Exploring the Buried Double Twisted Suture (BDTS) Technique in Blepharoplasty
Blepharoplasty is a surgical procedure aimed at correcting eyelid deformities and enhancing aesthetic appearance, employing various techniques tailored to individual patient needs. Among these techniques, the buried double twisted suture (BDTS) stands out for its innovative approach and promising outcomes, particularly in addressing conditions like upper eyelid epiblepharon. In a research paper written by Choi, Goldberg, and Lew (2016), the BDTS technique is detailed, highlighting its effectiveness in correcting upper eyelid epiblepharon and presenting favorable outcomes (Choi, Goldberg, & Lew, 2016).
Understanding the BDTS Technique
The BDTS technique is a refined method used in oculoplastic surgery to correct upper eyelid epiblepharon and similar conditions. Here's a breakdown of its components:
Suture Placement: A fine 6-0 nylon suture is meticulously passed through specific points in the upper eyelid, typically through the palpebral conjunctiva and skin.
Twisting: Once the suture is in place, it is twisted by tying two strands together at a central point. This twisting action ensures a secure fixation of the eyelid tissues.
Burial: After securely tying the suture, the knots are carefully buried deep within the subcutaneous tissue of the eyelid. This technique prevents the knots from protruding or being visible on the skin surface post-surgery.
The BDTS technique is valued for its simplicity in execution and effectiveness in achieving desired cosmetic outcomes, particularly in creating or enhancing a natural-looking double eyelid fold. Moreover, it is associated with a relatively low incidence of complications, making it a preferred choice for certain patients undergoing blepharoplasty.
Clinical Efficacy and Applications
Recent studies, such as those conducted at the Oculoplastic Clinic of Bundang CHA Medical Center, have demonstrated the clinical efficacy of blepharoplasty using the BDTS technique. These studies report significant improvements in margin reflex distance and successful outcomes in maintaining a double eyelid appearance post-surgery. The BDTS technique has also been noted for its minimal recurrence rates and effective management of complications such as knot exposure.
Application of the BDTS Technique
The BDTS technique finds broad application in correcting various eyelid conditions, particularly those where a natural-looking double eyelid fold is desired or where traditional incisional methods may be less suitable. Key applications include:
Upper Eyelid Epiblepharon: Highly effective in correcting the inward rotation of eyelashes and skin characteristic of upper eyelid epiblepharon, thereby alleviating discomfort and improving aesthetic appearance.
Double Eyelid Creation: Offers a reliable method for patients seeking cosmetic enhancement or correction of congenital eyelid conditions, such as absent or asymmetrical double eyelids.
Lower Eyelid and Epicanthal Fold: Can be adapted alongside lower eyelid surgeries or epicanthoplasty to address complex eyelid anatomy comprehensively, ensuring both correction and aesthetic balance.
Advantages Over Other Techniques
Compared to traditional incisional methods, the BDTS technique offers several advantages:
Minimal Scarring: No incisions along the eyelid crease reduce visible scarring, leading to faster recovery times and decreased postoperative swelling.
Reduced Complications: Buried sutures minimize the likelihood of suture-related complications, enhancing patient satisfaction with the aesthetic results.
Disadvantages of the BDTS Technique
While highly effective and minimally invasive, potential disadvantages include:
Technical Expertise Required: Precision in placement and tying of sutures is crucial; improper technique can lead to suboptimal outcomes.
Risk of Knot Exposure: Despite burying knots deep within tissues, there's a risk of knot exposure postoperatively, necessitating additional procedures.
Limited Versatility: May not be suitable for all eyelid conditions or anatomies, particularly complex cases requiring extensive tissue manipulation.
Recurrence Rates: While generally low, there's a possibility of recurrence, especially in patients with thick eyelid tissues or unique anatomical dynamics.
Who is the BDTS Technique Ideal For?
The BDTS technique is particularly well-suited for:
Young Patients with Epiblepharon: Effective in correcting eyelid conditions like epiblepharon, common among children causing inward eyelash and skin folding.
Patients Seeking Minimal Scarring: Ideal for those concerned about visible surgical marks and desiring quicker recovery times.
Mild to Moderate Eyelid Deformities: Suitable for cases where correction of eyelid creases and positioning of eyelashes can be achieved without extensive tissue manipulation.
Combined Procedures: Can be effectively combined with other eyelid surgeries to address multiple aesthetic concerns simultaneously.
Who Should Consider Alternatives?
While the BDTS technique offers numerous benefits, it may not be suitable for all patients or all types of eyelid conditions. Surgeons may recommend alternative approaches in the following scenarios:
Complex Eyelid Anatomy: Patients with complex eyelid structures or significant asymmetry may require more extensive surgical interventions or customized techniques to achieve optimal results.
Severe Eyelid Ptosis: For patients with severe eyelid ptosis (drooping), additional procedures such as levator resection or brow lift techniques may be necessary to address functional concerns along with aesthetic goals.
Prior Unsatisfactory Surgical Outcomes: Patients who have undergone previous eyelid surgeries with unsatisfactory outcomes or high rates of recurrence may benefit from alternative techniques tailored to their specific needs.
Conclusion
In conclusion, the buried double twisted suture (BDTS) technique in blepharoplasty represents a significant advancement in oculoplastic surgery, offering effective correction of eyelid deformities with minimal scarring and enhanced recovery outcomes. Tailored for patients with specific eyelid conditions and aesthetic goals, BDTS provides surgeons with a versatile tool to achieve both functional improvements and natural-looking results.
Understanding the BDTS technique's suitability for different patient profiles enables surgeons to optimize treatment plans, ensuring personalized care and satisfactory outcomes. By weighing its advantages, limitations, and alternatives, oculoplastic surgeons can deliver comprehensive care tailored to individual patient needs, thereby achieving optimal aesthetic and functional results.
Reference:
Choi, Seung Woo MD*; Goldberg, Robert A. MD†; Lew, Helen MD*. Blepharoplasty with a Buried Double Twisted Suture Technique to Correct Upper Eyelid Epiblepharon. Plastic and Reconstructive Surgery - Global Open 4(4):p e685, April 2016. | DOI: 10.1097/GOX.0000000000000667
Helen Lew, Su-Byung Yu, Young-Soo Yun, Sang-Yeul Lee; Correction of Epiblepharon of the Upper Eyelid by the Buried Suture Technique: Correlation with Morphological Features of the Upper Eyelid. Ophthalmologica 1 February 2008; 222 (2): 100–104. https://doi.org/10.1159/000112626
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