title: Secondary Blepharoplasty: Correction of the High Fold.
abstract: BACKGROUND
  Blepharoplasty is a common aesthetic surgery performed worldwide. In Asians, too high eyelid folds after blepharoplasty cause an unsatisfactory aesthetic outcome that is difficult to correct. In this article, the authors propose surgical techniques to correct the high eyelid fold after blepharoplasty.
  
  
  METHODS
  During a 4-year period, 213 secondary blepharoplasties were performed to correct high folds. Postoperative results were reviewed, graded, and analyzed.
  
  
  RESULTS
  Of 213 cases of secondary blepharoplasty to correct the high eyelid fold, almost all could achieve reduction of the fold size (98.59 %). One hundred and nine cases (51.17 %), 69 cases (32.40 %), and 32 cases (15.02 %) were classified as excellent, good, and fair results, respectively. Only three cases (1.41 %) were classified as poor results.
  
  
  CONCLUSIONS
  Secondary blepharoplasty to correct a high fold is a challenging procedure for aesthetic surgeons. Surgeons performing this operation need to have a thorough understanding of eyelid anatomy and its dynamics together with familiarity with secondary blepharoplasty to avoid any further injury to the levator muscle. The key points of this surgery are levator advancement and intervening between the levator aponeurosis and the overlying skin by in situ tissue or fat grafting.
  
  
  METHODS
  This journal requires the authors to assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .
authors.affiliation: Bangkok Skin Plastic Surgery Center, 62/196-7, Paholyothin Road, Bangkok, 10220, Thailand. kamolw@gmail.com.
authors.forename: Kamol
authors.initials: K
authors.lastname: Wattanakrai
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Bhumibol Adulyadej Hospital, Paholyothin Road, Bangkok, 10220, Thailand.
authors.forename: Nattawut
authors.initials: N
authors.lastname: Chiemchaisri
authors.affiliation: Division of Dermatology, Ramathibodi Laser Center, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
authors.forename: Penpun
authors.initials: P
authors.lastname: Wattanakrai
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D019882:Blepharoplasty / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D004954:Esthetics; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D014945:Wound Healing / Q000502:physiology
keywords: Asian blepharoplasty; Correction of the high fold; Eyelid ptosis; Fat graft; Oriental blepharoplasty; Ptosis correction; Revision blepharoplasty; Secondary blepharoplasty