Influence of exophthalmos on design of double eyelid incision / 中华医学美学美容杂志

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.

Clinical application of orbital ligament disruption combined with orbital septum fat release in improving facial aging / 中华医学美学美容杂志

Objective:To explore the clinical effect of the middle facial rejuvenation by cutting off the tear trough ligament and the orbicularis retaining ligament complex, opening the soft tissue spaces, combined with the lower eyelid muscle flap lateral canthus periosteum suspension and the orbital septum fat release.Methods:The clinical data of 39 patients with pouch and lacrimal groove, eyelid buccal groove depression in the Department of Cosmetic Surgery, Chongqing Chengshang Medical Beauty Clinic from June 2018 to June 2019 were retrospectively analyzed, including 2 males and 37 females, aged 30-58 (39±7) years. Through the incision of lower eyelid margin, the tear trough ligament and the orbicularis retaining ligament were completely severed. Up on the periosteum blunt, the preseptal, premaxillary and the prezygomatic spaces were dissected, and thus the fat of orbital diaphragmatic was fully expanded, by moving down and fixing on the inside, midside and outside periosteum of the inferior edge of the orbital bone. The lower eyelid muscle flap was suspended on the lateral canthus periosteum at the same time.Results:The patients were followed up for 12 months, the pouch, lacrimal groove and eyelid buccal groove depression were solved, the ptosis tissue of middle face was restored well and the effect was lasting. 3 patients felt the external eye angle traction after operation, and the symptoms disappeared 3-4 weeks later. 1 patient had mild eyelid ball separation due to hematoma organization after operation, and symptoms disappeared 3 months after anti scar treatment.Conclusions:For patients with pouch, lacrimal groove depression, eyelid buccal groove depression and midface tissue ptosis, the operation can safely and effectively solve the above problems and achieve the purpose of rejuvenation of the middle face, which is worthy of clinical application.

Clinical effects of lateral orbital septum fat release medial transfer on upper face depression / 中华医学美学美容杂志

Objective:To investigate the method and effect of correcting upper eyelid depression with released orbital diaphragmatic fat.Methods:From January 2017 to June 2020, there were 26 female patients with upper eyelid depression in this department of Hebei Chengde Stomatological Hospital. The patients aged 22-54 years, with average 43 years. An external mass orbital diaphragm fat release reverse folding repositioning with fat placement in the upper lid depression was performed in 26 patients. An incision about 4 mm long was made in the middle and lateral of the orbital diaphragm to ensure the integrity of the orbital diaphragm as far as possible. The photos of beauty seekers before and 6 months after operation were compared to observe the correction effect of upper eyelid depression and the shape of upper eyelid.Results:All 26 patients had one-stage healing of the surgical incision without infection, with inconspicuous incisional scarring. At 6 months postoperatively, 18 patients had satisfactory results; 1 patient had improved results due to insufficient fat; and 1 patient had poor results due to too little fat and poor filler placement, which was later improved by autologous fat grafting.Conclusions:External mass orbital fat release reverse folding repositioning for correction of upper eyelid depressions is a surgical procedure with obvious results, little trauma, and following the principle of anatomical recovery, which is worthy of clinical application.

Clinilal effects of a modified double-eyelid blepharoplasty: tarsus-orbicularis oculi muscle-septum fixation / 中华医学美学美容杂志

Objective:To observe the effect of a new modified double-eyelid operation.Methods:From February 2018 to January 2021, modified tarsal plate-orbicularis oculi muscle-orbital septum (TMS) suture was performed in 193 double-eyelid operation in the plastic surgery department of Peking Union Medical College Hospital, including 14 males and 179 females. The patients aged from 18 to 45 years with an average of (22.3±4.2) years. The patients were followed up for 6-24 months to observe the morphology of the double eyelid fold and complications.Results:The 193 patients were included. The double eyelid lines of 173 patients were smooth, natural, durable and the scar was shallow; both doctors and patients were satisfied. There were no obvious complications after the operation. The double eyelid line became shallow or disappeared in 11 patients, and the double eyelid asymmetry occurred in 7 patients after the operation. However, the folds were symmetrical and natural after secondary operation, and both doctors and patients were satisfied.Conclusions:TMS suture not only establishes a firm adhesion, but also effectively transmits the force of the levator aponeurosis with significant advantages. After the operation, the double eyelid line is smooth, natural and stable. Both doctors and patients are highly satisfied. It is an improved double eyelid procedure worthy of clinical promotion.

Application of orbital fat flap combined with free fat in correction of moderately or severe sunken upper eyelid and multiple folds / 中华医学美学美容杂志

Objective:To evaluate the use of orbital fat flap combined with free fat for the treatment of the moderately or severe sunken upper eyelid and multiple folded upper eyelids.Methods:From March 2017 to March 2019, orbital fat release and replacement and free abdominal fat transfer graft were adopted to treat 20 patients (1 male, 19 females, aged 20-47 years, with an average age of 29 years) with sunken upper eyelids of multiple folds in Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Xiamen University Siming Branch.Results:Twenty cases were treated successfully. The swelling gradually disappeared at 3 month postoperatively. Patients were followed up for 3 months to 12 months with sustained aesthetic results; no complications occurred. Free fat graft survived well, and no obvious scar, sags, or crests were present in the upper eyelid.Conclusions:It is a reasonable method for correcting sunken upper eyelid and multiple folds with orbital fat flap and free fat. Survival rate of the free fat is quite high in sunken upper eyelid. It is worth spreading.

Comparison of clinical efficacy between autologous fat injection and orbital septum fat reset for infraorbital margin depression in young people / 中华医学美学美容杂志

Objective:To compare the clinical efficacy of autologous fat injection and conjunctival pedicled orbital septal fat grafting for infraorbital margin depression in young people.Methods:Fourty young patients with lower eyelid pouch and infraorbital margin depression with age of 20 to 40 years and average age of 30.6 yaers in the First Affiliated Hospital of Nanchang University from September 2017 to September 2019 were enrolled. According to the surgical method, all patients were divided into 2 groups with 20 cases each. Group 1 underwent transconjunctival orbital septum fat reset. Group 2 underwent various autologous fat injection after proper amount of orbital septal fat being removed, including structural fat, fine-particle fat and nano-fat, performed in different parts and layers. The tear trough rating scale (TTRS) scores and patients＇ satisfaction at 1 year after operation between 2 groups were compared.Results:Compared with the preoperative TTRS scores, the differences in scores at 6 months and 1 year after surgery were statistically significant ( P<0.01). The scores between two groups were compared at 6 months and 1 year respectively after the operation, and the difference were both statistically significant ( P<0.01). 6 months after the operation, the TTRS scores including four items were carefully compared between the two groups. It showed that the reduction of tear groove depth ( P<0.05), pigmentation ( P<0.01) and wrinkle ( P<0.01) in group 2 were more obvious than those in group 1. The percentage of satisfaction in group 2 (95%) was higher than that in the group 1 (70%), and the difference was statistically significant ( P<0.01). Conclusions:For infraorbital margin depression of young people, after proper amount of orbital septal fat being removed, various free fats graft injection into different parts and layers could obtain better treatment results, reducing not only the depth of the tear groove, but also periorbital pigmentation and fine wrinkles.

Double-eyelid blepharoplasty by turning the orbital septum downward / 中华整形外科杂志

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.

Double-eyelid blepharoplasty by turning the orbital septum downward / 中华整形外科杂志

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.

Combination of orbicularis oculi muscular myolemma release and orbital septum reset to create double eyelid / 中华整形外科杂志

Objective@#To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle.@*Methods@#Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time.@*Results@#From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation).@*Conclusions@#The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

Combination of orbicularis oculi muscular myolemma release and orbital septum reset to create double eyelid / 中华整形外科杂志

Objective@#To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle.@*Methods@#Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time.@*Results@#From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation).@*Conclusions@#The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

Aesthetic Surgical Treatment of the Peri-orbital area in Hansen's Patients / 나학회지

BACKGROUND: Upper eyelid blepharoplasty has become one of the commonly practiced aesthetic operation. This upper eyelid blepharoplasty primarily conducted in aged person, while also addressing aesthetic concerns, include methods to rejuvenate the peri-orbital area and provide unobstructed eyesight. OBJECTIVE: Methods to affect rejuvenation of the peri-orbital area are variable and depend heavily on the patients. This makes evaluation of the patient a critically important component of the treatment process. Upper eyelid blepharoplasty requires treatment of the anterior and posterior lamella structures. Anterior lamella undergone a resection of the skin and orbicularis muscle to reduce the sagging appearance on the anterior surface of the upper eyelid. The retractor structures of the posterior lamella, especially the levator aponeurosis and the Müller's muscle, are advanced, tucked and plicated to the tarsus to add tension as needed to correct the blepharoptosis. This procedure, while also addressing aesthetic concerns, primarily adds tension to reduce or eliminate eyesight obstruction. Methods & Conclusion: These operation methods include : The plication procedures of posterior membranous septum and turn-over orbital septum to 2mm below the tarsus and traditional levartor complex tucking including levator aponeurosis and Müller muscle added. In addition to blepharoplasty and blepharoptosis in aged persons the brow-ptosis may also experience. This drooping of the eyebrow also contribute to eyesight obstruction and should be corrected. In general, treatment consists of a subbrow resection when the brow-lash distance is 25mm or more. When the brow-lash distance is less that 25mm, a supra-brow excision is required to prevent an angry or harsh appearance. However, when using the supra-brow method the possibility of an unwanted visible scar is more likely, a short incision direct brow-lift could be another alternative. But short incision brow-lift procedure can only use under the normal forehead muscle function.

Clinical application of orbital fat autograft for tear trough deformity through tranconjunctival approach / 中华整形外科杂志

Objective@#To discuss the orbital fat autograft for lower baggy eyelid with tear trough deformity and its therapeutic effect through tranconjunctival approach.@*Methods@#The patients with lower eyelid bag and tear trough deformity were included into the study. The included 32 patients met the following criterias: ①less than 40 years old; ②lower eyelid skin was not relaxed; ③less than 1 s in Snap test; ④Hirmand type Ⅰ and Ⅱ. They were treated with tranconjunctival lower blepharoplasty combined with the tears ligament relaxation. The orbital fat was repositioned on the depression site above orbital periosteum to correct tear trough deformity. The effect was evaluated through Tear Trough Rating Scale (TTRS) and satisfaction degree.@*Results@#Three cases with Hirmand type Ⅱ didn’t have good effect. Among them, the baggy eyelid was corrected in 2 cases, while the tear trough deformity need additional hyaluronic acid injection. One patient underwent secondary lower blepharoplasty through cutaneous incision. Good effect was achieved in the other 29 cases with no depression deformity and eyelid withdrawal. The TTRS scores 6 months after operation was significantly improved(P<0.01). Satisfaction degree was 100%(14/14) and 83.3%(15/18) in type Ⅰ and Ⅱ patients.@*Conclusions@#The technique can simultaneously improve lower eyelid bag and the tear trough deformity. It can be applied in periorbital rejuvenation for middle-aged and young patients.

Clinical effects of modified construction of double eyelid / 中华医学美学美容杂志

Objective To explore the application of the part of the orbicularis oculi muscle above the cutting margin and the orbital septum fixed to pretarsal fascia in construction of double eyelid.Methods We selected 30 aesthetic seekers asking for construction of double eyelid.We fixed the part of the orbicularis oculi muscle above the cutting margin and the orbital septum to pretarsal fascia in double eyelid operation and then evaluated the surgical effects,complications and satisfaction.Results 30 cases were successfully operated in this group,and the operation time was 1.0 ±0.2 hour.Five days after operation,we removed upper eyelid skin suture and observed that wound healing was good and double eyelid line was natural and smooth.Postoperative follow-up of 1 to 6 months,the effects were satisfactory.Conclusions This method is simple and effective in producing a satisfactory eye shape.

Autogenous orbital septum fat redistrbution in correction of sunken upper eyelid / 中华医学美学美容杂志

Objective To study the effect and methods of orbital septum fat redistribution or autogenous orbital septum granular fat transplantation methods on upper eyelid depression.Methods Blepharoplasty incision was used to cut open musculus orbicularis oculi and septum orbitale horizontally,exposuring orbital fat,the conjunction was relieved between orbit fat envelope and septum orbitale,displaced orbital fat was extended and replaced to the depression region of upper eyelid,and the wound was routinely sutured.For orbital septum fat volume depletion,appropriate amount of granular fat was injected into depression region and put fat backward upto supraorbital margin.Then,resetting orbital septum and closing incision were conducted with suture technique of blepharoplasty.Results Of 48 cases (96 eyes),32 cases was followed-up for 6 to 42 months with mean of 11 months.All cases got ideal outcomes,with smooth and symmetry lid folds,depression of upper eyelid were fixed and no complication occurred.Conclusions Orbital septum fat redistribution or autogenous orbital septum granular fat transplantation can anatomically reduce the fat distribution of upper eyelid.This method is easy and effective to improve the appearance of eyelid.

Asymmetry of soft tissue thickness of upper eyelids: a clinical study of Shanghai undergraduates undergoing double eyelid surgery / 中华医学美学美容杂志

Objective To study the asymmetry of the soft tissue thickness of upper eyelids in Shanghai female undergraduates undergoing double eyelid surgery.Methods Data were collected in 565 female students from Shanghai universities.Before surgery,oblique sagittal view images of the upper eyelids by 3.0T MRI were obtained and the following parameters were measured: soft tissue thickness at upper tarsal plate margin and upper central tarsal plate,sub-eyebrow and intra-orbital septum fat pad areas,and whole upper eyelid soft tissue areas.The resected orbicularis and intra-orbital septum fat were weighed by a highly accurated electronic balance.The eyelid asymmetry index (EAI) was calculated.Results The MRI (U/U2) central tarsal plate soft tissue thickness were:4.46±0.90 in the right side and 3.78±1.01 in the left; the intra orbital septum fat areas were:172.33±49.29 in the right and 136.34±37.42 in the left; the whole tissue areas were: 697.13±146.99 in the right and 500.66±158.87 in the left (P＜0.01 for all).The weight of the resected orbicularis oculi muscle and intra orbital septum fat pad were (0.18±0.05) g and (0.17±0.06) g for the right side,and (0.15±0.04) g and (0.06±0.05) g for the left side (P＜0.01 for all),respec tively.The orbicularis EAI was 0.17±0.06,and the intra orbital septum fat EAI was 0.41 ±0.08.Conclusions The asymmetric phenomenon of the upper eyelids' soft tissue thickness is commonly found in the Shanghai female undergraduates,and the main manifestation is that orbicularis and intra orbital septum fat in right side are thicker than that in the left.

Baggy eyelids anaplasty through posterior orbital septum fat displacement / 中华医学美学美容杂志

Objective To explore the baggy eyelids anaplasty through posterior orbital septum fat displacement. Methods Orbital septum and posterior orbital septum fat were exposed through palpebral margin incision, internal orbital septum fat was released and sutured with arcuate expansion of capsulopalpebral fascia at the middle lower eyelid, which was taken as the function of tighting the flaccid lower eyelid at transverse direction. On such a basis, the muscle and skin were repaired and so did orbital septum and baggy eyelids.Results Ofthe 38 patients with this operation, baggy eyelids anaplasty was performed with satisfactory results.Conclusion The method of baggy eyelids plasty through posterior orbital septum fat displacement could reduce hemorrhage, prevent enophthalmos and decrease baggy eye palindromia, with better long-term effects.

Crimpling and repairing of orbital septum in plasty of lower eyelid bags / 中华医学美学美容杂志

Objective To discuss the implications of orbital septum repairing and crimpling in the plastic surgery of lower eyelid bags. Methods The ultimate results were analyzed in the patients (aged less than 40) who received three different operations from six months to five years and the effect of operation and recrudescence of lower eyelid sag were observed. The procedures included simple fat removal, fat removal plus orbicularis oculi hanging, and orbicularis oculi hanging plus orbital septum repairing and crimplling. Results Since 2002, 157 cases were treated, and the ultimate effects of patients were analyzed. 86 cases treated with orbicularis oculi hanging plus orbital septum repairing and crimplling reached the best results without recurrence. 71 cases treated with simple fat removal or fat removal plus orbicularis oculi hanging experienced recurrence in different degree within a short period. Conclusion The weakness and laxation of the former wall causes the formation of lower eyelid bag, the appearance and recrudescence mainly locate below the former wall. Orbital septum repairing and crimpling most effectively strengthen the underside of the former wall. Orbicularis oculi hanging strengthens the top of the former wall and prevents any complications. The effects of the last procedure are better than that of the other two in the near future or in the long term.

Septal Approach on Upper Blepharoplasty in Elderly Person

PURPOSE: Blepharoplasty plays a vital role in facial rejuvenation. Aging eyelids are the result of relaxation of lid structures as the skin, the orbicularis muscle, and mainly the septum, with subsequent protrusion or pseudoherniation of intraorbital fat contents. Traditional blepharoplasty has often involved the excision of excessive lax skin and muscle and removal of fat, leaving the eyelid unnatural and even causing the brow ptosis. The authors propose the septal approach through which the amount of skin excision can be decreased and solid fixation can be achieved in the upper blepharoplasty. METHODS: From November 2007 to February 2010, total of 15 patients underwent upper blepharoplasty with septal approach. In 9 patients, orbital septum anchored into the orbital periosteum only. But in 6 patients, the attenuated septum was strengthened through shortening and fixing into orbital periosteum with non-absorbable suture. RESULTS: Pleasing results were obtained from most of the patients. But one patient who had septum anchoring procedure complained of slight undercorrection, therefore secondary operation with septum shortening procedure was followed. CONCLUSION: We found that the method using orbital septum fixation into orbital periosteum has several advantages: less amount of skin excision, less recurrence rate, and more natural appearance. And the results were reliable and satisfactory.

Anatomic Characteristics of Upper Eyelid Structures Important in Ptosis Surgery

Exact understanding of the upper eyelids is essential to the success of an anterior surgical approach for the correction of blepharoptosis. Therfore, we undertook this study using cadaver dissection, histologic sections, surgical observations, and review of MRI findings to gain a better understanding of the anatomical characteristics of the orbital septum and associated connective tissue structures which are important in ptosis surgery. The basic distinction of the upper eyelid structures between Oriental and Occidental is the relationship of the orbital septum and the levator aponeurosis. The orbital septum appears as a thick multilayered connective tissue originating just inside the superior orbital rim, but its inferior extension become thin progressively and blends with levator aponeurosis on an average of 1.6mm below the superior tarsal horder. Therefore the preaponeurotic fat is allowed to proceed to the anterior tarsal surface, resulting in a characteristic appearance of oriental eyelids. The levator aponeurosis maintains its thick and obvious structure continuously to the anterior tarsal surface near the lower margin of the upper lid. We resected levator aponeurosis with Muller's muscle which plays a important role in lid elevation for the correction of congenital htepharoptosis, and obtained excellent results.