Surgical Decision Making in Incisional Blepharoplasty in Asians.

[BACKGROUND] Owing to the prevalence of congenital single eyelids among Asians, methods are needed to create a double-eyelid fold. Incisional blepharoplasty is considered an ideal method for this purpose. The classical approach tends to create a stable but less dynamic fold. Subsequent refinements aim to achieve a balance between stability and dynamism. However, there are many procedural variations due to anatomical differences, which may account for the varying surgical outcomes. This systematic review explored the current techniques used in Asian blepharoplasty and focuses on the efforts to balance stability and dynamism in double-eyelid-fold creation.

[METHODS AND MATERIALS] A literature search was conducted across PubMed and EMBASE databases.

[RESULTS] We analyzed the effect of different surgical procedures on fold formation in Asians on the basis of anatomical features. We identified the essential steps of blepharoplasty: debulking the upper eyelid tissue (removing skin, orbicularis, retro-orbicularis oculi fat, and orbital fat), preparing the dynamic system by adjusting the aponeurosis and surrounding structures for proper corneal coverage, and establishing a connection between the anterior and posterior lamellae for a double-eyelid fold. However, debates are still ongoing on the best approach to achieve an ideal balance between stability and dynamism.

[CONCLUSION] Research interest in the identification of methodologies for optimizing the effects of incisional blepharoplasty has increased substantially. Further studies should aim to develop surgical strategies tailored to patients' anatomical characteristics.

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