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In double eyelid operation, if the eyes have too little fat and soft tissue, or if the orbital fat were removed too much in the operation, the double eyelid crease is too high. And the supra-tarsal recess becomes hollow and the adhesion of eyelid crease occurs even in orbital septum and levator muscle. Secondary double eyelid operation in response to these problem needs to correct the height of eyelid crease or the supra-tarsal depression by releasing the inadequately high eyelid fold and preventing re-adhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of double eyelid should be appropriately lowered, the adhesion should be released, and the bulky lower flap should be flattened. In case the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, free-fat graft or dermis-fat graft has been done to correct supra-tarsal depression and re-adhesion. These graft materials are extracted from a distant donor site. Even if the adjacent tissue was not sufficient, we made the superiorly based local flap or graft of pre-tarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease and help prevent re-adhesion. Of the 1225 patients with high placement of supra-tarsal fold with bulky lower skin flap, we used pretarsal fibro-muscular flap in 914 patients and pretarsal fibro-muscular graft in treating 311 patients from November 1997 to October 2005. And we eventually found that the operation was successful in making a natural eye shape and preventing re-adhesion with no requirement of a distant donor site. We found that the pretarsal fibro-muscular flap or graft were effective in reducing the operative time and lowering the risk of post-operative infection, preventing the re-adhesion, correcting the supratarsal depression and making a natural eye shape with a slender eyelid line.
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