Septoaponeurotic Junctional Thickening Fixation Technique in 13,500 Asian Upper Blepharoplasties: Evidence-Based Outcomes Driving Technical Refinement.

[BACKGROUND] To evaluate the anatomical rationale and clinical efficacy of septoaponeurotic junctional thickening (SAJT) fixation technique in Asian upper blepharoplasty.

[METHODS] Retrospective analysis of 13,500 consecutive cases (12,150 primary blepharoplasties; 1,350 revisions) performed between 2016 and 2025 utilizing the SAJT fixation technique. Critical technical refinements included: (1) precise delineation and surgical isolation of the SAJT zone as a distinct fibrous flap and (2) precise fixation of this fibrous flap to the dermal layer of the lower skin flap to achieve physiologically dynamic fold formation.

[RESULTS] Postoperative evaluation at 6 months revealed: 95.6% high satisfaction and 2.3% basic satisfaction. All achieve natural-appearing double eyelids without visible scarring: unilateral or bilateral fold loss or bilateral asymmetry: 210 cases (n=13,500, 1.6%). Dissatisfaction with fold height ( inadequate height and excessive height) was reported in 62 cases (0.46%). All cases requiring revision for postoperative complications achieved 100% patient satisfaction following surgical re-exploration and readjustment of the original SAJT fixation architecture.

[CONCLUSIONS] As the largest reported series, this study establishes SAJT fixation technique as the top choice for Asian upper blepharoplasty, combining anatomical fidelity with surgical practicality.

[LEVEL OF EVIDENCE IV] 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 .