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Surgical Correction of Multiple Upper Eyelid Folds in East Asians

Lew, Dae Hyun M.D., Ph.D.; Kang, Jong Hwa M.D.; Cho, In Chang M.D., Ph.D.

Plastic and Reconstructive Surgery: March 2011 - Volume 127 - Issue 3 - p 1323-1331
doi: 10.1097/PRS.0b013e318205f32b
Cosmetic: Original Articles

Background: Unwanted multiple upper eyelid folds may occur after various blepharoplasty procedures used in Asian “double-eyelid” surgery. These multiple lines are caused by adhesions that may occur after inappropriate manipulation during blepharoplasty. Correction is difficult in cases of multiple reoperations because the adhesions in such cases are severe and an insufficient amount of tissue remains for reconstruction.

Methods: The authors divided 62 patients into three groups. Patients in group 1 developed lines for reasons unrelated to eyelid surgery, those in group 2 developed lines after blepharoplasty, and those in group 3 developed lines after secondary operations. After skin incision, the authors performed a complete dissection and release of the scar tissue. Then, the authors augmented the preorbital area using eyelid tissues such as the orbicularis oculi muscle and orbital fat to prevent readhesion of the orbicularis oculi and levator muscles. For severe cases, unwanted creases were prevented by rolling the orbicularis oculi muscle and attaching a thick piece of tape to the problem area after surgery.

Results: In 57 patients (92 percent), the unwanted lines disappeared completely. Five patients (8 percent) experienced recurrence of the lines, but these lines were successfully corrected by reoperation. All cases with recurrence were in groups 2 and 3, in which the adhesions were very severe.

Conclusions: The most important factors for correction of unwanted multiple fold lines are accurate dissection, the maintenance of sufficient tissue, and prevention of readhesion between the skin and levator using other soft-tissue augmentation. This method can provide very satisfactory results, even in severe cases.

Seoul, Korea

From the Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, and the Bando Eye Aesthetic and Plastic Surgery Clinic.

Received for publication May 9, 2010; accepted September 20, 2010.

Disclosure:The authors have no financial disclosures; they have no relevant commercial associations.

In Chang Cho, M.D., Ph.D., Bando Eye Aesthetic and Plastic Surgery Clinic, Iztower 8F, Yeoksam-dong 821, Gangnam-gu, Seoul 135-080, Korea,

©2011American Society of Plastic Surgeons