Correction of High Fold without Skin Excision

PURPOSE: Double-eyelid operation is one of the most common cosmetic operations among Korean patients. In such operations, however, the complexity of and individual differences in the patients' anatomical structures may cause various complications, such as asymmetry, retraction of the eyelid, and the occurrence of a high fold. A high fold occurs frequently, and its correction is not very simple. Many methods have been developed to correct it, and among these, the operation involving the excision of the skin between the previous double-eyelid line and the new double-eyelid line is usually selected by plastic surgeons. In many cases, however, patients have insufficient eyelid skins for this operation. In this study, the authors introduce an operation procedure for high-fold correction that does not involve skin excision METHODS: From June 2005 to June 2009, 246 cases were treated with this procedure. After the incision of the new double-eyelid line, dissection was done between the previous scar tissue and the levator aponeurosis. Then the orbital septum, orbital fat or the retro-orbicularis oculi fat was slid down and sutured with a tarsal plate. Such sutures were repeated at four to five points, including the lateral and medial limbus, to prevent the reattachment of the previous scar and to create a new double-eyelid line at the end of the orbital septum. RESULTS: Most of the high-fold patients were satisfied with the procedure described above. Their previous scar was hidden under the new double-eyelid line after the operation. In the six cases, the scar was visible in the patients who had a very high and deep inner line. As such, scar revision was undertaken three months after the operation. It is known that scar revision is also required after an operation involving skin excision in the case of a very high inner-eyelid line. CONCLUSION: This method is an appropriate procedure for high-fold correction for patients who have insufficient upper-eyelid skin.

Experiences in Reduction of Height of Double Eyelid Fold

Most Koreans who do not have supratarsal fold are anatomically quite different from Caucasians, and double eyelid operation is one of the most common operations in Korea. However, it might cause various complications, and high fold might occur as a complication. The purpose of this study is to introduce an appropriate operation procedures to correct the high fold. From March 1999 to April 2008, 45 patients experienced secondary blepharoplasty due to high fold after double eyelid operation. We divided patients into four groups to correct the high fold. We operated the first group with lower flap dissection method because of mild high fold and bulky lower flap eyelid. We operated the second group them with upper orbital fat slide down anchoring method due to sufficient orbital fat. We operated the third group with the free fat graft method due to insufficient orbital fat. We operated the fourth group with ptosis correction method. The lower flap dissection method was applied to most of the forth cases because of thick lower flap. The upper orbital fat slide down anchoring method is to drag orbital septum-fat down to prevent readhesion and showed the best result without any complication. The case of insufficient fat could be corrected through the free fat graft to prevent readhesion. The case of ptosis which was corrected by the levator advancement-Muller Tucking method showed good result. The operation to correct the high fold could be very difficult and in order to get good result, one needs to exactly know anatomical structure of upper eyelid, and accurate understanding of how much orbital fat should be left by pushing eyelid skin and eyeball down. It is suggested that the best method to use is the upper orbital fat slide down anchoring method. It would be better to use the free fat graft for patients who suffer from insufficient fat. In cases of ptosis, the use of the levator advancement- Muller tucking method is recommended.