The purpose of this article is to introduce author's method of double fold operation by using skin-tarsal plate-muscle-skin fixation. Three thousand patients were operated during last ten years.
The incision line is 7 to 10mm above the ciliary margin while the skin is pulled upward. Excess skin and orbicularis oculi muscle is removed. Orbital septum is opened on its lateral part and orbital fat is removed. 1) Skin of the lower flap, 2) tarsal plate and/or levator aponeurosis, 3) orbicularis oculi muscle of the upper flap, and 4) skin of the upper flap are sutured with removable suture material. The fixations are performed at three points of each eyelids(midpupillary line, medial and lateral margin of the tarsal plate). Additional nine stitches of skin-levator-skin fixation are put on each eyelid. Sutures were removed on third to 6th postoperative-day.
Most of the patient were satisfied with the result. Only 30 patient complained loss of fold. However, 150 patients had conjunctival bleb and 15 patient suffered from dellen.
This method is unique method which can avoid triple fold by fixating the orbicularis muscle of the upper flap.