Septoaponeurotic Junctional Thickening Fixation Technique in 13,500 Asian Upper Blepharoplasties: Evidence-Based...

To evaluate the anatomical rationale and clinical efficacy of septoaponeurotic junctional thickening (SAJT) fixation technique in Asian upper blepharoplasty.

Retrospective analysis of 13,500 consecutive cases (12,150 primary blepharoplasties; 1,350 revisions) performed between 2016 and 2025 utilizing the SAJT fixation technique. Critical technical refinements included: (1) precise delineation and surgical isolation of the SAJT zone as a distinct fibrous flap and (2) precise fixation of this fibrous flap to the dermal layer of the lower skin flap to achieve physiologically dynamic fold formation.

Postoperative evaluation at 6 months revealed: 95.6% high satisfaction and 2.3% basic satisfaction. All achieve natural-appearing double eyelids without visible scarring: unilateral or bilateral fold loss or bilateral asymmetry: 210 cases (n=13,500, 1.6%). Dissatisfaction with fold height ( inadequate height and excessive height) was reported in 62 cases (0.46%). All cases requiring revision for postoperative complications achieved 100% patient satisfaction following surgical re-exploration and readjustment of the original SAJT fixation architecture.

As the largest reported series, this study establishes SAJT fixation technique as the top choice for Asian upper blepharoplasty, combining anatomical fidelity with surgical practicality.

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