Partial-incision technique for creation of the double eyelid

Abstract

Background: Three principal techniques exist with which to create the Asian double eyelid: the suture, partial-incision, and full-incision methods. The partial-incision method is reliable and long-lasting without many of the drawbacks of the full-incision method. Objective: The surgical technique of the partial-incision method is reviewed in a stepwise fashion so that the reader can reproduce this method for double-eyelid creation. Methods: Preoperative lid measurements were made with the patient in an upright sitting position to account for the effects of gravity on the lid. An incision was made through both the skin and orbicularis muscle to expose the underlying orbital septum. The lateral septum was lifted upward and a small wedge of elevated septum removed to permit entry into the preaponeurotic adipose tissue, which was then teased forward through the aperture in the orbital septum. Normally, only half of the exposed fat is removed, leaving a small adipose cuff on the hemostat. The remaining adipose cuff was cauterized and the wound inspected for hemostasis. Suture fixation was accomplished with a 7-0 nylon suture to tack the levator aponeurosis to the inferior skin edge along the incision line. The suture was passed through the epidermis to ensure permanence. Results: We have successfully used the partial-incision method of double-eyelid correction in 1500 cases. The 3 notable complications that can occur are loss of the lid crease, suture extrusion, and asymmetry. All of these complications occur in approximately 2% to 3% of cases but are easily corrected. The apparent elevated appearance of the lid height during the postoperative period is attributed to edema and diminishes by 1 to 2 mm to a more natural position after 3 to 12 months. Conclusions: The partial-incision approach is a simple, safe, and straightforward approach to double-eyelid creation that can be performed even by surgeons with relatively little experience in the technique.