Refinement of double eyelidplasty in Asian Patients: Attachment of the Septoapoponeurotic union to the Pretarsal Dermis

Abstract

Background: Standard approaches for creating a double eyelid in Asian patients may cause hematoma, asymmetry, early release of the fold, or an unsatisfactory appearance.

Objective: We report an approach to creating a double eyelid based on integration of the septoaponeurotic union into the dermis of the pretarsal skin.

Methods: A preoperative design was drawn with the patient in the supine and sitting positions, with the fold level always located 8 to 10 mm from the lid margin. An incision was made and deepened by removal of a narrow strip of the orbicularis muscle until the anterior orbital septum was identified. The entire length of the anterior orbital septum was opened, and a dissection was performed along the avascular plane between the orbital fat and the posterior orbital septum. The septoaponeurotic union was sutured to the lower edge of the incised pretarsal dermis. The levels of the double-fold line were checked with the patient in the supine and sitting positions.

Results: Results in a series of 610 patients treated between March 1996 and March 1999 were satisfactory. Complications included a 2% rate of diminution of the double fold occurring in patients treated early in the series, probably caused by loose sutures between the septoaponeurotic union and the lower edge of the incised pretarsal skin. In 10 patients, the fold line was asymmetric or too high. All patients with complications were treated successfully by reoperation with use of the same technique.

Conclusions: Creation of a double eyelid through attachment of the septoaponeurotic union to the pretarsal dermis can provide a secure double eyelid with a more aesthetic appearance.