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