title: High Double Eyelid Fold Correction Using Wide Dual-Plane Dissection.
abstract: BACKGROUND
  The ability to correct unnatural-appearing, high, and deep double eyelid folds has been limited by the lack of redundant upper eyelid skin and the presence of prior incision line scars in patients.
  
  
  METHODS
  From January 2000 to September 2011, 256 patients with high and deep double eyelid folds underwent our fold-lowering procedure. The first dissection was made at the superficial layer between the orbicularis oculi muscle and orbital septum/retroorbicularis oculi fat. The second dissection was at a deeper layer between the preaponeurotic fat and levator aponeurosis. The dissection proceeded 7 to 8 mm farther cephalad to the prior fold line to separate the upper flap and the floor from the prior fold line. The lower flap was undermined caudally to obtain normal skin tension, and the lower flap was secured to the septoaponeurosis junctional thickening or pretarsal tissue. Six months after surgery, the correction of the high fold scar and change in fold height (with eyes closed) was documented.
  
  
  RESULTS
  Using the authors' technique, unnatural-appearing, high, and deep double eyelid folds were converted to lower nondepressed folds. Although prior high fold incision scars could be seen postoperatively on close examination, they were not easily visible. Complications included fold height asymmetry in 10 cases, persistence of the prior fold in 5 cases, and redundant upper flap skin that needed further excision in 25 cases.
  
  
  CONCLUSIONS
  Using a wide double-layer dissection, high folds were lowered successfully even in situations where there was no redundant upper eyelid skin for excision.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; †Department of Energy and Electrical Engineering, Korea Polytechnic University, Siheung; and ‡Ohkims Plastic Surgical Clinic, Ilsan, South Korea.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Kim
authors.forename: Woo-Seok
authors.initials: WS
authors.lastname: Kim
authors.forename: Se Kwang
authors.initials: SK
authors.lastname: Oh
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D019882:Blepharoplasty / Q000379:methods*; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D004954:Esthetics; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000637:transplantation*; D014945:Wound Healing / Q000502:physiology*