2.5. Surgical Procedure
bipolar coagulation
The upper blepharoplasties were performed by two surgeons (J.J., R.H.S.) in an outpatient environment. The surgical procedure was standardised prior to the study. The patients underwent the removal of upper eyelid skin only (group A) or the additional removal of a strip of orbicularis oculi muscle (group B); all the other steps were identical. The surgical landmarks and planned skin excisions were marked on the patient whilst in an upright position. Approximately 1.7 mL of Ultracaine DS Forte (40 mg Articain, 10 µg Epinephrine per mL), a local anaesthetic fluid, was injected subcutaneously per side. A scalpel was used to remove the marked excess upper eyelid skin and, in group B, 3–4 mm of the underlying orbicularis oculi muscle. The orbital septum was coagulated and the muscle edges were approximated with bipolar coagulation. The skin was sutured with Ethilon 6-0 (Ethicon, Cornelia, Georgia, GA, USA) intracutaneously in a running fashion and adhesive suture strips were placed. When indicated, the patients underwent removal of a significant amount of protruding medial fat.