LAUSR

BACKGROUND 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 swollen-like inferior skin below the palpebral crease. OBJECTIVES To introduce a modified PMIT which creates scarless, dynamic and natural double eyelids with a limited amount of eyelid skin excision. METHODS From January 2018 to December 2020, 382 patients (764 eyelids) underwent double eyelid surgeries using 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 (OMM), and skin dermis. The overall aesthetic outcomes, which are indicated by surgeon and patient self-assessed satisfaction, and complications, were postoperatively evaluated at different follow-ups. RESULTS The mean follow-up period was 7.6 months (range, 6-12 months). Of the patients, 332 (86.9%) reported a satisfactory self-assessment of outcomes 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. CONCLUSIONS Our modified PMIT technique was capable of achieving scarless and natural-looking double eyelids with biomimetic anatomical structure.