What it means for a patient
- Both common ways of closing an upper eyelid incision gave the same scar at 6 months.
- The intradermal stitch may look slightly better in the first week. One of the two evaluators saw this difference.
- Most patients rated their eyelids as much improved or very much improved.
- The authors conclude the choice can rest on the surgeon's preference and workflow.
- Limits: 50 patients, one surgeon, one center.
Why this paper matters
It compared two eyelid skin closures side by side in the same patients and found equal scar results at 6 months.
Overview
Upper eyelid surgery leaves a scar in the lid crease, and the best way to close the skin is still debated. In this randomized study, each patient had one eyelid closed with an intradermal suture and the other with a continuous external running suture, both in 6-0 nylon. One oculoplastic surgeon at a university-affiliated center performed all the operations.
Findings
- 50 patients, bilateral upper blepharoplasty, one surgeon.
- Each eyelid was randomly assigned to an intradermal or a continuous external running suture.
- Standardized photos from day 7 and 6 months were rated by 2 blinded oculoplastic surgeons.
- Patients completed the Global Aesthetic Improvement Scale; scar quality was scored with the POSAS Observer scale.
- Day 7, first evaluator: intradermal side favored, 60% (P = .013).
- Day 7, second evaluator: no significant difference.
- At 6 months, both methods gave comparable appearance.
- POSAS Observer scores showed no significant difference between techniques at either time point.
- Patients rating their result "much improved" or "very much improved": 80%.
- No suture-related complications; 1 case of wound separation on one side could not be attributed to either technique.
- The journal assigned Level of Evidence 3.
Terms
- Upper blepharoplasty: surgery to remove excess skin, and sometimes fat, from the upper eyelids.
- Intradermal suture: a stitch placed within the skin, below the surface, with little of it visible.
- Continuous external running suture: one stitch that runs along the wound on the skin surface.
- 6-0 nylon: a very fine, non-dissolving suture thread.
- Intraindividual design: each patient serves as their own comparison, one eyelid per method.
- POSAS: the Patient and Observer Scar Assessment Scale, a standard scar rating tool.
- Global Aesthetic Improvement Scale: a rating of how much appearance changed after treatment.
- Wound dehiscence: separation of the edges of a closed wound.
- Oculoplastic surgeon: an eye surgeon trained in eyelid and eye socket surgery.