Subciliary Incision for External Dacryocystorhinostomy

Abstract

Subciliary DCR provides an excellent functional cosmetic scar outcome while retaining the access and advantages of external DCR procedure.

Tear Trough Incision for External Dacryocystorhinostomy

“…Using a similar approach with the incision placed in a relaxed skin tension line of the eyelid, Akaishi et al 30 reported that patients graded their scar on average between invisible and minimally visible at 6 months after surgery. Dave et al 21 studied the subciliary approach in 16 patients. At the final follow up, 88% of patients rated the scar as invisible and 100% rated it as invisible or minimally visible.…”

“…[11][12][13][14][15][16] However, several studies have proved that a wellplaced exDCR incision can result in an inconspicuous scar to surgeon and patient alike. [17][18][19] Previously described incision sites include relaxed tension lines of the lower eyelid, 20 and subciliary 21 and transconjunctival incisions. 22 Although mentioned in the literature, incision in the tear trough has not been studied prospectively.…”

Aesthetic assessment in periciliary “v-incision” versus conventional external dacryocystorhinostomy in Asians

“…Nonetheless, a number of external DCR scar assessment studies only had subjective patient grading but without physician grading [3,10,30,31]. For those studies that included physician grading, they relied on a non-validated categorical grading scale based solely on whether the scar is invisible to very visible [8,9,[11][12][13]21]. This simple grading scale neglected other parameters of scar assessment such as size, pigmentation, and suture marks.…”

“…Regardless of the surgical success, patients were asked to evaluate each of their incisions (using a mirror) by using the following scar grading scale described previously: 0 invisible, 1 minimally visible, 2 moderately visible, 3 very visible [8,9,21]. In addition, patients indicated their aesthetic satisfaction of the skin incisions by placing a single mark on a standard 100 mm visual analogue scale (VAS) [22].…”

“…For these reasons, external DCR is still being performed frequently. Conventionally, external DCR is performed by vertically incising the lateral nasal wall, and modified techniques of external DCR such as J-shaped, W-shaped, and subciliary incisions have been described either to minimize scar formation [5][6][7][8][9][10][11][12][13] or even to avoid a cutaneous scar through retrocaruncular and transconjunctival approaches [14][15][16][17]. Periciliary incisions near the skin-mucosal junction at the lacrimal portion of the lid margin is performed during V-Y epicanthoplasty to avoid noticeable scar formation in Asians [18][19][20].…”