BACKGROUND: Double eyelid blepharoplasty is the most popular cosmetic operation in Asian population. Various surgical techniques have been developed in order to create dynamic eyelid folds with natural-looking in recent years, but postoperative complications like so-called sausage-like appearance have not been resolved completely.
OBJECTIVE: To create natural-looking dynamic folds, we propose a new method imitating the original anatomical structure of congenital double-eyelid.
METHODS: Eighty-six patients who underwent the double-eyelid surgery from June 1st, 2018 to October 31st, 2020 were included in this retrospective study, including 10 males and 76 females, aged 18-39 years (mean 27.4 ± 5.6 years). All the included patients received double eyelid surgery performed by the same senior doctor, using the pretarsal orbicularis oculi muscle-releasing technique. Patient Reported Outcome Measures questionnaires were administrated to assess the severity of scarring, pain, and asymmetry, as well as functional and appearance issues. Surgical outcome was assessed through objective and subjective evaluation forms (PROM and patient satisfaction rate).
RESULTS: Among the 86 patients, 5 were lost during the follow-up period. The absolute number of enrolled patients is 81. 91.36% of the enrolled patients reported minimal or non-visible scarring at the double eyelid incision. As to functional and appearance issues, the main problem were asymmetry (12.35%) and the narrowing of the supratarsal crease width (8.64%). No supratarsal depression and \"sausage-like\" appearance occurred in this study. 95.1% of patients reported either good or excellent outcome (mean score: 108 of 120) based on analysis of PROM results, and 96.3% of patients reported either high or very high satisfaction (mean score: 96 of 120) for the patient satisfaction assessment.
CONCLUSIONS: This new surgical method of double-eyelid blepharoplasty provides comparatively safe and effective results.

BACKGROUND: Double-eyelid blepharoplasty was the most prevailing cosmetic procedures in China. To reduce the visible scar and unnatural crease after the removal of the OOM in the traditional full-incision double-eyelid technique. This research tried to introduce and promote the orbicularis oculi muscle sparing full-incision double-eyelid blepharoplasty with more conservative resection of upper eyelid soft tissue.
METHODS: The orbicularis oculi muscle sparing full-incision double-eyelid blepharoplasty was operated and evaluated in 227 patients (454 eyes), and the esthetic results, the satisfaction of patients and complications were scored and analyzed at 6-12 months postoperative.
RESULTS: Of the 227 patient, 164 (72.25%) patients were very satisfied, and 49 (21.59%) patients were satisfied, 14 (6.17%) patients were unsatisfied mainly because of the loss of palpebral fold or shallow folds. The average subjective scar score was 4.92 with 209 (92.1%) patients scored very satisfied, 18 patients scored satisfied. No patients experienced the eyelid numbness, dry eyes, and stitch abscess. 8 patients (3.52%) developed mild eye irritation in early postoperative period, however the symptoms resolved spontaneously in 2 weeks.
CONCLUSIONS: The orbiculars oculi muscle sparing full-incision double-eyelid blepharoplasty contributes to the conservation of the physiology of the eyelid structure, producing a reliable, nature, dynamic double-eyelid crease with a light scar and less complication.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: This study aims to assess the feasibility and efficacy of a three mini-incision upper blepharoplasty combined with simultaneous orbital fat pad repositioning for correcting primary multiple upper eyelid folds in East Asians.
METHODS: A retrospective analysis of 75 patients who underwent three mini-incision double-eyelid blepharoplasty in conjunction with orbital fat pad repositioning for the correction of multiple upper eyelid folds between January 2018 and January 2022 was conducted. During the surgery, the lateral extension of the central upper eyelid fat mass was anchored medially to the upper medial eyelid via three small skin incisions. Postoperative follow-up was carried out to evaluate the improvement in multiple upper eyelid folds, and patient satisfaction was measured.
RESULTS: The follow-up period ranged from 6 to 36 months, with an average of 12 months. Post-surgery, the multiple fold lines were completely resolved in 71 patients (95%), while relapse occurred in 4 patients (5%). The overall satisfaction rate was 88%.
CONCLUSIONS: The three mini-incision double-eyelid blepharoplasty combined with simultaneous orbital fat repositioning is an effective method for correcting primary multiple upper eyelid folds. This technique presents a novel alternative for patients with primary multiple eyelid folds, particularly those who are hesitant to undergo a full-incision double-eyelid procedure.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Asian upper blepharoplasty is one of the most popular cosmetic procedures for Asians, but less optimal result is still common. The authors\' comprehensive approach to Asian upper blepharoplasty includes (1) to determine both the height and length of the upper skin crease; (2) to create more ideal anatomy of the upper eyelid; (3) to reconstruct the desirable anatomic structure of the upper eyelid skin crease; and (4) to add a medial epicanthoplasty if needed to enhance cosmetic results.

