A Modified Procedure for Blepharoplasty: Physiological Structure Reconstruction of Upper Eyelids.

[BACKGROUND] Double eyelid operation has become the most popular cosmetic procedure in China, while how to make sure the acquired double eyelids the same as congenital ones is still a problem.

[OBJECTIVE] This study aimed to explore a design and operation procedure to obtain natural and dynamic double eyelids, which are accordant with the congenital double eyelids both in appearance and movement.

[METHODS] The authors conducted a retrospective review of 352 patients who underwent our operation from October 2012 to October 2018. The procedures were performed by one senior surgeon. First, design the incision line 7 to 8 mm distance parallel to the ciliary margin. Then, cut down the skin and orbicularis muscle, and dissect the orbicularis myocutaneous flap from the anterior surface of the tarsal plate. Next, expose the orbital septum transversely in the lowest site from lateral to medial direction, and dispose of the fat tissue herniated spontaneously. Subsequently, suture the upper margin of pretarsal orbicularis myocutaneous flap to the levator aponeurosis. Finally, the skin edge of incision was closed interruptedly. The patients were followed up from 6 to 30 months after surgery by 2 surgeons to evaluate the long-term results.

[RESULTS] A total of 352 patients with 704 eyes were operated on and followed up in our study. There were 29 patients (8.2%) that showed slight asymmetry, and 7 eyes (2.0%) showed shallow creases. Besides that, all the creases were symmetry, parallel and natural. Just as congenital double eyelids, when opening eyes there was no sausagelike appearance, and when closing eyes there were no depressed scars.

[CONCLUSIONS] By reconstructing the physiological structure of upper eyelids, our double eyelid operation creates dynamic double eyelids, which are accordant with the congenital ones both in appearance and movement.