The hinge effect of the posterior septum and levator muscle fixation technique in Asian double-eyelid operation

Background In Korea, upper eyelid puffiness with the mild ptosis is frequently reported and the levator muscle advancement is needed in double-eyelid operation. After levator muscle advancement in ptosis, continuous discomfort of upper eyelid may be noted. So we paid attention to the elasticity of the posterior septum. We advanced the levator muscle and sutured the connected posterior septum to the lower incisional margin of the upper eyelid skin as a hinge. The posterior septum effectively controls the pulling power of the levator muscle to create the natural supratarsal fold. Herein, we aimed to present our levator muscle fixation technique using posterior septum in double-eyelid operation of the mild ptosis. Methods We performed double-eyelid operation in 30 patients with mild ptosis aged 18–55 years since 2017 to create a supratarsal fold. We opened the anterior septum, and the posterior septum and the connected levator muscle are dissected from the Muller’s muscle. The levator muscle is advanced for ~ 2 mm. Then, the advanced levator muscle was fixed, and the posterior septum connected to the lower incisional margin of the upper eyelid skin was sutured. Results No depressed scar formation and no complete loss of the supratarsal fold occurred. Postsurgical discomfort on upper eyelid resolved in 2 months. The suprafold was not loosened 12 months postoperatively. All patients were satisfied with the outcome. Conclusions Our levator muscle fixation technique produces lesser discomfort and creates more naturally appearing supratarsal folds than any other technique for double-eyelid operation of East Asians. Level of Evidence: Level IV, therapeutic study.