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Intratarsal Fixation at the Same Level as the Skin Incision to Reduce Asymmetric Double Eyelids: Evaluation of Symmetry Using Photogrammetry

Han, Kihwan MD, PhD*; Yeo, Hyeonjung MD*; Choi, Tae Hyun MD, PhD; Son, Daegu MD, PhD*; Kim, Jun Hyung MD, PhD*

doi: 10.1097/SAP.0b013e3181b022e3
Aesthetic Surgery

One of the most common complications of double eyelid operations is asymmetry. To reduce asymmetry, we fixed the dermis to the tarsal plate at the same level as the skin incision, and objectively evaluated the symmetry of the height using photogrammetry.

Of 30 patients who had double eyelid operations by the intratarsal fixation technique, 15 patients completed a minimum follow-up of 6 months. After the skin incision and removal of the orbicularis oculi muscle and the orbital fat, the pretarsal fat pad was excised to expose the superior portion of the tarsal plate. The 3 fixation points were marked on the tarsal plate at the same level with the skin incision using a spreading caliper. The dermis was fixed to the marked points of the tarsal plate and the skin was closed.

The height of the double eyelid was measured by clinical photography at 4 points when the eyes were opened and at 3 points when the eyes were closed. The height proportional index at each point was obtained by dividing the height of the left double eyelid by that of the right double eyelid. We compared each height proportional index with “1” to evaluate the symmetry of both double eyelids using a paired t test.

The follow-up period was an average of 9.0 months. The mean height proportional indices were 0.97 (a), 0.96 (b), 0.98 (c), 1.08 (d), 0.97 (e), 1.02 (f), and 1.13 (g). According to a paired t test, the height of the left double eyelid was not different from that of the right double eyelid.

Intratarsal fixation, along with other previously known methods, decreases asymmetric double eyelids.

From the *Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea; and †Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.

Received January 20, 2009, and accepted for publication, after revision, May 27, 2009.

Supported by the Korea Healthcare Technology Research and Development Project, Ministry of Health and Welfare, Republic of Korea (A080049).

Reprints: Tae Hyun Choi, MD, PhD, 101 Daehang-Ro, 28 Yeongeon-Dong, Seoul 110-744 South Korea. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.