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Objective:To compare the postoperative effects of double eyelid surgery with different exophthalmos to find its influence on the surgery and necessary changes in preoperative design and during operation.Methods:A total of 50 female patients with single eyelid seeking beauty from June 2021 to March 2022 were selected from the Department of Plastic Surgery, Affiliated Hospital of Qingdao University. The ocular protrusion was measured by HETEL ophthalmostatometer before surgery. Both eyes at 12-15 mm were taken as normal group ( n=26), both eyes at 16-18 mm as mild protrusion group ( n=14) and both eyes at 19-22 mm as severe protrusion group ( n=10). All the patients were treated with double-eyelid surgery by orbital septum and unified postoperative nursing. Results:After six months of follow-up, there was no difference in eyelid width with closed eyes (all P>0.05). The width of double eyelid with open eyes in normal group was smaller than that in mild protrusion group ( F=23.23, all P<0.05), and the width of double eyelid with open eyes in mild protrusion group was smaller than that in severe protrusion group ( F=47.70, all P<0.05). There was no difference in the improvement rate of facial aesthetics among the three groups ( P>0.05). The " feeling of meet" and scar formation in the normal group were less than those in the mild protrusion group ( F=16.92, F=33.45, all P<0.05), and the " feeling of meet" and scar formation in the mild protrusion group were less than those in the severe protrusion group ( F=27.93, F=28.53, all P<0.05). The improvement rate of normal group was higher than that of mild and severe protrusion group (χ 2=7.25, 7.89, all P<0.05). There was no difference in the improvement rate between the mild and severe protrusion groups ( P>0.05). Conclusions:In clinical practice, it is necessary to make corresponding changes in the preoperative design and operation of double eyelid surgery for patients with high eyeball protrusion.
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OBJECTIVE@#To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia.@*METHODS@#To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications.@*RESULTS@#Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion.@*CONCLUSION@#When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.
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Humans , Blepharoptosis/surgery , Treatment Outcome , Retrospective Studies , Blepharoplasty/methods , Eyelids/surgery , Iatrogenic Disease , Oculomotor Muscles/surgeryABSTRACT
Objective:To explore the clinical effect of SVF-gel transplantation combined with double eyelid operation for upper eyelid depression.Methods:From January 2018 to October 2019, the Cosmetic Surgery Department of Henan Plastic Surgery Hospital treated 58 famale patients with sunken single eyelid and double eyelid, they aged 24-53, and the average age was (35±7) years old. A total of 58 patients with sunken upper eyelid were divided into two groups: SVF-gel group (study group) and traditional autologous fat (Coleman fat) group (control group), 29 cases in each group. Before the operation, patients in the study group were injected with SVF-gel, while those in the control group were injected with Coleman fat. After filling the fat, the traditional double eyelid line was designed in both groups.Results:Three months after operation, the patients in the study group and the patients in the control group had same survival rate of fat filling: the satisfactory rate of fat filling and the effect of double eyelid were 93.10% and 89.66% in the study group, respectively, while 82.76% and 82.76% in the control group.In the control group, there were 4, 1 and 3 cases of gross appearance, tubercle and unevenness respectively, while in the study group, there were no postoperative complications.Conclusions:SVF-gel is superior to traditional structural fat in the double eyelid surgery of upper eyelid sunken type. The patients are satisfied with the surgery and the clinical effect is good.
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Objective:To explore the clinical efficacy of the double eyelid plasty with incision in eyelids margin position and internal fixation.Methods:A retrospective analysis was carried out in 47 patients who underwent double eyelid surgery in the outpatient department of our hospital from September 2015 to June 2017. There were 5 males and 42 females, aged from 17 to 32 (25±4) years. The skin was incised above the eyelid margin of 1-2 mm after anesthesia, orbicularis oculi muscle under the eyelid line, loose organization, and orbital septum fat were stripped and removed. The dermis and the tarsus were sutured under the double eyelid line, and the skin was sutured without any tension.Results:After collecting and analyzing 47 cases from September 2015 to June 2017 in our hospital with this method, we found that all 47 patients achievedⅠincision healing, which showed slight swell, natural and smooth radian of double eyelid, and without complications such as infection, hematoma and ptosis. And this method showed no obvious scar hyperplasia around incision line and thus possessed high patient satisfaction.Conclusions:With the advantage of less trauma, quick recovery, unobvious scar, natural and beartiful double eyelids, this method can be used as a supplementary method for the reconstruction of the blepharoplasty, which is worth promoting.
