Asian eyelid crease formation (double eyelid operation) by suture ligation method

Table 5.1

Indications for surgery

Absent or incomplete upper eyelid crease
No anatomic soft-tissue redundancy such as dermatochalasis and orbital fat prolapse

Table 5.2

Preoperative evaluation

Prior facial surgery or trauma, including open or closed crease fixation surgery
Dry eye symptoms
Prior refractive surgery
Degree of dermatochalasis and fat prolapse
Presence of lacrimal gland prolapse
Presence of concurrent eyebrow ptosis, eyelid ptosis, eyelash ptosis or entropion
Epicanthal fold and shape
Crease asymmetry
Type of crease desired: nasal taper, parallel, and lateral flare
Discussion of crease permanence with suture ligation method


The suture ligation method is an alternative method of upper eyelid crease formation in the Asian eyelid. In Chapter 4 , the open technique of Asian upper blepharoplasty was described and the relative advantages and disadvantages were discussed. The major advantages of the suture ligation method as discussed in this chapter are the rapid recovery and minimally invasive nature compared to the open surgical approach. The primary disadvantage of the suture ligation method is the tendency of the crease to fade with time.

When considering the suture ligation method, the preoperative exam should not disclose any significant dermatochalasis, fat prolapse, ptosis or other eyelid malposition. If present, these factors can be specifically addressed with an open surgical approach ( Chapter 4 ). The goal of the suture ligation method is to create a surgical adhesion between the levator aponeurosis and the overlying subcutaneous tissue while avoiding a larger, open incision.

Surgical Technique

Figure 5.1A

Marking of the eyelid crease height

Careful marking is essential for surgical success. Compared to the Occidental eyelid, the Asian eyelid crease is 2–4 mm lower, with males averaging 4–6 mm and females 6–8 mm centrally ( Figure 5.1 ). The height of the central eyelid crease provides the foundation for the newly created crease. Calipers are used to mark the central eyelid height bilaterally and this is compared for symmetry.

Figures 5.1B–E, Continued

Marking of the new eyelid crease

Once the central height of the new eyelid crease is determined, three markings are made along this newly proposed crease. A wooden splint is used to indent the central marking and to simulate the new crease ( Figures 5.1B and 5.1C ). As the patient is asked to look up and down, the surgeon evaluates the new crease to determine if it will be natural. If the crease appears too high, then the central height is lowered and a new crease is simulated with the wooden splint. Once satisfied, nasal and temporal markings are made in line with the new crease ( Figures 5.1D and 5.1E ). The markings are best performed while the patient looks down and then reconfirmed when looking up. Excess ink from the marking pen should be blotted with a gauze to minimize bleeding of the dye on the skin.

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May 16, 2019 | Posted by in Reconstructive surgery | Comments Off on Asian eyelid crease formation (double eyelid operation) by suture ligation method
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