Surgical Correction of Multiple Upper Eyelid Folds in East Asians

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.