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Objective:To explore the effect of the principle of tissue gradient difference in repairing the over wide eyelid fold after double eyelid operation by incision.Methods:From July 2019 to July 2020, we applied the principle of tissue gradient difference to 30 cases (a total of 60 eyes; age ranging 20-35 years with mean 30) of female patients with excessively wide eyelids after incision double eyelid surgery needing a repair. All cases were from the Plastic Surgery Department of Sichuan Provincial People＇s Hospital. The difference in tissue gradient was manifested as the difference in thickness, texture and tension of soft tissues such as the skin above and below the double eyelid line and the orbicularis oculi muscle.Results:Satisfactory evaluation results showed in a total of 30 patients with 60 eyes, 95.0% ( n=57) were satisfied, and 5.0% ( n=3) were dissatisfied. Two of the patients received the second repair due to the inconsistency of the double eyelid width after correction. One patient obtained satisfactory double eyelid morphology after the second repair, and the other patient obtained satisfactory double eyelid morphology after the third repair. Evaluation results of double eyelid morphology showed that it obeyed a normal distribution by analyzing the difference between preoperative and postoperative double eyelid morphology scores. The results of paired t test showed that the double eyelid morphology was significantly improved 6 months after operation compared with preoperative, and the difference was statistically significant ( t=15.86, P<0.01). Conclusions:The principle of tissue gradient difference guides the repair of double eyelid width that is simple and easy, the effect is good, and it is worth applying.
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@#AIM: To investigate the changes of ocular surface and tear film before and after double eyelid operation with incision method.<p>METHODS: Ocular surface disease index questionnaire survey, S I t, break-up time of tear film(BUT), corneal fluorescein staining, tear fern test(TFT)and conjunctive impression cytology were examined at 17 patients(34 eyes)to evaluate function of ocular surface and tear film before and after the double eyelid operation with incision method.<p>RESULTS: There was significant difference in ocular surface disease index questionnaire survey scores before and after surgery(<i>P</i><0.001). The score increased within 2wk postoperatively. There was significant difference in corneal fluorescein staining scores before and after surgery(<i>P</i>=0.008). The corneal epithelial staining spots increased within one day postoperatively. There was significant difference in S I t result before and after surgery(<i>P</i><0.001)and it increased within 2wk postoperatively. There was significant difference in conjunctive impression cytology before and after surgery(<i>P</i><0.001). Conjunctival goblet cells reduced within 1d postoperatively. There was no significant difference statistically in BUT of tear film and TFT before and after surgery(<i>P</i>>0.05).<p>CONCLUSION:In the early stage after surgery, patients showed obvious discomfort and irritation symptoms, and the corneal and conjunctival epithelium was slightly damaged. With the reconstruction of the ocular surface microenvironment and removal of sutures, all test results recovered to the preoperative level.
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Objective@#To explore the practicability and reproducibility of judgment method and assessment indexes for the end point of double eyelid surgery using 4+ 1 photography in supine position.@*Methods@#From 2017 October to 2018 October, 158 patients were included and randomly divided into 2 groups. Photos were taken by 4 + 1 photography in supine position of 79 patients, while other 79 patients in control group were evaluated by traditional observation. By 4+ 1 photography in supine position, the surgeon stood at the head side of the patient, taking photos with eyes movement: looking straight forward, looking up, looking downward and eye-closed. It was to observe the upper eyelid creases, upper and lower tissues of double eyelid creases, and upper and lower eyelid margo palpebrae. In addition, the surgeon looked from patient′s feet to observe the indexes such as upper margo palpebrae, to make a decision whether the surgery could finish. In control group, the surgeon observed the upper eyelid creases, upper and lower tissues of double eyelid creases and upper and lower eyelid margo palpebrae. The patient has to sit if necessary.@*Results@#All 158 patients were performed double eyelid surgery successfully. Average times of valuating end point was 1.20 by 4+ 1 Photography in supine position, and 1.53 in control group. The operation time of 4+ 1 photography group is (151.65±21.58) s, and control group were (241.53±33.53) s. The satisfaction level was increased to 89.87% in 4+ 1 photography group, compared to 78.48% in control group.@*Conclusions@#The 4+ 1 Photography method is simple and easy to practice. The observation indexes are accurate and comprehensive. It is useful in determining the end point of double eyelid plasty in supine position.