Objectives: To investigate the changes of dry eye-related clinical manifestations, ocular surface parameters, and tear inflammatory cytokines after upper blepharoplasty. Methods: Forty eyes of 20 who underwent upper blepharoplasty were divided into either the group with or the group without preexisting dry eye before upper blepharoplasty. Ocular Surface Disease Index (OSDI), Schirmer I test, tear meniscus height, lipid layer thickness, non-invasive tear break-up time (NIKBUT), fluorescein tear film break-up time (FBUT), corneal fluorescein staining, meibum expression, lid margin changes, and tear inflammatory cytokines were assessed preoperatively and at 1, 3, and 6 months postoperatively. Correlations between inflammatory cytokines and dry eye-related parameters were determined. Results: The OSDI scores increased significantly at 1 month (p = 0.040) and subsequently decreased to the preoperative levels at 6 months postoperatively in subjects with dry eye. First (f)-NIKBUT and FBUT were significantly shortened at 1, 3, and 6 months postoperatively in subjects with dry eye (f-NIKBUT: p <0.001, p = 0.010, p = 0.042; FBUT: p = 0.002, p = 0.005, p = 0.037, respectively), but were only shortened at 1 month (p = 0.028, p = 0.005) and returned to baseline levels at 6 months postoperatively in subjects without preexisting dry eye. A significant increasing trend of interleukin (IL)-6 was found in both dry eye and subjects without preexisting dry eye (p = 0.016, p = 0.008), while IL-8 and tumor necrosis factor alpha (TNF-α) were only found to be increased in subjects with dry eye postoperatively (p = 0.031, p = 0.031). The levels of IL-8 and TNF-α were positively correlated with OSDI scores (p = 0.046, p = 0.043, respectively) and negatively correlated with f-NIKBUT and FBUT (p = 0.026, p = 0.006, respectively). Conclusions: Upper blepharoplasty might increase the release of tear inflammatory cytokines and tear film instability that contribute to the development of postoperative dry eye in the early postoperative period and the changes most relieved in 6 months. Preexisting dry eye is a higher risk factor for worse and persistent ocular surface damage after upper blepharoplasty.

Purpose: This study aimed to investigate the effect of transcutaneous upper eyelid blepharoplasty on lipid layer thickness (LLT) and blink parameters in young women during the early postoperative period. Methods: This prospective study included 110 eyes of 55 young female patients (age range, 19-31 years) who underwent transcutaneous upper eyelid blepharoplasty. The LLT and blink parameters measured using a LipiView interferometer were recorded before the surgery and 1 week and 1 month after the surgery. Ocular Surface Disease Index (OSDI) score, noninvasive tear film breakup time (NITBUT), and palpebral fissure height (PFH) measurements were also performed at each time point. Results: The number of blinks significantly decreased (P < 0.001), and the number of partial blinks and partial blink rate (PBR) significantly increased 1 week after the surgery (P = 0.002 and P < 0.001); they all returned to baseline in 1 month. The LLT and OSDI score increased significantly 1 week and 1 month after the surgery (P < 0.001 and P < 0.001). A significant increase in the NITBUT and a significant decrease in the PFH were observed 1 week after the surgery (P < 0.001 and P < 0.001), and the values returned to baseline 1 month after the surgery. No clinical correlation was found between blink parameters and ocular surface parameters. Conclusions: Transcutaneous upper eyelid blepharoplasty led to a change in blink parameters and ocular surface parameters during the early postoperative period. However, this influence was temporary, and the transitory change in blink parameters had no effects on the ocular surface environment.

BACKGROUND: Double-eyelid blepharoplasty remains popular in east Asia. To avoid rigid eyelids and sinking scar after double-eyelid blepharoplasty, a new surgical approach with selective neurovascular preservation (SNVP) method is proposed to crease more physiological and dynamic double-eyelid crease.
METHODS: During the full-incision double-eyelid surgery, a strip of preseptal orbicularis oculi muscle was resected. The longitudinally spreading upper eyelid nerves and vessels were preserved carefully. Four to five anchoring points between these neurovascular branches were made to reach the pretarsal fascia. Skin- orbicularis oculi muscle-pretarsal fascia sutures were placed on the anchoring points.
RESULTS: From May 2018 to April 2020, 385 patients received double-eyelid surgery with SNVP method. Eyelid edema resolved quickly within a week and generally disappeared in 4 weeks. In total, 259 (67.27%) patients scored very satisfied, and 109 (28.31%) patients scored satisfied on six-month follow-up.
CONCLUSIONS: The SNVP approach can produce reliable and dynamic palpebral crease with inconspicuous scar. Vital neurovascular branches of upper eyelid could be saved, thus reducing postoperative complications and recovery period.
UNASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: In Asian women, upper eyelid skin laxity, lateral hooding, and upper eyelid and brow asymmetry in the aging upper eyelid are prominently and frequently seen. It is difficult to completely resolve these problems with the classical single-incision method. In this study, we investigate the utility of a double-incision approach to address aging-related changes of the upper eyelid.
METHODS: From September 2017 to March 2019, 51 patients underwent this procedure. Through a sub-brow incision, the skin and subcutaneous tissue were excised and the orbicularis oculi muscle (OOM) flap and muscular-cutaneous flap were separated. The OOM flap was lifted and fixed to the periosteum through the sub-brow fat pad and covered by the upper muscular-cutaneous flap. Through an eyelid crease incision, the supratarsal upper eyelid skin, muscle, and orbital fat were excised, excessive tension was alleviated, and double-fold eyelids were adjusted and reshaped if needed. The results were evaluated by asking the surgeon and patient involved to allocate a categorical (poor, fair, good, very good, excellent) scores and comparisons between pre- and postoperative brow position.
RESULTS: The average follow-up period was 12 months. Most patients were satisfied with the results, barring two cases each of vomiting and transient numbness over the forehead region and three revisions. The mean surgeon and patient categorical scores associated with satisfaction with the overall outcome at 6 months were 4.2 ± 0.6 (range 3.0-5.0) and 4.0 ± 0.7 (range 2.0-5.0), respectively. The brow position was stable during follow-up period.
CONCLUSIONS: A double-incision approach is a safe, effective, durable, and esthetic way for treating patients presenting with upper eyelid aging.