It is strange that all textbooks of anatomy describe the depressor septi nasi muscle singly, without an antagonist. Incidentally, in 1986, a small rod of soft tissue was found between the medial crura of the two alar cartilages during a rhinoplastic operation with the external approach technique of Anderson and Ries. From 1990 through 1995, anatomic dissections of the nasolabial region under 3.5x loupe magnification were performed on 14 Chinese formalin-preserved cadavers, one fresh Chinese cadaver, and one fresh American white female cadaver. The small soft-tissue rod was found in every one of the dissected cadavers, and it was seen to be a pair of muscles. Each one of these paired small muscles arose from the aponeurosis on the dorsum of the nose and inserted into the muscular substance of the upper lip at the base of the columella and to the anterior spine of the maxilla. Histologic examinations of these muscles stained with hematoxylin and eosin and Masson trichrome showed that they were striated muscles. According to its origin and insertion, this newly found muscle was called the "levator septi nasi." Its clinical significance in cleft lip deformity and its relations to the orbicularis oris muscle, the dermocartilaginous ligament of Pitanguy, and the nasal superficial musculoaponeurotic system of Letourneau and Daniel are all discussed.
I t is commonly accepted that double-eyelid surgery results in largerappearing eyes, a soft and womanly appearance, clear-cut features and a refreshed appearance to the face (1). Upper eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia because nearly one-half of the Asian population lacks a supratarsal fold (2). The first cutaneous suture technique was devised by Mikamo (reported by Lam [3]). Various methods have been described, broadly including the incisional, nonincisional and mini-incisional methods (4). The present article introduces a modified mini-incisional technique. METHODSA total of 372 patients (325 women and 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years (mean 24 years of age), and all underwent the modified mini-incisional upper blepharoplasty. Bilateral surgeries were performed in 341 patients and unilateral procedures in 31 patients. The follow-up period was three to 12 months (mean nine months) to evaluate the effect. Patient satisfaction was evaluated three months postoperatively. Satisfactory results indicated no multiple eyelids, no shifting or disappearance of the fold, and symmetrical heights of the fold when the difference between the bilateral heights was <1 mm. Complications were recorded. Preoperative evaluationThe desires of the patients were understood during consultation and they were taken into consideration before the operative design. With the patient sitting, the height and shape of the desired double-eyelid line were simulated. A probe was used to push the upper eyelid upward to form a crease in front of a mirror. The crease position was confirmed when the patient was satisfied with the simulated crease, which was usually approximately 7 mm to 10 mm above the ciliary margin. The symmetry of the line on the bilateral upper eyelid was verified. The proposed double-eyelid line was marked using a marker pen. All patients were photographed pre-and postoperatively. Surgical procedureThe operation was performed under local anesthesia. 1% lidocaine (5 mL) containing 1:100,000 of epinephrine was injected into each eyelid. Four 2 mm incisions were made along the double-eyelid line. BACkGROUND: Double-eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia. OBjECTIVE: To introduce a modified mini-incisional technique to form a double eyelid. METHODS: A total of 372 patients (325 women, 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years, with a mean age of 24 years. All patients underwent the modified mini-incisional upper blepharoplasty. In the technique, four 2 mm incisions were made along the designed fold. The orbicularis muscle overlying the levator aponeurosis was removed. The removal of the lateral fat pad was completed accordingly. The medial fat pad was also removed if necessary. Suture was used to fix the skin to pretarsal fascia along the double-eyelid line. The double-eyelid crease was formed after the operation. RESULTS...
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