Skin–Tarsus–Skin Combined with Orbicularis–Tarsus–Orbicularis Fixation Technique Creates a Double Eyelid: A Case Series

Abstract

Background: The skin–tarsus–skin and orbicularis–tarsus–orbicularis fixation methods are widely used in double-eyelid surgery. Both methods have limitations. In this study, the two surgical methods were integrated and applied to form a stable double eyelid that mimics the natural physiological structure with minimal visible scarring. Methods: At the inner, middle, and outer sites of the double-eyelid line, 7-0 silk sutures were passed successively through the orbicularis oculi muscle at the lower edge of the incision, the tarsus/anterior tarsus tissue, and the orbicularis oculi muscle at the upper edge of the incision, and the skin was sutured with 8-0 thread. The remaining parts were fixed with 8-0 silk sutures successively passed through the skin at the lower edge of the incision, tarsus/anterior tarsus tissue, and skin at the upper edge of the incision. Scar formation, incidence of complications, and patient satisfaction were observed and recorded during follow-up. Results: Fifty-eight patients were included. The follow-up ranged from 3 to 24 months (mean, 8 months) with 47 patients undergoing primary and 11 secondary/revision surgery. Twelve cases showed slight linear scars and in 46 cases, surgical marks were almost invisible, and there were no dynamic depressed scars. Evaluation of patient satisfaction showed high satisfaction scores (VAS score, 8.56 ± 0.51). The main reason for dissatisfaction was asymmetry of the double eyelid. There were no significant complications. Conclusion: A skin–tarsus–skin combined with orbicularis–tarsus–orbicularis fixation technique can produce a long-lasting, natural-looking double eyelid.