A Conservative Crease-Height-Adjustable Asian Double Eyelid Surgery Technique Based on Live Anatomical Studies

Background: Ideal methods for double-eyelid crease creation in Asian upper eyelids remain controversial because of the complexity of the Asian upper eyelid anatomy. Key issues include the underestimation of tarsal height and the septum/aponeurosis fusion point height (FPH), which may underlie the unnaturally high creases in many classic double-eyelid procedures. Methods: A total of 1272 patients had tarsal heights measured. Among 386 patients with orbital septa opened, FPHs and other anatomic findings were documented. Based on the anatomic findings, a novel method for double-eyelid crease formation was designed. This method involves preserving the pretarsal fibrofatty tissue and using horizontal mattress sutures to connect the orbicularis oculi muscle, through the pretarsal fibrofatty tissue and levator aponeurosis, to the pretarsal membrane (MAP method) as the linkage mechanism. Results: Tarsal height levels were higher than reported in many previous studies. In the supine position, all FPHs were higher than the tarsi. Eyelid creases using the MAP method are created below the superior tarsal edges at varying heights, accommodating individual patient requests while achieving well-formed creases and improved eyelid mechanics. The recovery was brief, and the results were long-lasting with a minimal failure rate. Conclusions: Tarsal heights and FPHs are not as low as previously thought, which could explain why many classic surgical procedures have various issues. The proposed MAP method for Asian double-eyelid blepharoplasty allows for conservative crease-height adjustability with results that are dynamic, natural, and durable. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.