Double eyelid procedure by removal of transconjunctival orbital fat and buried sutures combined with sling technique to avoid wounding the eyelid.

In the typical transconjunctival buried suture procedure for double eyelids, the adhesion between the skin and the pretarsal tissue or conjunctiva through the tarsal plate and the sling with the skin, the levator, and Muller's muscle are obtained by suturing. These are assisted by the stab wound or a needle through the eyelid skin, and the skin wound takes several days to heal. Also these suturing knots are buried under the skin on the tarsal plate, so that these will tend to appear on the skin surface later on. Removing the excess orbital fat that migrates to the area of fixation and jeopardizes the effect of the suturing technique is performed with skin incision and usually leaves a linear scar. The author devised a method that makes a double eyelid with two linear, wide sutures that lie between the levator and Muller's muscle and the immediately adjacent subdermal tissue of the skin by using one thread. It also reduces the excess orbital fat through the conjunctiva without wounding the skin and makes face washing or application of make-up possible immediately after the operation. Only one ligation is left at the lateral subconjunctiva to avoid its appearance on the skin surface to effect easy correction in case necessary. This method has evolved from previous method of transcutaneously burying sutures for the double eyelid, which was made wide by a linear suture by using one thread. Insufficient results were observed in eight of 280 cases.