Repair of Unsatisfactory Double Eyelid: Strategies for Reconstructing the Sliding Plane in Cases of Insufficient or Absent Orbital Septum Fat.

Abstract

Damage to the orbital septum, coupled with insufficient or absent orbital fat, presents considerable challenges in the realm of eyelid repair surgery. The establishment of a well-defined sliding plane within the upper eyelid is pivotal for achieving optimal repair outcomes. Herein, we developed a technique that aimed at reconstructing the sliding plane to facilitate effective double eyelid repair and improve both the morphology and function of the upper eyelid. The medical records of patients who underwent double eyelid repair surgery using this technique from January of 2020 to January of 2025 were reviewed. On the basis of the severity of preoperative upper eyelid adhesion, patients were categorized into 2 distinct groups. Two independent observers were responsible for collecting preoperative and postoperative photographs, conducting physical examination scoring, and evaluating postoperative outcomes alongside satisfaction rates. Plus, any complications encountered were meticulously documented. A total of 102 patients (198 eyes) underwent double eyelid repair surgery from January 2020 to January 2025. On the basis of consistent evaluations by patients and plastic surgeons, they were divided into a mild group (142 eyes) and a severe group (56 eyes). In the mild group, the mean preoperative physical examination score was 1.56, and the mean postoperative score was 0.08, with a statistically significant difference (Z=-14.735, P<0.001). Among the 142 eyes in the mild group, 130 were satisfied, yielding a satisfaction rate of 91.55%. In the severe group, the mean preoperative score was 4.53, and the mean postoperative score was 0.11, also with a statistically significant difference (Z=-9.824, P<0.001). Among the 56 eyes in the severe group, 52 were satisfied, resulting in a satisfaction rate of 96.30%. No serious complications were observed. The technique of reconstructing the sliding plane can achieve optimal repair results and improve upper eyelid morphology and function. Level IV-clinical study.