Aesthetic Plastic Surgery

, Volume 43, Issue 2, pp 395–403 | Cite as

Corrective Strategies for a Complex Deformity Caused by “European-Style Double Eyelid” Blepharoplasty in Asians

  • Shiwei GuoEmail author
  • Mingyong YangEmail author
  • Chuande Zhou
  • Wei Lv
  • Jiaqi Zhang
  • Congmin Gu
  • Xuan Fang
Original Article Oculoplastic



“European-style double eyelid” blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity.


During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively.


The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory.


The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function.

Level of Evidence IV

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Secondary blepharoplasty Correction of the high fold Preaponeurotic fat flap transfer Free dermis-fat graft Free fat graft 



The authors received the funding support of Graduate Education Reform Project of Peking Union Medical College (No. 10023-2016-004-04).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Minimally Invasive Plastic Surgery Center, Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Anatomy and Histo Embryology, School of Basic Medical SciencePeking UniversityBeijingChina

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