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(A-F) These photographs help us understand the actual surgery. Eyelid pinch cramped the lower eyelid for hemostasis, and 4-0 silk sutures retracted the eyelid skin for the separation of the skin and the orbicularis. (A) The dissection of the posterior layer of the capsulopalpebral fascia (CPF). First, cut the CPF complex at the inferior border of the tarsus. Visualize the conjunctiva on the silver plate of the pinch and dig along the layer. Avoid puncturing the conjunctiva. (B) The dissection of the anterior layer of the CPF. Second, locate the orbital fat layer beneath the septum. Dig down that layer inferiorly, approximately 7-8 mm from the tarsus. (C and D) CPF advancement. Three points were marked with a skin marker on the tarsus and 5 mm inferiorly from the cut end of the CPF. The dissected CPF was sutured to the tarsus with three sutures of 6-0 polysorb. (E) Ciliary everted suturing. Nylon suture (7-0) tied dermis and tarsus, resulting in eversion of the cilia. Normally, five or six stiches are needed. (F) Direction of cilia at the end of the surgery. All cilia are corrected to their normal positions. Palpebration has no influence on the ciliary position.
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Without puncturing the conjunctiva, dissections along the layer are completed (Figure 1A). Next, the orbital fat layer beneath the septum is identified, and the layer is dissected inferiorly approximately 7-8 mm from the tarsus (Figure 1B). After the Jones procedure with CPF is completed, the modified Hotz procedure (ciliary-everted suture) is performed between the tarsus and solid dermis tissue (Figure 1E). The ciliary directions are shown to be corrected after the operation (Figure 1F).
A simple diagram of the lower eyelid and our combination procedure.. Notes: The pink round structure represents the tarsus, and the thin yellow structure represents the capsulopalpebral fascia (CPF). The green circle shows the binding location of the CPF and the tarsus. The blue circle shows the ciliary everted suture, which ties the dermis to the tarsus.
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