title: Using Levator Aponeurosis to Create Physiologically Natural Double Eyelid: A New Reconstruction Technique Based on Three Key Factors in Double Eyelid Formation.
abstract: BACKGROUND
  Double eyelidplasty has 3 key factors: motor power, connecting tissue, and skin adhesion.
  
  
  OBJECTIVE
  To create natural double eyelid, new anatomy structure should be rebuilt according to physiological double eyelid in these 3 aspects.
  
  
  METHODS
  Levator aponeurosis is used as "connecting tissue" to transmit dynamic "motor power" of levator muscle to upper eyelid, and "skin adhesion" is induced between levator aponeurosis and skin in a plane manner. Postoperation evaluation includes stability of double eyelid, asymmetry, double fold curve, and scar formation.
  
  
  RESULTS
  A total of 119 patients were operated on in this study. Two hundred fourteen eyes (89.9%) showed good fold curve and 13 eyes (5.5%) showed fair results. No scar on the upper eyelid was encountered, 24 patients (20.2%) had fair scar formation and 89 patients (74.8%) had no prominent scar.
  
  
  CONCLUSIONS
  This novel surgical technique utilized pretarsal levator aponeurosis as the connecting material to bridge levator muscle and upper eyelid skin; by establishing a direct force transmission mechanism, palpebral crease is created in a more natural way in terms of anatomy and physiology. Furthermore, skin adhesion is formed between levator aponeurosis and dermis in a planar manner, allowing for more stable palpebral crease and more preserved orbicularis oculi in situ, thereby minimizing eyelid scar formation.
authors.affiliation: From the Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.forename: Ming
authors.initials: M
authors.lastname: Zhu
authors.forename: Xusong
authors.initials: X
authors.lastname: Luo
authors.forename: Qun
authors.initials: Q
authors.lastname: Yang
authors.forename: Xi
authors.initials: X
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Fei
authors.initials: F
authors.lastname: Liu
mesh_terms: D000328:Adult; D000070606:Aponeurosis / Q000601:surgery*; D019882:Blepharoplasty / Q000379:methods*; D002681:China; D004954:Esthetics; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D016896:Treatment Outcome