Experiences in Reduction of Height of Double Eyelid Fold

Choi, Hong Hyeuk; Hong, Sung Hee; Hong, Seung Eup

Abstract

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.