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Objective@#To investigate a new approach for double-eyelid blepharoplasty.@*Methods@#Double-eyelid blepharoplasty was performed by turning the orbital septum downward and fixing it to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia, which is imitating physiological mechanical conduction. During double-eyelid blepharoplasty, the orbital septum was cut horizontally. Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the outcomes of this double-eyelid surgical procedure in patients undergoing the procedure from December 2015 to February 2018.@*Results@#622 eyes of 311 patients were included in the final analysis. Sutures were removed 7 days after surgery. All double-eyelid lines were well-formed, and the eyelids closed well. Three-to twelve-month follow-up results revealed that the double-eyelid shape was natural, no patients experienced upper eyelid retraction or incomplete eye closure. Notched scars did not occur, and patient satisfaction was achieved in all cases. 281 patients were fully satisfied with the surgical results and 30 were basically satisfied with the surgical results.@*Conclusions@#Turning the orbital septum downward is a good approach for double-eyelid blepharoplasty.
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Objective@#To investigate a new approach for double-eyelid blepharoplasty.@*Methods@#Double-eyelid blepharoplasty was performed by turning the orbital septum downward and fixing it to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia, which is imitating physiological mechanical conduction. During double-eyelid blepharoplasty, the orbital septum was cut horizontally. Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the outcomes of this double-eyelid surgical procedure in patients undergoing the procedure from December 2015 to February 2018.@*Results@#622 eyes of 311 patients were included in the final analysis. Sutures were removed 7 days after surgery. All double-eyelid lines were well-formed, and the eyelids closed well. Three-to twelve-month follow-up results revealed that the double-eyelid shape was natural, no patients experienced upper eyelid retraction or incomplete eye closure. Notched scars did not occur, and patient satisfaction was achieved in all cases. 281 patients were fully satisfied with the surgical results and 30 were basically satisfied with the surgical results.@*Conclusions@#Turning the orbital septum downward is a good approach for double-eyelid blepharoplasty.
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Objective@#To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation.@*Methods@#A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision.@*Results@#All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results.@*Conclusions@#The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty.
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Objective@#To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation.@*Methods@#A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision.@*Results@#All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results.@*Conclusions@#The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty.
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Eyes play a dominating role in the facial aesthetics. In the past decades, East Asian consider the westernized stereoscopic and double eyelid eyes as beautiful, as a result, double-eyelid blepharoplasty become the most commonly performed aesthetic plastic surgery continuing to gain popularity in East Asian. The authors summarized the important progress and innovative conclusion on upper eyelid anatomy, preoperative evaluation, double-eyelid blepharoplasty for Asian males as well as objective outcome assessment of double eyelid surgery in recent 10 years, which we hope could pave the way for surgeons to better understand, investigate and modify double eyelid surgery along with better serve the patients.
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Objective To evaluate the clinical efficacy of topical fat redistribution in combination with shortening of upper eyelid levator muscle in patients with excessively wide palpebral fissure after double-eyelid operation.Methods Twenty patients with excessively wide palpebral fissure after undergoing double-eyelid operation were selected.The double-eyelid line was aesthetically re-designed,the skin or incisional scar between the original and new double-eyelid lines was excised,and the scarring adhesion among different tissues was fully isolated.The fat tissues within the orbital septum,deep orbit and anterior orbital septum combined with ROOF reconstruction were performed to block the adhesion tissues,shortening of levator muscle of the upper eyelid was equally conducted to enhance the cosmetic effect.Results Seventeen patients were satisfied with the cosmetic appearance following once double-eyelid operation.Two cases underwent twice operations due to different height between bilateral papebral fissures.One patient was unsatisfied with the cosmetic appearance.Conclusions Fat redistribution in combination with shortening of levator muscle of the upper eyelid can not only repair excessively wide palpebral fissure complicated with ptosis and upper eyelid depression,but also enhance the exposure rate of the cornea and increase the cosmetic appearance,which is consistent with contem porary aesthetic perception.
