Subbrow Blepharoplasty Using Microvascular Clips to Estimate Skin Removal: A Novel Technique in Asian Patients With Severe Dermatochalasis

Summary: A subbrow blepharoplasty is frequently performed to address ptosis resulting from dermatochalasis or lateral hooding, particularly in Asian patients. In cases with severe dermatochalasis or excessive lateral hooding, extensive skin removal is required, and the preoperative estimation and comprehensive planning for the skin removal are crucial to achieving good aesthetic results. Conventional estimation methods such as pinching the eyelid with forceps or manually stretching the eyelid upward are simple and straightforward but lack the precision required for optimal outcomes. These methods estimate the skin removal at only 1 point on each eyelid. It is also difficult to evaluate both eyelids simultaneously. To overcome these shortcomings, we have applied a simulation technique that uses disposable microvascular clips. The technique involves pinching the skin at the medial and lateral thirds of each eyelid (4 points on both eyelids) with the clips while the patient is sitting upright and looking straight ahead, thus enabling a precise and bilateral evaluation. It also enables standardized clinical photography for feedback. A total of 31 patients have undergone a subbrow blepharoplasty with this new technique at our institution, and all 31 patients obtained good surgical outcomes, as simulated preoperatively, and required no revisional surgery. Our new method with microvascular clips was especially effective in cases with severe dermatochalasis and/or preoperative asymmetry.