BACKGROUND: Blepharoplasty in Asia is almost synonymous with double-eyelid surgery, which refers to the creation of a palpebral fold by supratarsal fixation in patients with no visible or a low supratarsal crease. The best way to develop the supratarsal crease is to achieve a permanent attachment between the dermis and the levator aponeurosis/tarsal plate at an appropriate height. OBJECTIVES: The authors describe the results of their mini-incision technique for developing a double eyelid. This method combines the benefits of both nonincisional and open techniques; two minute (2-3 mm) incisions are made together with debulking of the pretarsal soft tissues. METHODS: The authors conducted a retrospective review of 526 consecutive patients who underwent the mini-incision upper blepharoplasty between March 1998 and December 2008. To evaluate the long-term results of the procedure, data were collected retrospectively on the number of patients who experienced disappearance of the double folds following surgery (and the point at which the folds were lost). Attempts were made to identify the likely reasons for the loss of folds by means of history and retrospective intraoperative assessment. Any complications encountered with this method were also identified. RESULTS: A total of 526 cases of mini-incision upper blepharoplasty were included in this study. There were 450 bilateral and 76 unilateral procedures. Of these, a total of 58 patients (11%) subsequently underwent further operations: 26 patients had height readjustment because of dissatisfaction with the initial height (ie, it was too low), 32 patients had subsequent surgeries to reestablish lost double folds. The overall disappearance rate of the folds with this technique was 6% (17 unilateral; 15 bilateral). The mean rate of fold disappearance was 14% (32/214) during the first four years in which the senior author was performing this technique, but only 3% (11/312) in the last six years of the study period. This is most likely due to the learning curve for this technique. CONCLUSIONS: The mini-incision technique offers a simple, safe, and reproducible approach to double eyelids in patients with no supratarsal folds, combining the best of both suture and open techniques.
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