Using Levator Aponeurosis to Create Physiologically Natural Double Eyelid: A New Reconstruction Technique Based on Three Key Factors in Double Eyelid Formation

Background: Double eyelidplasty has 3 key factors: motor power, connecting tissue, and skin adhesion. Objective: To create natural double eyelid, new anatomy structure should be rebuilt according to physiological double eyelid in these 3 aspects. Methods: Levator aponeurosis is used as "connecting tissue" to transmit dynamic "motor power" of levator muscle to upper eyelid, and "skin adhesion" is induced between levator aponeurosis and skin in a plane manner. Postoperation evaluation includes stability of double eyelid, asymmetry, double fold curve, and scar formation. Results: A total of 119 patients were operated on in this study. Two hundred fourteen eyes (89.9%) showed good fold curve and 13 eyes (5.5%) showed fair results. No scar on the upper eyelid was encountered, 24 patients (20.2%) had fair scar formation and 89 patients (74.8%) had no prominent scar. Conclusions: This novel surgical technique utilized pretarsal levator aponeurosis as the connecting material to bridge levator muscle and upper eyelid skin; by establishing a direct force transmission mechanism, palpebral crease is created in a more natural way in terms of anatomy and physiology. Furthermore, skin adhesion is formed between levator aponeurosis and dermis in a planar manner, allowing for more stable palpebral crease and more preserved orbicularis oculi in situ, thereby minimizing eyelid scar formation.

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