Orbicularis-levator fixation in double-eyelid operation

One of the characteristic features of the East Asian person's eyelids is the lack of a supratarsal fold. A relaxed upper eyelid skin, due to the lack of supratarsal fixation, causes coverage of the tarsal margin of the upper eyelid. Thus the palpebral fissure looks smaller, giving a slit-eye appearance. Unlike those lids with a natural supratarsal crease, the levator palpebrae muscle and/or aponeurosis does not extend and attach to the pretarsal skin. The purpose of the double-eyelid operation is to create a supratarsal fold in the eyelids of Asian patients. Numerous surgical procedures have been developed to establish adherence between the levator aponeurosis and the eyelid skin. There are 2 main goals for this procedure: (1) a smooth, tight skin below the newly created supratarsal crease and (2) firm fixation between the levator aponeurosis and the skin to prevent relapse to a single eyelid. Most procedures described rely on loose cicatrization between the skin and the levator aponeurosis.