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Using Levator Aponeurosis to Create Physiologically Natural Double Eyelid: A New Reconstruction Technique Based on Three Key Factors in Double Eyelid Formation

Lu, Lin MD, PhD; Zhu, Ming MD, PhD; Luo, Xusong MD, PhD; Yang, Qun MD; Wang, Xi MD; Yang, Jun MD, PhD; Liu, Fei MD, PhD

doi: 10.1097/SAP.0000000000000951
Aesthetic Surgery

Background Double eyelidplasty has 3 key factors: motor power, connecting tissue, and skin adhesion.

Objective To create natural double eyelid, new anatomy structure should be rebuilt according to physiological double eyelid in these 3 aspects.

Methods Levator aponeurosis is used as “connecting tissue” to transmit dynamic “motor power” of levator muscle to upper eyelid, and “skin adhesion” is induced between levator aponeurosis and skin in a plane manner. Postoperation evaluation includes stability of double eyelid, asymmetry, double fold curve, and scar formation.

Results A total of 119 patients were operated on in this study. Two hundred fourteen eyes (89.9%) showed good fold curve and 13 eyes (5.5%) showed fair results. No scar on the upper eyelid was encountered, 24 patients (20.2%) had fair scar formation and 89 patients (74.8%) had no prominent scar.

Conclusions This novel surgical technique utilized pretarsal levator aponeurosis as the connecting material to bridge levator muscle and upper eyelid skin; by establishing a direct force transmission mechanism, palpebral crease is created in a more natural way in terms of anatomy and physiology. Furthermore, skin adhesion is formed between levator aponeurosis and dermis in a planar manner, allowing for more stable palpebral crease and more preserved orbicularis oculi in situ, thereby minimizing eyelid scar formation.

From the Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, China

Received July 9, 2016, and accepted for publication, after revision October 11, 2016.

The first 2 authors contributed equally to this work.

This study was supported by National Natural Science Youth Foundation of China (81401613).

Conflicts of interest and sources of funding: None declared.

Reprints: Fei Liu MD, PhD, 639 Zhi Zao Ju Road, Shanghai 200011, China. E-mail:

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