Using the authors' technique, unnatural-appearing, high, and deep double eyelid folds were converted to lower nondepressed folds. Six months after surgery, the correction of the high fold scar and change in fold height (with eyes closed) was documented. The lower flap was undermined caudally to obtain normal skin tension, and the lower flap was secured to the septoaponeurosis junctional thickening or pretarsal tissue. The dissection proceeded 7 to 8 mm farther cephalad to the prior fold line to separate the upper flap and the floor from the prior fold line. The second dissection was at a deeper layer between the preaponeurotic fat and levator aponeurosis. The first dissection was made at the superficial layer between the orbicularis oculi muscle and orbital septum/retroorbicularis oculi fat. The ability to correct unnatural-appearing, high, and deep double eyelid folds has been limited by the lack of redundant upper eyelid skin and the presence of prior incision line scars in patients.įrom January 2000 to September 2011, 256 patients with high and deep double eyelid folds underwent our fold-lowering procedure.
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