PRIME Journal Vol. 11 Issue 4

The surface sutures are removed two weeks postoperatively ( Figure 4 ). Complications Asymmetry One of the most common causes of asymmetry is unrecognised ptosis (hanging lid due to weak muscle) before surgical procedure. A careful examination is needed to preclude this potential complication. Another common cause of postoperative asymmetry is the failure to compensate for the asymmetric brow. Most people have one brow lower than the other; inmost cases, the right brow is lower. The two creases should compensate for the asymmetry by removing additional upper lid skin from the lower brow. Alternatively, the crease can be set slightly higher on the side with the lower brow. A technical point that contributes to asymmetry is intraoperative swelling that distorts the anatomy. Reoperation to correct asymmetry is usually performed after 3–8 months. Loss of crease The most common cause of crease loss or indistinct crease in either the closed or open method is unrecognised pre-existing ptosis. This is due to the ptotic patient’s dependence on brow lifting in order to open the eyes. In the ptotic eye, the under-functioning muscle is unable to forma complete crease. There are other causes of fold failure. In the closed technique, a common cause is the cheese-wiring effect of the suture through the deeper soft tissues, leading to loss of crease. In the open technique, another common cause of fold References 1. CollinJR,BeardC,Wood I. Experimentalandclinicaldataonthe insertionofthe levatorpalpebrae superiorismuscle.AmJOphthalmol. 1978;85:792–801 2. ChenWPD.AsianBlepharoplastyand theEyelidCrease.3rd.Edition.Elsevier Science,2016 3. MikanoK.Atechnique inthedouble eyelidoperation.JChugaishinpo1896 4. MillardDR jr.Orientalperegrinations. PlastReconstrSurg1955,16:319-36 5. SayocBT.Plasticreconstructionof thesuperiorfold insliteyes.BullPhil OphthalOtolaryngol1953;1:2 6. FernandezLR.Doubleeyelid operation intheOriental inHawaii.Plast ReconstrSurg1960;25:257-264 Double eyelid surgery is a specific type of eyelid surgery in which creases in the upper eyelids are formed, creating double eyelids The physical feature of double eyelids has become increasingly popular among the Asian populations Procedures, pros and cons for the different surgical techniques are briefly evaluated and discussed Key points failure is the lack of adequate fixation between the skin and the underlying structures 2 . Conclusions The semi-open and closedmethods have many benefits; they possess a relative simplicity and potential reversibility. Scars are less noticeable. Although less permanent than an open procedure, its flexibility makes it a good option for young patients with no previous eye surgery. The openmethod is preferred for patients with thicker skin or thick muscle. The procedure is ideal, especially due to the long (often lifelong) durability of the result, together with the option to remove excess skin in the same procedure ( Figure 5–6 ). Declaration of interest None Figures 2-6 © Jesper Thulesen | BLEPHAROPLASTY | AESTHETIC FEATURE | September/October 2021 37