A Modified Palpebral Marginal Incision Technique Using Levator Aponeurotic Flap in Blepharoplasty

Double-eyelid surgery is one of the most common cosmetic surgeries performed in Asians. The palpebral marginal incision technique (PMIT) conceals the incision scar and creates natural-looking double-eyelids. However, the amount of eyelid skin removed by conventional PMIT is limited, which potentially results in an unnatural crease or inferior skin below the palpebral crease that appears swollen.

The aim of this study was to introduce a modified PMIT which creates scarless, dynamic, and natural double-eyelids with a limited amount of eyelid skin excision.

From January 2018 to December 2020, 382 patients (764 eyelids) underwent double-eyelid surgeries with the described technique. The key point was to form a pretarsal levator aponeurotic flap, acting as a soft motor transmission to bridge tarsus, orbicularis oculi muscle, and skin dermis. Satisfaction with the overall aesthetic outcomes-as assessed by surgeon and patients-and complications were postoperatively evaluated at various follow-ups.

The mean follow-up period was 7.6 months (range, 6-12 months). Of the patients, 332 (86.9%) reported self-assessment of outcomes as satisfactory and 37 (9.7%) as fair. Secondary operations were required for 13 (3.4%) patients for double-eyelid asymmetry or crease curve malformations. Early-stage hematoma (12 cases) and lagophthalmos (19 cases) were observed and completely recovered within 1 month.

Our modified PMIT technique was capable of achieving scarless and natural-looking double-eyelids with a biomimetic anatomic structure.