Super-fine Nail Art Brush: A Helpful Surgical Marking Pen for Preoperative Design of Double-eyelid Blepharoplasty

Clinical use of the surgical marking pen is a valuable adjunct to the surgeon. The ability to have a convenient vehicle for obtaining skin markings is extremely helpful in the planning of many surgical procedures.1 The preoperative design of double-eyelid blepharoplasty includes estimating the height of the double-eyelid line and the amount of skin to be removed and marking it accurately. Accurate marking not only reflects the doctor’s surgical philosophy but also helps the doctor perform the operation more effectively. It can also be used to confirm the patient’s requirements and surgical plan, ensuring the desired surgical outcome, which is a key factor in achieving the desired outcome.2 Currently, the commonly used preoperative marking tools for plastic surgeons include toothpicks, marker pens, needle tips, tweezers, and so on. It is well known that the skin of the eyelid is soft and thin, with rich blood vessels and nerves. When performing preoperative marking, sharp and rigid tools are prone to causing discomfort to the patient and even lead to skin injury. Moreover, the soft eyelid skin will slightly depress under pressure, causing design deviation.3 Blepharoplasty operation requires very fine operation; the thickness and fluidity of the preoperative marking lines directly affect the surgical outcome and even produce postoperative deformities, such as uneven eyelid folds and asymmetry. In addition, the use of different ink for preoperative marking may cause complications such as contamination of the operative field, postoperative infection, and residual pigmentation.4,5 The author proposes a super-fine nail art brush, a novel tool, which may solve this problem. The super-fine nail art brush is often used to help nail technicians create crisp and clean lines; the brush is made of soft and elastic nylon fiber, with proper flexibility and not-easy-to-lose bristles. The brush head length is 7 mm, and the line width is 0.2 mm. The nail art brush features a lightweight and ergonomic design, making it comfortable to hold and easy to control (Fig. 1). During the preoperative design, soak the bristles in methylene blue injection solution to draw thin lines on the eyelid (Fig. 2).Fig. 1.: A super-fine nail art brush drawing a line on paper. The super-fine nail art brush draws thinner and smoother lines than a marker pen or toothpick.Fig. 2.: Use of the super-fine nail art brush for preoperative marking of double-eyelid blepharoplasty. The super-fine nail art brush provides valid and accurate information on the eyelid and reduces patient discomfort.We find this simple and inexpensive tool (approximately US $7.90) to be safe, comfortable, and accurate in preoperative design. First, the super-fine line size provides valid and accurate information on the eyelid. Second, the proper flexibility of the brush head reduces patient discomfort. Third, the longer brush head size can store sufficient methylene blue injection solution, providing long-lasting endurance and avoiding pigment residue. Fourth, this tool can be repeatedly sterilized (60 s in 75% ethanol) to avoid the risk of infection. Our aim is to share our experiences with this simple and convenient auxiliary marking tool. To the best of our knowledge, this method has not been reported. Whether it can prospectively improve outcomes or complications regarding double-eyelid surgery is under investigation. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. PATIENT CONSENT The patient provided written consent for the use of his image.