Removal of a Large Amount of Pretarsal Tissue Through Three Mini Incisions in the Construction of a Double Eyelid

Background The surgical procedure aimed at constructing the upper eyelid crease is the cosmetic operation most commonly requested by Asian patients. The incisional approach leaves a permanent crease, but the swelling period can last longer than 3 months, and a distinct scar usually is unavoidable. Many mini-incisional techniques with incisions of varying sizes and locations have been developed, but the removal of pretarsal tissue has not been sufficient because these procedures wipe out only small pockets of soft tissue immediately inferior to skin for placement of the suture. Thus, the formed double eyelid may not be durable. The technique the authors introduce is a modified mini-incisional technique that combines the benefits of both the incisional and the usual mini-incisional methods. Methods Three 3- to 4-mm mini-incisions were made on each upper eyelid. The orbicularis muscle was isolated carefully from the skin and then cut off as much as possible in three directions: down (toward the palpebral margin), left, and right. Finally, the three incisions were sutured, and a vivid fold was created. This technique was applied for 110 patients. The follow-up period ranged from 3 to 12 months. The patients were welcomed for further treatment if any problems occurred at any time. An extra 3 years of follow-up evaluation was applied for 24 patients (46 cases) to assess the long-term maintenance of the fold. Results This study enrolled 110 patients (212 cases). A natural-looking skin fold appeared after the edema period. The scar was not obvious. Disappearance of the fold was not found in any case during 3–12 months (mean, 9 months) of follow-up evaluation. Obvious shifting of the fold was found in four cases during the additional 3 years of follow-up evaluation, but disappearance of the fold was not found in any case. Conclusion This modified technique was found to be successful in developing a natural-appearing, long-lasting suprapalpebral fold with an inconspicuous scar. It combines the best of both the open and usual mini-incisional techniques. Because a large amount of pretarsal soft tissue is removed, the double fold is less likely to fade away. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .