Correction of High Fold without Skin Excision

ABSTRACT

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.