloid scarring after surgery. With double eyelid surgery, Asians are more prone to scarring in a highly visible area of the face; therefore, it was critical to implement a technique that had very minimal or almost no scarring. As surgeons gained more in-depth and detailed understanding of the eye’s anatomy, they began to develop a minimally invasive technique, one in which there was minimal incision and thus minimal scarring. They coupled this with the development of special instrumentation specifically tailored for this surgery that would allow this procedure to be executed properly.

Today, procedures such as double eyelid surgery, eye enlargement, epicanthoplasty, and lateral canthoplasty result in very little to almost no signs of visible scarring. Specifically, suture technique is a minimally invasive procedure where double eyelid fold is made utilizing sutures instead of incision. An advancement within the suture technique, is the introduction of the 3D ST™ where not only double eyelid is created but also eye enlargement (ptosis) surgery is simultaneously performed. In addition, ptosis surgery by itself can be performed inside the eye (conjunctiva) where only a pinpoint incision is required on the skin.

It is also important to understand that minimally invasive technique does not only apply to skin incision. It also pertains to the tissue underneath the skin not being traumatized during surgery. Though incision is commonly thought of as leading to more trauma, real trauma occurs inside the tissue below the skin during surgery. When utilizing a minimally invasive technique, the surgeon follows and preserves the natural anatomic tissue plane. In recent years, surgeons have conducted extensive anatomic and histologic research especially in South Korea. By performing ultra-fine dissection and following the newly discovered microscopic tissue planes, a patient’s recovery time and swelling will be greatly reduced.

Most interestingly, this technically demanding surgical approach and understanding of detailed anatomy means that the surgical incision for an incision double eyelid and incision lower eyelid surgeries heals less visibly. In fact, an incision double eyelid fold created can mimic a natural double eyelid. If one compares an incision double eyelid using an “internal” minimally invasive technique double eyelid surgery to a double eyelid created using the suture technique, the incision double eyelid results are more profound, versatile, and dynamic for the following reasons:

  • Suture technique folds are not as crisp and the depth of the fold is not as responsive to the eye elevating muscle.
  • An incision double eyelid surgery performed with ptosis surgery utilizing the “internal” minimally invasive technique will not only open and enlarge the eye, but will make the fold respond similarly to a natural double eyelid.
  • The suture technique is one dimensional whereas incision technique is multidimensional, as the surgeon can excise excess skin and can functionally improve the eye elevating muscle.
  • Most importantly, the “internal” minimally invasive technique can only be performed by a plastic surgeon that has studied the most recent histologic advancements and has experience operating utilizing this technique.