Facial Plast Surg
DOI: 10.1055/a-2611-1471
Original Research

Blepharoplasty Revision Technique for Disappearing Double Eyelid Line: A Biomimetic Approach for Establishing Skin and Pretarsal Fascia Connection

Mingyu Zhao
1   The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Tailing Wang
1   The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Chong Zou
1   The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
› Author Affiliations

Abstract

Introduction

Double eyelid surgery has associated complications including fold disappearance over time.

Objectives and Hypothesis

To assess a novel surgical method for double eyelid revision.

Study Design

Retrospective study.

Methods

We analyzed data from 60 patients with disappearing double eyelid folds. The procedure involved suturing the pretarsal fascia, orbicularis oculi muscle, and dermis at the lower incision edge. Aesthetic outcomes and patient satisfaction were assessed during postoperative follow-up.

Results

All patients had satisfactory results with no double eyelid crease disappearance during the follow-up period. The eyelid morphology was satisfactory in 59 cases and moderately satisfactory in one case. Patient satisfaction was 98.3%. Crease disappearance was not observed during the follow-up.

Conclusion

This study discusses a novel surgical method for stable double eyelid morphology with more secure internal fixation and low fold disappearance risk. Moreover, dynamic force transmission leads to more stability with less noticeable incision scars.



Publication History

Article published online:
30 May 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Young SM, Kim YD. Complications of Asian double eyelid surgery: prevention and management. Facial Plast Surg 2020; 36 (05) 592-601
  • 2 Zhao Y, Shi J, Ren B, Jin S, Chen W. Recovery of subcutaneous orbital fascia under preserved skin below the original crease in the repair of excessively high double-eyelid folds. J Plast Reconstr Aesthet Surg 2024; 92: 104-110
  • 3 Shi H, Liu M, Huang W, Wang Z. Revisional Asian blepharoplasty of the high eyelid fold: tarsus-orbicularis fixation combined with orbital fat repositioning technique. J Craniofac Surg 2023; 34 (02) 738-742
  • 4 Zhu Z, Yuan ZQ, Lu L. et al. Unsatisfactory upper blepharoplasty revision technique: reconstruction of the upper orbital septum and its fusion point. Aesthetic Plast Surg 2021; 45 (06) 2790-2797
  • 5 Suo L, Li J, Fu R, Xie Y, Huang RL. A four-step technique for creating individual double-eyelid crease shapes: a free-style design. Plast Reconstr Surg 2020; 146 (04) 756-765
  • 6 Wang X, Du Y, Wu H, Zhang S, Qi X, Nie K. Repair techniques for failed double-eyelids involving restoration of eyelid anatomical structure and function. Aesthetic Plast Surg 2019; 43 (03) 702-710
  • 7 Kim KK, Kim WS, Oh SK, Kim HS. High double eyelid fold correction using wide dual-plane dissection. Ann Plast Surg 2017; 78 (04) 365-370
  • 8 Bang YH, Chu HH, Park SH, Kim JH, Cho JW, Kim YS. The fallacy of the levator expansion theory. Plast Reconstr Surg 1999; 103 (06) 1788-1791 , discussion 1792–1793
  • 9 Cheng J, Xu FZ. Anatomic microstructure of the upper eyelid in the oriental double eyelid. Plast Reconstr Surg 2001; 107 (07) 1665-1668
  • 10 Lu TY, Kadir K, Ngeow WC. The Asian eyelids and the role of Asian blepharoplasty. Malays Dent J 2016;2: https://web.mda.org.my/wp-content/uploads/2021/11/2016-02-02-kathreena.pdf
  • 11 Takayanagi S. Case studies in Asian blepharoplasty. Aesthet Surg J 2011; 31 (02) 171-179
  • 12 Park JI. Orbicularis-levator fixation in double-eyelid operation. Arch Facial Plast Surg 1999; 1 (02) 90-95 , discussion 96
  • 13 Lu X, Ye Y, Qian Y. A modified double-eyelid blepharoplasty: tarsus linkage mechanism. Aesthetic Plast Surg 2023; 47 (06) 2440-2446
  • 14 Sun W, Wang Y, Song T, Wu D, Li H, Yin N. Orbicularis-tarsus fixation approach in double-eyelid blepharoplasty: a modification of Park's technique. Aesthetic Plast Surg 2018; 42 (06) 1582-1590
  • 15 Flowers RS. Asian blepharoplasty. Aesthet Surg J 2002; 22 (06) 558-568
  • 16 Zhou X, Wang H. Orbicularis–white line fixation in Asian blepharoplasty: kiss technique. Aesthetic Plast Surg 2019; 43 (06) 1553-1560
  • 17 Pan L, Sun Y, Yan S. et al. A flexible suspension technique of blepharoplasty: clinical application and comparison with traditional technique. Aesthetic Plast Surg 2019; 43 (02) 404-411
  • 18 Li G, Ding W, Tan J, Zhang B, Chen X, He B. A new method for double-eyelid blepharoplasty using orbital septum. Ann Plast Surg 2018; 81 (06) 633-636
  • 19 Jin R, Shen Y, Yu W. et al. Tarsal-fixation with aponeurotic flap linkage in blepharoplasty: bridge technique. Aesthet Surg J 2020; 40 (12) NP648-NP654
  • 20 Zhang M, Wu J, Chen L, Ren Z, Gao W. A new anatomy finding of levator aponeurosis and Müller muscle at pretarsal plate in Asian males. Ophthalmic Plast Reconstr Surg 2020; 36 (03) 311-314
  • 21 Kakizaki H, Zako M, Nakano T, Asamoto K, Miyaishi O, Iwaki M. The levator aponeurosis consists of two layers that include smooth muscle. Ophthalmic Plast Reconstr Surg 2005; 21 (04) 281-284
  • 22 Huang J, Feng Y, Li Z. et al. Double-eyelid blepharoplasty: dermis-outer orbicularis fascia-orbicularis-levator fixation technique with preorbicular venous network preservation. Aesthetic Plast Surg 2022; 46 (01) 231-236