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Objective The multiple malformation of upper eyelid,including the excessive width of fold line,sunken and/or multiple folded upper eyelid are the common complications after blepharoplasty.The aim of this study was to investigate the clinical effect of orbital septum fat redistribution on correcting these deformities.Methods From September 2015 to September 2017,38 patients with multiple malformations of upper eyelid were treated.The incision of upper eyelid and the excessive skin was designed and resected.After completely relieving the scar adhesion zones,we set the lateral orbital septum fat free and transposed it to the inner side of orbital septum or superior border of tarsus with suturing fixation.Then we routinely completed the double eyelid operation.Results Thirty-eight patients with multiple malformations of upper eyelid were treated successfully.The patients were followed up for 6 months to one year,and the results were totally satisfactory.The operation was not performed again.Conclusions The orbital septum fat redistribution can successfully correct the multi ple malformation of upper eyelid.It should become a regular procedure in blepharoplasty.
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Objective To evaluate the clinical effects of small-incision orbicularis-levator fixation technique for monocular double-eyelid blepharoplasty.Methods Data were collected in 56 patients (5 males and 51 females) with monocular double eyelid from January 2013 to January 2014.All patients underwent small-incision orbicularis-levator fixation blepharoplasty.To ensure the symmetry between the two eyelids,extensive study and design might be done before the surgery,including the positon of incisions,the amount of tissue removed,the tightness of sutures fixation during surgery,and so on.Results All patients were successfully operated and were performed postoperative follow-up for 19.3±3.4 months.MRI was taken on their upper eyelids preoperatively and 6 months postoperatively.Before the surgery,the MRI orbicularis oculi muscle thickness were 4.08±0.74 U in the left side and 4.81±1.05 U in the right (t=2.66,P＜0.05);the areas of orbit fat were 84.26±9.75 U2 in the left and 93.85±12.15 U2 in the right (t =3.21,P＜0.05).As for 6 months postoperatively,the MRI orbicularis oculi muscle thickness were 4.07±0.69 U in the left side and 4.37±0.99 U in the right (t=1.46,P=0.15);the areas of orbit fat were 82.88±8.81 U2 in the left and 85.30±11.94 U2 in the right (t =1.21,P=0.23).Fifty-four patients were satisfied with surgery,the eyelid's crease turned narrow in 1 case and disappeared in 1 case.Those 2 cases were adjusted by secondary surgery using the same method.Conclusions Small-incision orbicularis-levator fixation blepharoplasty has a high success rate,with acceptable bilateral symmetry and slight scar.
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Objective@#To investigate the clinical effect of modified three minimally invasive blepharoplasty of double-fixation method.@*Methods@#From April 2015 to December 2016, 82 patients were included, all received minimally invasive blepharoplasty. Three 3 mm-long small incision (at medial, middle and lateral) were designed, then part of the orbicularis oculi muscle and pretarsal fat were removed. Pretarsal fascia was then sutured with orbicularis oculi muscle and skin with two-layer-suture to form double eyelid respectively.@*Results@#With up to 18 months follow-up, all patients had short period of detumescence within 7-12 days, high satisfaction rate with long lasting and natural double eyelid shape were achieved, no obvious scarring was noted.@*Conclusions@#Modified three minimally invasive blepharoplasty of double-fixation method has presented the merits of accurate presentation, natural shape, quicker recovery and less trauma, which makes it worthy of clinical presentation.
