A Modified Palpebral Marginal Incision Technique Using Levator Aponeurotic Flap in Blepharoplasty.

[BACKGROUND] Double-eyelid surgery is one of the most common cosmetic surgeries performed in Asians. The palpebral marginal incision technique (PMIT) conceals the incision scar and creates natural-looking double-eyelids. However, the amount of eyelid skin removed by conventional PMIT is limited, which potentially results in an unnatural crease or inferior skin below the palpebral crease that appears swollen.

[OBJECTIVES] The aim of this study was to introduce a modified PMIT which creates scarless, dynamic, and natural double-eyelids with a limited amount of eyelid skin excision.

[METHODS] From January 2018 to December 2020, 382 patients (764 eyelids) underwent double-eyelid surgeries with the described technique. The key point was to form a pretarsal levator aponeurotic flap, acting as a soft motor transmission to bridge tarsus, orbicularis oculi muscle, and skin dermis. Satisfaction with the overall aesthetic outcomes-as assessed by surgeon and patients-and complications were postoperatively evaluated at various follow-ups.

[RESULTS] The mean follow-up period was 7.6 months (range, 6-12 months). Of the patients, 332 (86.9%) reported self-assessment of outcomes as satisfactory and 37 (9.7%) as fair. Secondary operations were required for 13 (3.4%) patients for double-eyelid asymmetry or crease curve malformations. Early-stage hematoma (12 cases) and lagophthalmos (19 cases) were observed and completely recovered within 1 month.

[CONCLUSIONS] Our modified PMIT technique was capable of achieving scarless and natural-looking double-eyelids with a biomimetic anatomic structure.