Recovery of subcutaneous orbital fascia under preserved skin below the original crease in the repair of excessively high double eyelid folds

Background High eyelid fold is a common complication of upper eyelid surgery. This study proposes a novel technique for correcting high eyelid fold in Asian patients with too little eyelid skin and thick orbital fascia to improve cosmetic outcomes and patient satisfaction. Methods We retrospectively analysed the clinical data of 38 patients with high eyelid fold repaired at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July 2017 to April 2022. All patients were treated with this method of preserving the high eyelid fold and reconstructing the subcutaneous orbital fascia. Postoperative outcomes were reviewed and analysed using objective measures and subjective surgeon and patient evaluations. Results Thirty-eight patients (71 eyes) were included. Postoperative follow-up was 6-25 months. At 6 months postoperatively, the mean anatomic crease height decreased from 10.45mm to 6.22mm, the mean pretarsal show decreased from 3.20mm to 1.61mm, and the mean margin reflex distance 1 of the 31 patients with ptosis increased from 2.93mm to 3.87mm. (P<0.001). The compliance rate between the surgeon's assessment and patient satisfaction was 89.5%, with 31 cases considered good by both the surgeon and patient and one case considered poor by both (undercorrected ptosis), though a satisfactory result was achieved after reoperation. Neither recurrence of the original crease nor serious complications were reported. Conclusion By preserving high eyelid folds and reconstructing the subcutaneous orbital fascia, unnaturally high and deep eyelid folds were converted to lower, nondepressed folds.