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Objective@#Doubled blepharoplasty, which has a various types, is one of the commonest plastic surgery procedures. Incision method has a long-standing result but linear scars can be seen when eyes are closed. So it is necessary to improve this surgerical procedure. The aim of this report is to propose a novel palpebral margin incision technique which avoids scars in the upper eyelid.@*Methods@#15 patients undertook blepharoplasty with palpebral margin incision technique. All the patients in this study were healthy with no other serious diseases. The double-eyelid crease was formed after the operation.The aesthetic results were evaluated based on their satisfaction.@*Results@#All of the patients were satisfied with aesthetic results, and no significant complications occurred. And No obvious regression of the double fold took place.@*Conclusions@#This new method provides an effective way to achieve eyelid reconstruction without obvious scar in the upper eyelid which is of very important clinical significance and makes cosmetic surgery process take a step forward.
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Objective Patients with mild or moderate blepharoptosis performed with double eyelid operation only will lead to high complication rates,such as eyelid crease disappearance,unphysiological appearance.In such cases,utilizing levator aponeurosis can create more physiological double eyelid and correct blepharoptosis in the meantime.Methods Levator aponeurosis is utilized as "connecting tissue" to transmit dynamic "motor power" of levator muscle to upper eyelid.Levator advancement was performed at the same time to correct blepharoptosis.Results A total of 74 patients (125 eyes) were operated on in this study.117 eyes (93.6％) showed adequate blepharoptosis correction results,8 eyes (6.4％) showed inadequate correction results.Sixty six cases (89.2％) showed good symmetry results,5 cases (6.8％) showed fair results,3 cases (4％) showed bad symmetry results.One hundred and fourteen eyes (91.2％) showed stable crease,11 eyes (8.8％) showed fair results,no disappearance result was observed in this study.No scar hypertrophy or blepharoptosis on the upper eyelid was encountered.Conclusions This new technique uses pretarsal levator aponeurosis to connect levator muscle and upper eyelid skin,it transmits the dynamic power of the levator muscle to the lid skin directly,which created palperbral crease more anatomically and physiologically.In the meantime,levator advancement can be performed to correct blepharoptosis.Furthermore,"skin adhesion" is formed between levator aponeurosis and dermis in a plane planar manner,allowing for more stable palperbralpalpebral crease and more preserved,and preserving orbicularis oculi in situ,leaving no gap in skin and thus reducing eyelid scar formation.
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Objective To explore the clinical effect of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design.Methods We retrospectively reviewed the application and effect of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design between January 2015 and June 2016.There were 36 cases of severe epicanthus in this group,including 20 cases of thin eyelid,13 cases of mild swollen eye and 3 cases of moderate swollen eye.Results Follow-up by telephone or WeChat,satisfactory for the 26 cases,the basic satisfaction of 9 cases,1 case of dissatisfaction,moderate swollen eye and severe epicanthus.Conclusions In the case of severe epicanthus with a single eyelid and a mild swollen eyelid without thinning of the eyelid,the use of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmet ric Z-plasty with a two curve design is one of good choices of methods for the correction of epicanthus.
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Objective@#In order to explore the method to correct double eyelids line scars and to present its therapeutic schedule, curative effects, pathogenesis and precautions.@*Methods@#Surgical incisions were designed based on preoperative communication, original scars location and skin elasticity. Scar contracture and synechia was relaxed thoroughly. The pretarsal orbicularis oculi muscle of the lower incision margin was fixed to the pretarsal fascia on the new designer location of double eyelid line to firm shape. Complete pretarsal layer tissue were joined layer by layer with interrupted suture. Finally, the skin was sutured closely by locking stitch technique.@*Results@#From November 2014 to September 2016, 583 eyes with unsatisfied double eyelid scars were treated. Patients were followed up for 3 months to 1 year with sustained aesthetic. There is no visible man-made crease in 549 eyes under eye-closed state. Less than 1 mm wide scars with smooth surface were showed on 19 eyelids. Mild depressed or more than 1 mm wide scars still remained in 15 eyes with improved appearance.@*Conclusions@#Unsatisfied appearance caused by double eyelids line scars must be paid highly attention in clinical setting. The appearance can be effectively improved by proper surgical procedures and appropriate suture and fixation.