VCIT is the latest and most advanced technique for incision double eyelid surgery.
It was devised and is currently performed by Dr. Kenneth Kim, of Dream Medical Group, and other select surgeons in South Korea. This method has been gaining popularity in the Korean media and is considered to be a specialty in double eyelid surgery. This technique is unique in that it makes use of the septo-aponeurosis junctional thickening, a connective tissue in the eyelid. The septo-aponeurosis junctional thickening is comprised of the distal aspect of the levator and a thin layer of tissue that encases the eyelid fat. The identity of the septo-aponeurosis junctional thickening has been controversial among surgeons, mainly for the subtle role it plays and difficulty in locating it; it has often been simply known as a distal part of the levator. Despite its subtle and delicate nature, a selective group of surgeons found it had advantages as a base for suture anchorage through extensive research.
What is the Vector-Calibrated Incisional Technique?
(A) Side view of eyelid before operation; (B) low fixation; (C) high fixation; (D) conjoined septo-aponeurosis junctional thickening fixation.
As observed in (B) and (C), neither the tarsus nor the levator aponeurosis stretches toward the suture to minimize depth. This lack of elasticity/recoil effect causes a static appearance in the crease for tarsus fixation and deep crease for levator fixation. However, in (D), the septo-aponeurosis junctional thickening (gray) has stretched toward the suture, as compared to pre-operation in (A), reducing unnecessary depth and resulting in a dynamic crease that moves with the eyelid’s natural movements.
In performing VCIT, the septo-levator complex must be meticulously uncovered – its position is challenging to locate as it is hidden by layers of soft tissue. Because the septo-levator complex is located at a more superficial level than the levator aponeurosis, the sutures fasten to a thinner layer of tissue resulting in less depth penetration. Furthermore, due to the higher resilience and flexibility of the septo-levator complex, fixation to this area accommodates for any extra depth by virtue of its elastic attributes, much like a rubber band. This results in a softer, gentler crease depth, which more closely resembles a natural double eyelid in both appearance and movement.
In performing VCIT, the septo-aponeurosis junctional thickening must be meticulously uncovered – its position is challenging to locate as it is hidden by layers of soft tissue.
Because the septo-aponeurosis junctional thickening is located at a more superficial level than the levator aponeurosis, the sutures fasten to a thinner layer of tissue resulting in less depth penetration. Furthermore, due to the higher resilience and flexibility of the septo-aponeurosis junctional thickening, fixation to this area accommodates for any extra depth by virtue of its elastic attributes, much like a rubber band. This results in a softer, gentler crease depth, which more closely resembles a natural double eyelid in both appearance and movement.
Suture fixation at the septo-aponeurosis junctional.
The left image depicts the eyelid before surgery. The right image depicts post-operation of the sutures fixed at the septo-aponeurosis junctional thickening (shown in gray). Note the difference in shape of the conjoined between pre-operation and post-operation – the conjoined has stretched to accommodate the extra tension from the sutures, adding to the dynamicity of a crease formed by VCIT.
This new open technique takes advantage of much more than an alternate eyelid tissue–it utilizes biomechanics to find the ultimate balance. Many factors apply in finding this balance: determination of the crease height, amount of skin, fat, and other soft tissue to be excised, how much tightening is needed in the eye-elevating muscles, and the vector-calibrated length of the septo-aponeurosis junctional thickening. The new incision technique is appropriately named “Vector-Calibrated” because it applies clinical scientific knowledge in biomechanics to achieve the ideal aesthetic and functional balance in the eyelid. It differs significantly from prior techniques in that it does not arbitrarily create a crease at any desired height, but aims for calculated results that complement the entire eye.